[Psoriasis in the era of biologics]

Chronic plaque psoriasis is an immune-mediated, inflammatory skin disease with a heavy burden on quality of life of patients. Conventional systemic therapies, including cyclosporine, methotrexate, acitretin and photo(chemo)therapy, have proved to be effective, but the risk of toxicity prevents their prolonged and continuous use. Advances in the understanding of psoriasis immunopathogenesis have led to the development of drugs, designed to selectively interfere with the immune mechanisms that induce psoriasis, called biologics. These agents have proven to be a convenient, safe and effective alternative to conventional treatments, and have become an important part of the dermatologist therapeutic armamentarium. This review will focus on the mechanisms of action, guidelines for usage, efficacy data and safety concerns of the main biologics used in Europe for the treatment of moderate to severe plaque psoriasis: etanercept, infliximab, adalimumab. Although efalizumab's marketing authorization, approved since 2003, has been suspended recently (February 2009) across the European Union, it will also be briefly discussed.