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Acute generalized exanthematous pustulosis

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Acute generalized exanthematous pustulosis (AGEP) is characterized by the acute onset of numerous small, non-follicular, sterile pustules arising on a diffuse erythematous base in a febrile patient with an accompanying blood neutrophilia. Most cases occur in…

Actinomycosis

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Actinomycosis is an indolent infection that may be difficult to recognize initially and is caused by an anaerobic, Gram-positive rod that is a normal human commensal. Infections are usually the result of introduction of bacteria into…

Actinic prurigo: ( Synonyms: hereditary polymorphic light eruption of American Indians, Hutchinson summer prurigo, photodermatitis in North American Indians)

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Actinic prurigo (AP) is a distinct photodermatosis, diagnosed on the basis of characteristic clinical features and supported by phototest results and human leukocyte antigen (HLA) typing. It has a perennial nature, although it tends to be…

Actinic keratosis

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Actinic keratoses (AKs) are ill-defined, pink to skin-colored, scaly lesions found on chronically sun-exposed areas in light-skinned individuals. They most frequently appear on the face, ears, balding scalp, extensor forearms, and dorsal hands. AKs are a…

Acrodermatitis enteropathica

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Acrodermatitis enteropathica (AE) OMIM 201100 is a rare, autosomal-recessive, inherited disorder of zinc deficiency. It is caused by mutations in the SLC39A gene located on 8q24.3, which encodes for ZIP4 intestinal zinc transporter expressed in enterocytes…

Acne vulgaris

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Acne vulgaris is a chronic inflammatory disorder of the pilosebaceous unit with multifactorial pathogenesis. Numerous immune mechanisms are involved and are influenced by factors such as diet, genetics, and environment. There are four main pathogenic factors…

Acne keloidalis nuchae

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Acne keloidalis nuchae (AKN) is a chronic disorder predominantly affecting males with Afro-textured hair characterized by inflammatory changes of hair follicles on the posterior neck and scalp that result in fibrotic papules and cicatricial alopecia. Erythematous…

Acanthosis nigricans

Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports Open full size image Acanthosis nigricans is characterized by hyperpigmented, verrucous or velvety plaques that usually appear on flexural surfaces and in intertriginous regions. It is most commonly seen in individuals with insulin resistance states, especially obesity and diabetes, and…

Investigational Therapies for Psoriasis

Key points Investigational therapies aim to inhibit the specific immunologic mechanisms behind plaque psoriasis without widely affecting the normal immune system. Pathways targeted by investigational therapies include Janus kinase, tumor necrosis factor-α, interleukin-17, and interleukin-23. Phase II and phase III clinical trials have demonstrated strong safety and efficacy data for several agents, indicating an important future role in treating moderate-to-severe psoriasis. Introduction Enhanced insight into the…

Combination Therapies for Psoriasis

Key points Combination therapies of biologics and systemic agents for psoriasis treatment can potentially enhance efficacy of treatment, increase onset of remission, and decrease side effects by allowing for dose reductions. Potential therapeutic combinations examined include methotrexate paired with biologics; cyclosporine paired with biologics; acitretin paired with biologics; or phototherapy paired with biologics. Randomized clinical trials, case series, and case reports chronicling these therapeutic combinations have…

Biosimilars

Key points Through the Biologics Price Competition and Innovation act, the US Food and Drug Administration (FDA) has defined a biosimilar as a biologic product that is highly similar to the original product notwithstanding minor differences in clinically inactive components. Preclinical analytical assessments are used to determine variations in biosimilar agents and are critical for their approval. Inflectra (infliximab-dyyb, CT-P13), a recently approved biosimilar by the…

Ixekizumab

Key points Ixekizumab is a humanized monoclonal antibody against interleukin-17A. Ixekizumab is more efficacious in the treatment of plaque psoriasis in comparison to etanercept and placebo. Ixekizumab has led to higher clinical response rates and skin clearance rates in clinical trials than any other agent currently approved by the US Food and Drug Administration for the treatment of psoriasis. The most common side effects attributable to…

Secukinumab

Key points Secukinumab is a first-in-class human monoclonal antibody against interleukin-17A. Secukinumab has been demonstrated in clinical studies to be significantly more efficacious in the treatment of plaque psoriasis in comparison to etanercept and ustekinumab. The most common side effects attributable to secukinumab are monilial infections. Secukinumab is now US Food and Drug Administration–approved for the treatment of psoriatic arthritis and ankylosing spondylitis. Introduction Secukinumab is…

Ustekinumab

Key points Ustekinumab is a human immunoglobulin G κ monoclonal antibody that binds to the p40 protein subunit shared by interleukin-12 (IL-12) and IL-23 cytokines. Ustekinumab is safe and efficacious for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Efficacy, tolerability, ease of use, and long dosing intervals contribute to patient satisfaction and adherence. Introduction It can be argued that psoriasis is the most successfully…

Adalimumab

Key points Adalimumab is a safe and effective therapy for the treatment of moderate-to-severe psoriasis. The mechanism of action of adalimumab is inhibition of tumor necrosis factor-α (TNF-α), thereby inhibiting the inflammatory cascade leading to psoriatic skin lesions. Pivotal trials on adalimumab therapy for the treatment of psoriasis and psoriatic arthritis include CHAMPION, REVEAL, and ADEPT. Adalimumab is generally safe and well-tolerated. Annual tuberculosis screening is…

Infliximab

Key points Infliximab is a safe and effective therapy for the treatment of moderate-to-severe psoriasis. The mechanism of action of infliximab is inhibition of tumor necrosis factor-α, thereby inhibiting the inflammatory cascade leading to psoriatic skin lesions. Pivotal trials on infliximab therapy for the treatment of psoriasis and psoriatic arthritis include SPIRIT, EXPRESS, EXPRESS II, and IMPACT. Infliximab is generally safe and well-tolerated. Annual tuberculosis screening…

Etanercept

Key points Etanercept is a soluble human dimeric fusion protein that competitively binds and inhibits tumor necrosis factor. Etanercept improved psoriatic skin lesions in phase 2 and phase 3 clinical trials. Etanercept can be used in pediatric and geriatric populations and is pregnancy category B. The most common side effects of etanercept are injection-site reactions and infection. Introduction Etanercept, a tumor necrosis factor (TNF) inhibitor, was…

Apremilast

Key points Apremilast is the first small molecule phosphodiesterase 4 (PDE4) inhibitor approved for treatment of moderate-to-severe plaque psoriasis. Apremilast, in contrast to biologics, is not injectable, and its label does not require monitoring or screening for tuberculosis. Apremilast is the first selective PDE4 inhibitor that is US Food and Drug Administration approved for the treatment of active psoriatic arthritis. Apremilast has a favorable safety profile…

Cyclosporine

Key points Cyclosporine (CsA) is a highly effective treatment option for patients with moderate-to-severe plaque psoriasis with a rapid onset of action. Its mode of action includes the formation of a CsA-cyclophilin complex, which binds to and inhibits calcineurin. Inhibition of calcineurin activity depresses T-cell differentiation and inhibits interleukin-2 activity. CsA is dosed at 2.5 to 5.0 mg/kg/d in 2 divided oral doses, which may be increased…

Acitretin

Key points Acitretin is an effective agent for the treatment of plaque psoriasis and is often used in combination therapy (phototherapy and other systemic antipsoriatic agents). Acitretin is initially dosed at 10 to 25 mg/d with gradual escalation of 10 to 25 mg every 2 to 4 weeks done according disease response and patient tolerance. Acitretin is pregnancy category X; adequate counseling, abstinence from alcohol, birth control, and evaluation…