| Abstract | Psorijaza je česta kronična, nezarazna, imunoposredovana upalna bolest kože raznovrsnih
kliničkih manifestacija, povezana s brojnim komorbiditetima i negativnog utjecaja na život
bolesnika. MKB-11 svrstava psorijazu pod papuloskvamozne dermatoze koje se navode kao
podvrsta upalnih dermatoza. Etiopatogeneza bolesti uključuje genetske, imunosne i okolišne
čimbenike. Vulgarna psorijaza tipično se manifestira ovalnim ili nepravilnim, oštro ograničenim,
eritematoznim, uzdignutim plakovima prekrivenim sivkasto-bijelim ljuskama. Raspodjela
početka bolesti je bimodalna s vrhuncima između 16. i 22. godine te između 55. i 60. godine.
Težina bolesti određuje se indeksima BSA, PASI i DLQI. Odabir terapije ovisi o težini bolesti,
lokalizaciji lezija, komorbiditetima, dobi i spolu, trudnoći, lijekovima koje pacijent koristi i
pacijentovim preferencijama. U terapiji se koriste topička terapija, fototerapija, konvencionalna
sustavna terapija i ciljana terapija. Topička terapija psorijaze uključuje emolijense,
kortikosteroide, analoge vitamina D, inhibitore kalcineurina, keratolitike i ciljanu fototerapiju. To
je visoko učinkovita i iznimno sigurna terapija koja se primjenjuje kod blagih oblika bolesti i kao
adjuvantna terapija uz sustavnu terapiju. Efikasnost topičke terapije može se povećati
kombinacijom lijekova iz različitih skupina. Fototerapija primjenjuje svjetlosti točno određene
valne duljine iz spektra vidljive svjetlosti ili ultraljubičastog zračenja. Metode fototerapije
uključuju NB-UVB, PUVA, BB-UVB, excimer laser, PDL itd. Ultraljubičasto zračenje koristi se
u liječenju vulgarne psorijaze, a laseri se koriste za manje lokalizirane lezije. Konvencionalna
sustavna terapija uključuje prvenstveno ciklosporin A, metotreksat i acitretin. Danas se manje
koriste zbog nuspojava i bolje učinkovitosti biološke terapije. Ciljana terapija obuhvaća terapiju
malim molekulama (apremilast) i biološke lijekove. Biološki lijekovi su kompleksni proteini koji
ciljaju na specifične molekule koje sudjeluju u nastanku bolesti. U terapiji psorijaze odobreni
su TNF-α antagonisti (etanercept, adalimumab, infliksimab i certolizumab pegol), inhibitor IL-
12/23p40 (ustekinumab), inhibitori IL-17 (secukinumab, iksekizumab i brodalumab) i inhibitori
IL-23p19 (guselkumab, tidrakizumab i risankizumab). Biološki lijekovi predstavljaju visoko
učinkovit terapijski pristup za umjerenu do tešku psorijazu. U terapiji psorijaze također su bitni
edukacija pacijenata, savjetovanje o prestanku sa štetnim navikama, važnosti gubitka tjelesne
mase, tjelovježbe i zdrave prehrane, unaprjeđenje sna, kao i psihološka pomoć. |
| Abstract (english) | Psoriasis is a common chronic, non-contagious, immune mediated inflammatory cutaneous
disease of diverse clinical manifestations, linked to numerous comorbidities and with a
negative impact on a patient’s life. ICD-11 classifies psoriasis under papulosquamous
dermatoses, which are categorized as a subtype of inflammatory dermatoses. The
etiopathogenesis of the diseases includes genetic, immune, and environmental factors. Plaque
psoriasis typically presents with oval or irregular, well demarcated, erythematous, elevated
plaques covered with grey-white scales. Distribution of the onset of the disease is bimodal with
peaks between 16 and 22 years and between 55 and 60 years. BSA, PASI and DLQI are
instruments used to assess the severity of the disease. A therapeutic choice depends on the
severity of the disease, localization of lesions, comorbidities, age and gender, pregnancy, other
drugs a patient uses and a patient’s preferences. Topical therapy, phototherapy, conventional
systemic therapy, and targeted therapy are used in the treatment. A topical psoriasis therapy
includes emollients, corticosteroids, vitamin D analogues, calcineurin inhibitors and
keratolytics as well as a targeted phototherapy. This is a highly efficient and a very safe therapy
applied in a mild disease and as an adjuvant therapy alongside a systemic therapy. The
efficacy of topical therapy can be enhanced by combining medicines from different groups.
Phototherapy applies the light of a specific wavelength from the spectrum of a visible light or
ultraviolent radiation. Phototherapeutic methods include NB-UVB, PUVA, BB-UVB, excimer
lasers, PDL etc. Ultraviolet radiation is used in a treatment of stable plaque psoriasis, while
lasers are used for smaller localized lesions. A conventional systemic therapy includes
primarily ciclosporin A, methotrexate and acitretin. Nowadays, they are being used less due to
adverse effects and more effective biologic therapy. Targeted therapy includes therapy with
small molecules (apremilast) and biologics. Biologics are complex proteins that target specific
molecules involved in the etiopathogenesis of the disease. TNF-α antagonists (etanercept,
adalimumab, infliximab, and certolizumab pegol), anti-IL-12/23p40 agent (ustekinumab), anti-
IL-17 agents (secukinumab, ixekizumab, and brodalumab), and anti-IL-23p19 agents
(guselkumab, tildrakizumab, and risankizumab) are biologics that have been approved in the
treatment of psoriasis. Biologics represent a highly effective therapeutic approach in moderate
to severe psoriasis. Educating patients, counseling about the cessation of damaging habits
and about the importance of weight loss, exercise and healthy diet, sleep improvement, as well
as psychological help are also important in the treatment of psoriasis. |
