乾癬の病態と生物学的製剤による治療 (第77回東京女子医科大学学会総会 シンポジウム「生物学的製剤を用いた分子標的治療の進歩」) [in Japanese] Psoriasis : Pathogenesis and Biologic Therapy [in Japanese]
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The 77th Annual Meeting of the Society of Tokyo Women's Medical University第77回東京女子医科大学学会総会 平成23年10月8日(土) 東京女子医科大学 弥生記念講堂
Psoriasis is a chronic inflammatory skin disease. It includes four major subtypes: psoriasis vulgaris, psoriatic arthritis, pustular psoriasis and psoriatic erythroderma. Psoriasis vulgaris makes conspicuous scaly indurated erythema and sometimes presents widespread lesions. Psoriatic arthritis causes arthralgia and joint destruction in addition to skin eruption. These subtypes can considerably affect the patients' quality of life. Pustular psoriasis produces generalized severe erythema with pustules associated with fever and systemic inflammation. Psoriatic erythroderma may involve the entire skin surface which may result in a life-threatening condition. Conventional options for management of psoriasis include topical steroid therapy and activated vitamin D3, ultraviolet phototherapy and systemic treatment with etretinate, methotrexate and cyclosporin. Severe psoriasis cannot be controlled even with combined therapy of conventional treatment options and has been one of the main challenges in dermatology. However, developments in the use of biologics have changed the situation dramatically. Tumor necrosis factor (TNF)-α activates TNF- and iNOS-producing (TIP)-dendritic cells (DCs). TIP-DCs increase in psoriasis lesions and produce interleukin (IL)-23 and IL-12 that induce T helper (Th) 17 and Th1 cells, respectively. These cells have been specifically implicated as key players in the pathogenesis of psoriasis. For example, Th17 cells within the dermis make cytokines such as IL-17A and IL-22 which drive keratinocyte hyperproliferation. Based on this, biological agents employed in the treatment of psoriasis are as follows; infliximab, a chimeric anti-TNF-α monoclonal antibody, adalimumab, a fully human anti-TNF-α monoclonal antibody, and ustekinumab, a fully human monoclonal antibody that specifically targets the p40 subunit that is shared by IL-12 and IL-23. These biologics enables the control of severe psoriasis and marks a new stage in the treatment of the disease. Moreover, several new biologics are currently under development.
- Journal of Tokyo Women's Medical College
Journal of Tokyo Women's Medical College 82(2), 80-85, 2012-04
Tokyo Women's Medical University