Psoriasis is a chronic inflammatory
skin disease affecting 2-3% of the population worldwide.
Psoriasis results from a complex and dynamic interplay between genetic and environmental factors that trigger an excessive inflammatory response in the skin which is driven by several mediators including
TNF-alpha. The common form of the disease, termed 'chronic plaque
psoriasis' is characterized by erythematous scaly plaques, typically on elbows, knees, scalp and buttocks.
Psoriasis does not only affect the skin but also the nails and sometimes it is associated to a form of negative
spondyloarthropathy, named the
psoriatic arthritis (PsA), which could affect joints, tendons and/or the bone. Moreover,
psoriasis is also frequently associated to metabolic comorbidities including
obesity,
dyslipidemia, diabetes and
non alcoholic fatty liver disease. Consequently,
psoriasis causes a high degree of morbidity and impairment of quality of life. There is no definite cure for
psoriasis although there are treatments which could induce its remission. During the past decade, new very selective
biological therapies for the management of
psoriasis have been licensed.
Biological drugs include
TNF-alpha inhibitors (
etanercept,
infliximab and
adalimumab) and
ustekinumab which is an anti-IL 2/23
monoclonal antibody.
Infliximab is very effective in the treatment of
psoriasis either with nail involvement and/or PsA. Considering the characteristics of this
drug, we propose a specific profile of the patient candidate to
infliximab treatment. In particular, the main patient characteristics which drive the physician in selecting
infliximab include the presence of a severe chronic plaque
psoriasis, particularly if it is associated to a severe nail involvement and/or PsA, the urgency of
psoriasis clearing, poor compliance of the patient for
self-medication and the prospective of a long term continuous treatment.