2017 年 24 巻 1 号 p. 43-53
Most cutaneous diseases are associated with dysfunctions of the immune system and are commonly treated with immunosuppressants. Especially, psoriasis treatment types vary greatly, and include topical corticosteroids, topical vitamin D3, phototherapy, cyclosporine, retinoids, and biologics. Psoriasis is a chronic disease that is characterized by red patches covered with thick white scales, and often has a significant negative impact on patients’ quality of life (QOL). The pathophysiology of psoriasis is linked to various cytokines, with tumor necrosis factor (TNF)-α, interleukin (IL)-23, and IL-17 considered to play key roles in the disease. Patients with severe psoriasis or impaired QOL are often treated with cyclosporine and biologics. Cyclosporine, the most commonly used immunosuppressant, has been used in Japan for 20 years, and data on methods of administration and prevention of adverse events are abundant. Biologics, which include anti-TNFα antibodies (infliximab, adalimumab), anti-IL-12/23 p40 antibodies (ustekinumab), and anti-IL-17A antibodies (secukinumab), are new drugs that have established efficacy and safety profiles in the treatment of moderate-to-severe psoriasis. This increasing number of psoriasis treatments prompts the need for detailed comparisons with respect to patient symptoms and needs. Here, we describe the characteristics of each medicine, and how to select the appropriate treatment for each patient.