如果你是数以百万计的牛皮癣的人谁不满意自己目前的治疗之一，它的时间来看看治疗一种近来下来的管道。
银屑病treatment has evolved over the years. More than 40 years ago, a new era in therapy began when the systemic drug methotrexate was successfully used to manage the skin disorder. About a decade ago, researchers were hailing the introduction of biologic agents—genetically engineered therapies derived from living organisms— as an alternative. Today, a new generation of biologics that may be more effective has entered the spotlight—the Food and Drug Administration (FDA) approved the first drug of its kind in January 2015.
免疫功能低下
Plaque psoriasis, the most common form of the disorder, is a chronic autoimmune disease that affects the skin, forming patches, or plaques, of thick red skin lesions covered with silvery scales that flake off easily. Psoriasis is marked by cycles of flaring and clearing. Symptoms vary from mild to extreme. Some people have a few scaly patches on their elbows, knees or scalp; others suffer from debilitating flare-ups that involve large areas of the body. Thirty percent of patients develop psoriatic arthritis.
银屑病has no cure but can be managed in most people, although moderate to severe psoriasis requires lifelong treatment. People with mild psoriasis may be able to reduce symptoms and improve appearance with topical treatments. Stronger therapies are typically reserved for people who have moderate to severe psoriasis, which covers more than 5 to 10 percent of the body’s surface, and for those whose psoriasis affects the face, palms, or soles.
镇上新药物
新批准的药物，苏金单抗（Cosentyx），继续与生物牛皮癣的靶向治疗的发展趋势。依那西普（Enbrel的），阿达木单抗（Humira的），英夫利昔单抗（Remicade）和优特克单抗（Stelara的）是有效的生物制剂的实例。他们常常产生谁没有回应其他疗法的人快速，显着的改善。所有通过注射给药，从一次或每周两次到每三个月一次，并改善数周时间内看到。
年长的生物处理家中在任特定过度的免疫细胞提示细胞的皮肤细胞或蛋白质的生产过剩是帮助引起炎症。苏金单抗使用不同的作用机制：它结合到真实参与炎症并防止其触发有助于银屑病的响应称为白细胞介素17A（IL-17A）的蛋白质。
“虽然第一代生物药物继续控制银屑病中发挥了很大的作用，苏金单抗为我们提供了另一种一线选择，一个已经在临床试验中被证明是一样安全有效的，如果不是更多的话，比earlier drugs,” says Alan Menter, M.D., chief of the division of dermatology at Baylor University Medical Center at Dallas. After 12 weeks of drug use, more than 80 percent of patients in a clinical trial saw significant improvement, which lasted at least one year on continued therapy. Psoriatic symptoms completely disappeared in 25 percent of patients.
“生物制剂之间的最大区别在于，我们有超过10年的数百万患者的安全数据对当前生物药物，” M输入说，“而我们没有对苏金单抗长期安全性的数据还没有。”
Adverse effects included diarrhea and upper-respiratory infections. People prone to infections or who have Crohn’s disease shouldn’t use secukinumab. Generally, people with serious infections should avoid biologic drugs. Biologics may possibly increase the risk of lymphoma and tuberculosis. Their side effects include pain at the injection site, nausea, vomiting, headache and fever. A major downside to biologics is their high cost.
个人待遇
生物制剂是一个广泛的牛皮癣治疗方案之一。有时需要一种试错方法来确定有效性。长期的治疗和新药，医生可以调整治疗到什么是最适合每个个体和专家强调决策密切地参与病人的重要性。
医生选择治疗牛皮癣取决于几个因素，如影响身体，病灶的厚度，红斑和脱屑，潜在的副作用，费用，病人的整体健康度，以及病人的意愿等方面的策略。
Because no single psoriasis treatment is effective for everyone, personal preference is key. “More than half of people with psoriasis aren’t satisfied with their treatment,” says Menter, who also chairs the American Academy of Dermatology’s psoriasis guidelines committee. “Understanding all the options available can help you find the one that’s best for you.”
为了达到更好的结果，医生往往结合药物，光，外敷疗法来治疗中度至重度牛皮癣，它允许较低的剂量每剂和降低毒性的风险。
Psoriatic lesions may become resistant to a treatment over time, and patients may need to switch therapies periodically. Rotational therapy can also reduce adverse effects that result from long-term drug use.
Systemic drugs
Moderate to severe psoriasis is often treated with powerful systemic medications, so called because they work throughout the body. Below is a brief overview of the commonly used systemic drugs:
■甲氨蝶呤为有效地约40％的患者。它抑制整个免疫系统在对比生物制剂，靶向特定细胞。许多人多年来对甲氨蝶呤做得很好。但由于该仿制药可引起肝脏问题，患者一定要仔细验血监测每隔一至三个月。患者通常服用此药每周一次，无论是通过口或注射，并可能需要长达三个月，他们看到了在改善之前。副作用包括恶心，头痛和疲劳。由于消费的肝毒性的风险增加酒精当患者一定要谨慎。此外，含磺胺药可从来没有采取与甲氨蝶呤。
■环孢素可以更迅速地清除牛皮癣比甲氨蝶呤，但由于它的作用下它只能用于短期的。这是主要的副作用，特别是老年人，是高血压。患者应约12周后，切换到另一个治疗牛皮癣的持续管理。它不应该被人显著免疫系统受损或容易发生感染使用。
■全身维甲酸，synthetic forms of vitamin A, are used to treat moderate to severe psoriasis. Acitretin (Soriatane) is an oral retinoid that’s often combined with light therapy. Improvements may be seen within one month, but it can take three to six months to see full results. It works well on people with predominantly hand and foot psoriasis. Potential side effects include dry skin, cracked lips, nosebleeds, poor night vision, hair loss, joint pain, depression, elevated triglyceride levels, and liver damage. Because acitretin doesn’t affect the immune system, it can be used long term by people prone to infections.
■Apremilast（Otezla）an oral systemic drug that reduces inflammation, was approved last September to treat plaque psoriasis. Apremilast can begin to clear psoriasis in a few weeks; side effects may include diarrhea, stomach upset, headache, and upper-respiratory tract infection.
我们的建议
跟你的医生如果你不改善上particular regimen or having side effects. “Chances are at least one of the treatments available will be effective for you,” Menter says.
“Keep in mind that you may need to try different treatments— or combinations of treatments—to determine what works for you.” Menter urges patients to become educated about psoriasis and familiar with treatment options. A good resource is the [National Psoriasis Foundation](www. psoriasis.org).