Ten years of infliximab: its role in dermatology

Psoriasis is a common chronic inflammatory disease of the skin. Psoriatic arthritis may develop in about 20% of psoriasis patients while metabolic syndrome is a frequent comorbidity, and risk of cardiovascular disease is increased in psoriasis patients. Classical systemic treatments have not evolved much during the last decades; biological therapies on the contrary have added most significant progress in systemic treatment during the last 10 years. In particular tumor necrosis factor (TNF) blockade has changed the treatment outcomes in moderate to severe psoriasis patients. With drugs such as infliximab treatment goals of 75% improvement of psoriasis lesions together with significant improvement of quality of life can be achieved. Furthermore, skin clearance is possible in many patients with continued maintenance treatment with infliximab. More recent pivotal studies have shown that associated nail psoriasis responds well to infliximab, an outcome that was difficult to reach with classical therapies. There is good evidence that infliximab may be useful in other dermatological conditions such as pyoderma gangrenosum and hidradenitis suppurativa. Infliximab is an intravenous administration over a 2-hour period. Some patients may develop infusion reactions, and dermatologists need to be well aware of any possible adverse events that may be associated with anti-TNF treatment. Today, dermatologists have collected a broad experience with infliximab treatment of psoriasis and they have thus advanced their clinical practice accordingly.