Search

Die topische Behandlung der Psoriasis und ihrer Sonderformen hat einen hohen Stellenwert im Praxisalltag. Sie ist Therapiestandard bei leichter Psoriasis und wird unterstützend auch bei mittelschwerer bis schwerer Psoriasis eingesetzt. Bei der Optimierung der Behandlung der Psoriasis spielt neben den geeigneten Wirkstoffen auch die Wahl der Galenik eine entscheidende Rolle. Die Weiterentwicklungen in diesem Bereich wurden in der 2017 publizierten Aktualisierung der S3-Leitlinie nicht berücksichtigt. Der vorliegende Behandlungspfad wurde im Rahmen der PsoNet-­Sprecherkonferenz erarbeitet und durch die nationale Versorgungskonferenz Psoriasis bestätigt. Er stellt eine Illustration der aktuellen Optionen dar. Die Fachinformationen der genannten Präparate sind dabei stets zu berücksichtigen. Die Festlegung von Therapiezielen mit dem Patienten ist obligat und adhärenzsteigernd. Dabei sollten die persönlichen Präferenzen und Vorerfahrungen des Patienten berücksichtigt werden. Goldstandard in der Initialphase ist die Fixkombination aus Calcipotriol (Cal) 50 μg/g und Betamethason-Dipropionat (Bet) 0,5 mg/g 1x täglich über vier bis acht Wochen. Als Darreichungsform ist der Schaum am effektivsten, wobei die individuelle Wahl der Grundlage auch nach Patientenpräferenz erfolgen sollte. In der Erhaltungsphase hat sich die 1-2x wöchentliche (proaktive) Anwendung dieser Fixkombination bewährt. In zweiter Linie können auch Vitamin D3 Analoga (Calcipotriol, Tacalcitol) und topische Corticosteroide als Monotherapie zur Anwendung kommen. Eine begleitende wirkstofffreie topische Basistherapie sollte regelhaft empfohlen werden. Bei besonderen Therapiesituationen werden spezifische Empfehlungen gegeben. Reicht eine alleinige Lokaltherapie nicht aus, sollte eine Therapieeskalation analog der S3-Leitlinie zur Therapie der Psoriasis erfolgen.

The German guideline for the treatment of psoriasis vulgaris was updated using GRADE methodology. The guideline is based on a systematic literature review completed on December 1, 2016, and on a formal consensus and approval process. The second part of this short version of the guideline covers the following special patient populations and treatment situations: tuberculosis screening before and during psoriasis treatment, choice of psoriasis treatment for individuals wishing to have children, as well as during pregnancy and breast-feeding, and patients with joint involvement and vaccinations. In addition, recommendations on the choice of treatment are presented for patients with the following comorbidities: hepatitis and other hepatic impairment, HIV, malignancies, neurological and psychiatric disorders, ischemic heart disease and congestive heart failure, diabetes mellitus, renal impairment and inflammatory bowel disease.

The German guideline for the treatment of psoriasis vulgaris was updated using GRADE methodology. The guideline is based on a systematic literature review completed on December 1, 2016, and on a formal consensus and approval process. The first section of this short version of the guideline covers systemic treatment options considered relevant by the expert panel and approved in Germany at the time of the consensus conference (acitretin, adalimumab, apremilast, cyclosporine, etanercept, fumaric acid esters, infliximab, methotrexate, secukinumab and ustekinumab). Detailed information is provided on the management and monitoring of the included treatment options.

Die deutsche Psoriasis‐Leitlinie zur Behandlung der Psoriasis vulgaris wurde unter Verwendung der GRADE‐Methodik aktualisiert. Die Leitlinie wurde aufbauend auf einer systematischen Literaturrecherche (letzte Update‐Recherche am 01.12.2016) entwickelt und in einem formalen Konsensus‐ und Freigabeverfahren verabschiedet. Der erste Teil dieser Kurzfassung stellt die Empfehlungen zu den von der Expertengruppe als relevant befundenen und zum Zeitpunkt der Konsensuskonferenz zugelassenen Therapien dar (Acitretin, Adalimumab, Apremilast, Ciclosporin, Etanercept, Fumarsaureester, Infliximab, Methotrexat, Secukinumab, Ustekinumab). Die Leitlinie gibt Hinweise zu Management und Uberwachung der eingeschlossenen Therapieoptionen.

Zusammenfassung Hintergrund Aktuelle Daten aus der Versorgungsforschung zeigen, dass Vitamin-D3-Analoga, Kortikosteroide und deren fixe Kombinationen in der topischen Langzeittherapie der Psoriasis sehr unterschiedlich eingesetzt werden. Zielsetzung Bewertung der wissenschaftlichen Evidenz zur topischen Langzeittherapie mit Vitamin-D3-Analoga, Kortikosteroiden und deren Kombinationen bei der Psoriasis vulgaris und der Kopfhaut-Psoriasis und Entwicklung einer Praxisempfehlung. Methodik Systematische Literaturrecherche in PubMed® und Embase® und informeller Expertenkonsens. Ergebnisse Die Suchstrategie ergab insgesamt 21 relevante Arbeiten. Die beste Evidenz in der topischen Langzeittherapie lag fur die Fixkombination aus Calcipotriol und Betamethason vor. In direkten Vergleichsstudien zeigte diese Fixkombination bei der Psoriasis vulgaris eine uberlegene Vertraglichkeit und Wirtschaftlichkeit im Vergleich zu den Monopraparaten. Bei der Kopfhaut-Psoriasis war die Fixkombination in Gelformulierung der Calcipotriol-Monotherapie uberlegen. Feste, einfache Anwendungsschemata zeigten einen hoheren Therapieerfolg als Bei-Bedarf-Therapien. Praxisempfehlungen Patienten mussen aktiv in die Wahl der Therapie, der Grundlage und der Anwendungsweise einbezogen werden. In der Praxis haben sich neben der Langzeittherapie mit der Fixkombination auch andere Therapieschemata unter Einbeziehung der Calcipotriol-Monotherapie bewahrt. Aufgrund des guten Nutzen-Risiko-Profils in Studien zur Erhaltungstherapie und aufgrund der hoheren Wirtschaftlichkeit ist im Anschluss an die Initialtherapie eine 1- bis 2-mal wochentliche Applikation der Fixkombination zu empfehlen.

Summary Background Current data from daily practice show that vitamin D3 analogues, corticosteroids and their fixed combination products are used heterogeneously for topical long-term treatment of psoriasis. Aim To evaluate scientific evidence about topical long-term therapy with vitamin D3 analogues, corticosteroids and their two-compound-products in psoriasis vulgaris and scalp psoriasis and to develop daily practice recommendations. Methods Systematic literature review via PubMed® and Embase® and informal expert consensus. Results The search strategy identified 21 relevant clinical trials. Best evidence regarding topical long term treatment was available for the two-compound-formulation containing calcipotriene and betamethasone. In a comparative trial in psoriasis vulgaris the two-compound-formulation showed superior tolerability and cost effectiveness compared to monotherapy. In scalp psoriasis the two-compound-gel was superior compared to calcipotriene monotherapy. Standardized and simplified treatment application modes resulted in a better clinical outcome comparing to on-demand therapies. Daily practice recommendations Patients should be proactively involved in the choice of treatment, formulation and mode of application. Besides long-term treatment with the two-compound-formulation other treatment regimens including calcipotriene monotherapy can also be considered. Due to a favorable risk-benefit ratio in maintenance trials and due to better cost-effectiveness the application of two-compound-products once or twice a week after initial therapy is recommended.

Summary Background Safety and efficacy of fumaric acid esters (FAE) in patients with psoriasis requiring treated comorbidit condition were investigated. Patients and Methods Data collected from 7 dermatology centers were used for a retrospective analysis of patients treated continuously with FAE for at least 6 weeks who required at least one medication for a comorbid condition. The records were analyzed at baseline and after 1, 3, 6, 12 and 24 months of therapy. Safety parameters were monitored and the severity of skin symptoms was assessed by ‘Physician's Global Assessment’ (PGA). Results A total of 69 patients with moderate to severe psoriasis and a mean duration of 27.4 months of continuous treatment were included in the study. In less than 5% were interactions between FAE and co-medications observed. Changes of hepatic, renal or hematological laboratory parameters were usually insignificant and required a modification of FAE treatment in less than 12% of the cases. The percentage of patients documented as markedly improved or clear was 61% after 6 months, 77% after 12 months, and 75% after 24 months of therapy. Conclusions In patients with moderate to severe psoriasis on co-medications, FAE were effective and safe without any noteworthy drug interactions.

Psoriasis is a chronic immune-mediated skin disease with highly variable patterns of presentation, both between patients and in individuals over time. Its course can be influenced by various triggers. Since there is no cure for psoriasis, patients with moderate-to-severe plaque-type psoriasis often require lifelong therapy to control their disease. Traditional approaches such as cyclosporine or methotrexate are problematic for long-term use because of organ toxicity, other side effects, drug interactions and a loss of efficacy over time. Efalizumab is a recombinant monoclonal IgG1-antibody, approved in Germany for the management of moderate-to-severe plaque-type psoriasis. Its efficacy and safety have been demonstrated in clinical trials with thousands of patients,especially with regard to long-term therapy. Therefore, a change of paradigm from the traditional therapy of inflammatory episodes to continuous control of psoriasis seems possible. This supplement deals with practical aspects of using efalizumab in the outpatient setting.

Zusammenfassung Aufgrund der Schwere ihres Krankheitsbildes benotigen etwa 20 % aller Psoriasis-Patienten eine Photo- und/oder eine systemische Therapie. Probleme der entsprechenden etablierten Therapieformen bezuglich unerwunschter Wirkungen, Kontraindikationen, Therapieresistenz und fehlende Langzeitwirkung i. S. einer „remittive therapy” unterstreichen die Notwendigkeit der Entwicklung verbesserter Therapeutika zur Behandlung der Psoriasis. In den letzten Jahren wurden die technischen Voraussetzungen geschaffen, um therapeutische Molekule aus lebenden Zellen zu gewinnen, die gezielt krankheitsrelevante Mediatoren oder Zell-Zell-Interaktionen inhibieren konnen. Mehrere dieser sog. Biologics haben das Potential, die Therapiemoglichkeiten bei mittelschwerer bis schwerer Psoriasis entscheidend zu verbessern. Hier stellt die Arbeitsgruppe Psoriasis der Arbeitsgemeinschaft Dermatologische Forschung (ADF) den aktuellen Stand der Psoriasistherapie dar. Vor diesem Hintergrund werden die Eigenschaften diesbezuglich aktuell relevanter Biologics diskutiert. Der Fokus liegt auf deren potentiellem medizinischen Nutzen sowie fur die praktische Anwendung wichtigen Sicherheitsaspekten. Daneben wird auf juristische und gesundheitsokonomische Aspekte eingegangen, die ebenfalls Einflus auf den Einsatz der Biologics haben.

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque-type psoriasis in adults including systemic therapy, UV therapy and topical therapies. The therapeutic recommendations were developed based on the results of a systematic literature search and were finalized during a consensus meeting using structured consensus methods (nominal group process).

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance (Richards et al. in J Am Acad Dermatol 41(4):581-583, 1999). To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis first published in 2006 and now updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. This short version of the guidelines presents the resulting series of therapeutic recommendations, which were based on a systematic literature search and discussed and approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs, as well as detailed information on how best to apply the treatments described (for full version please see Nast et al. in JDDG Suppl 2:S1-S104, 2011 or http://www.psoriasis-leitlinie.de ).

Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (Delta PASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is >= 75%. The treatment regimen should be modified if improvement of PASI is = 50% but 5 but can be continued if the DLQI is

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed lack of satisfaction with the efficacy of available treatments and a high rate of non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) initiated a project to develop evidence-based guidelines for the management of psoriasis. These resulting Guidelines focus on induction therapy in cases of mild, moderate, and severe plaquetype psoriasis in adults. The Guidelines include evidence-based evaluation of the efficacy of all currently available therapeutic options in Germany. In addition, they offer detailed information on how best to administer the various treatments and give information on contraindications, adverse drug reactions, and drug interactions as well as estimates of practicability and cost. The Guidelines were developed following the recommendations of the Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF). The therapeutic recommendations were developed by an expert group and finalized during interdisciplinary consensus conferences.

Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ). peerReviewed

In February 2009, the European Medicines Agency's (EMEA) Committee for Medicinal Products for Human Use (CHMP) had recommended the suspension of efalizumab's (Raptiva) marketing authorization, because its benefits in the treatment of psoriasis were modest, while there was a risk of serious side effects in patients receiving the medicine, including the occurrence of progressive multifocal leukoencephalopathy (PML). The guideline group has changed the guideline accordingly.

summary A specific peptidoleukotriene receptor antagonist, Ro 23-3544, was tested for its efficacy in modulating DNFB-induced allergic and croton oil-induced irritant contact dermatitis in mouse ears. Treatment shortly after elicitation of the dermatitis, and for up to 5 days thereafter, was moderately effective in suppressing DNFB-induced ear swelling in a dose-dependent fashion. Daily pre-treatment of the ears for 1 week caused a more marked reduction of DNFB-induced ear swelling during the first 48 h after elicitation. No reduction, but rather an increase in ear swelling was observed with croton oil-induced dermatitis. These results indicate that peptidoleukotrienes play a role in the early stages of elicitation of murine allergic, but not irritant contact dermatitis and that a specific receptor antagonist can only partially reverse the effect of peptidoleukotrienes once the dermatitis is established.

A 5-lipoxygenase inhibitor (5-LPI) and a platelet-activating factor antagonist (PAF-A) were studied in dinitrofluorobenzene (DNFB)-induced allergic and croton-oil-induced irritant murine contact dermatitis. Both inhibitors, at 1 and 5% concentrations, significantly reduced the ear swelling in allergic dermatitis while irritant dermatitis was far less affected. This suggests that 5-lipoxygenase-dependent mediators and PAF are involved in allergic contact dermatitis and that these mediators play only a minor role in irritant dermatitis.