Psoriasis: Which therapy for which patient: Focus on special populations and chronic infections

Abstract

Despite the availability of several new systemic agents for psoriasis treatment, choosing the right therapy in certain patient populations can be challenging. There are few up-to-date reviews on systemic drugs for moderate to severe psoriasis in pregnant and pediatric patients and in patients with concomitant chronic infections, such as hepatitis, HIV, and latent tuberculosis. These groups are usually excluded from clinical trials, and much of the available evidence is based on anecdotal case reports and case series. As a chronic disease, psoriasis requires long-term treatment, and there are concerns of adverse maternal-fetal outcomes, long-term side effects in children, and the reactivation of latent infections with the use of systemic agents in these patients. The second article in this continuing medical education series provides insights for choosing appropriate systemic agents for treating moderate to severe psoriasis in pregnant and pediatric patients and in the setting of chronic infections, such as hepatitis, HIV, and latent tuberculosis.

Keywords: HIV; IL-12/23; IL-17; IL-23; TNF-α; acitretin; adalimumab; apremilast; biologic; brodalumab; certolizumab; comorbidities; cyclosporine; etanercept; golimumab; hepatitis; infliximab; ixekizumab; methotrexate; pediatric; pregnancy; psoriasis; psoriatic arthritis; secukinumab; systemic; traditional agents; tuberculosis; ustekinumab.