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Table of Contents
Year : 2022  |  Volume : 40  |  Issue : 2  |  Page : 65-66

The other side of biologics for psoriasis

Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

Date of Submission17-May-2022
Date of Acceptance17-May-2022
Date of Web Publication29-Jun-2022

Correspondence Address:
Dr. Chao-Chun Yang
Department of Dermatology, National Cheng Kung University Hospital, 138 Sheng Li Rd., 704 Tainan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ds.ds_29_22

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How to cite this article:
Yang CC. The other side of biologics for psoriasis. Dermatol Sin 2022;40:65-6

How to cite this URL:
Yang CC. The other side of biologics for psoriasis. Dermatol Sin [serial online] 2022 [cited 2022 Dec 3];40:65-6. Available from: https://www.dermsinica.org/text.asp?2022/40/2/65/349028

The treatment for moderate-to-severe chronic plaque psoriasis advances greatly on account of the introduction of biologics in recent years. The list of biologics expanded rapidly, from anti-tumor necrosis factor-alpha (TNF-α), anti-interleukin (IL)-12/23, and anti-IL17 to anti-IL-23. As the biologics evolve, the treatment efficacy for psoriasis increased dramatically.[1] Almost or complete clearance of skin lesions could be achieved in a significant proportion of psoriasis patients by the use of biologics.[2]

Despite the great advancement in treatment efficacy, the safety profiles and economic burden of biologics are also important issues to be considered when applying these updated treatments to psoriasis patients.[3],[4] Among the side effects, the activation of latent tuberculosis (TB) gained much attention, especially in countries with higher prevalence of TB, owing to its frequent association with the use of anti-TNF-α. In this issue of Dermatologica Sinica, Huang and Tsai demonstrated that an extremely low rate of seroconversion (<1%) in patients using anti-IL-23 biologics, including guselkumab and risankizumab, for more than 1 year,[5] and reactivation of latent TB was not found. The findings suggested a low risk of TB infection or reactivation of anti-IL23 biologics.

COVID-19 pandemic has a profound impact on the medical system and the strategies to cope with this new infection are increasingly demanded. In patients with immune-mediated inflammatory diseases, the adjustment of ongoing medications, including biologics and immunosuppressants, when COVID-19 infection is confirmed, is critical and increasingly encountered. A review article in this issue of Dermatologica Sinica provides the state-of-the-art information on this question.[6]

Intralesional injection of triamcinolone acetonide for alopecia areata is a common clinical practice but debates exist regarding the concentration for optimal efficacy and a low rate of adverse effect such as skin atrophy. Su et al. conducted a meta-analysis on this topic and an optimal concentration of triamcinolone acetonide was suggested.[7]

The connection between brain and skin may be more intense than you thought, due to their common ectodermal origin. The diagnosis of skin diseases relies on the visible morphological signs but a comprehensive care requires careful approaches to the internal invisible symptoms. In this issue of Dermatologica Sinica, Bondade et al. provided a review on the “skin-brain axis” and its impact on dermatological practice.[8]

The way to a comprehensive and effective dermatological management is there, when you look at the other side of diseases and treatments.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Chen YC, Huang YT, Yang CC, Lai EC, Liu CH, Hsu CK, et al. Real-world efficacy of biological agents in moderate-to-severe plaque psoriasis: An analysis of 75 patients in Taiwan. PLoS One 2020;15:e0244620.  Back to cited text no. 1
Tsai TF, Hsieh TY, Chi CC, Chou CT, Hsieh LF, Chen HH, et al. Recommendations for psoriatic arthritis management: A joint position paper of the Taiwan rheumatology association and the Taiwanese association for psoriasis and skin immunology. J Formos Med Assoc 2021;120:926-38.  Back to cited text no. 2
Chiu HY, Chiu YM, Chang Liao NF, Chi CC, Tsai TF, Hsieh CY, et al. Predictors of hepatitis B and C virus reactivation in patients with psoriasis treated with biologic agents: A 9-year multicenter cohort study. J Am Acad Dermatol 2021;85:337-44.  Back to cited text no. 3
Yu S, Tsao YH, Tu HP, Lan CC. Drug survival of biologic agents in patients with psoriatic arthritis from a medical center in southern Taiwan. Dermatol Sin 2022;40:20-7.  Back to cited text no. 4
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Huang YW, Tsai TF. Risk of QuantiFERON-tuberculosis gold in-tube test in patients with psoriasis receiving anti-interleukin-23 monoclonal antibodies treatment. Dermatol Sin 2022;40:94-9.  Back to cited text no. 5
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Yu CL, Lin YT, Chi CC. Recommendations on use of systemic treatments for immune-mediated dermatologic disorders in patients with confirmed COVID-19 infection: A rapid review. Dermatol Sin 2022;40:67-70.  Back to cited text no. 6
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Su HA, Chen YT, Chen YC. The optimal concentration of intralesional triamcinolone acetonide for patchy alopecia areata: A systematic review and meta-analysis. Dermatol Sin 2022;40:85-93.  Back to cited text no. 7
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Bondade S, Hosthota A, Bindushree R, Raj PR. Psychodermatology: An evolving paradigm. Dermatol Sin 2022;40:71-7.  Back to cited text no. 8
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