Photodynamic systemic biological therapy of the severe forms of psoriasis

The present-day prevalence of psoriasis is characterized by the enhanced frequency of its torpid forms resistant to the treatment by the traditional methods and the ever growing occurrence of severe disease responsible for the significant deterioration of the patients’ quality of life and even incapacitation. The standard treatment of the patients presenting with severe forms of psoriasis resistant to the traditional therapeutic modalities includes the application of biological therapy. The use of the biological preparations produces, in the majority of cases, the beneficial effect. However, the development of the torpid process dictates the necessity of including cytostatic or immunosuppressive preparations in the therapeutic regimen. At the same time, this approach is undesirable in certain cases of the local pathological process because of an elevated risk of adverse side effects and the development of uncontrollable systemic immunosuppression. We report in this article the observations of three patients treated with ustekinumab, the biological preparation for systemic therapy. Isolated psoriatic patches torpid to the treatment persisted in these patients after the injection of ustekinumab on the 28th week. A session of photodynamic therapy (PDT) with the use of methyl aminolevulinic acid additionally prescribed to each patient resulted in positive dynamics of the cutaneous pathological process as apparent from the estimation of the values of the prevalence and severity indices of psoriasis, the size of the affected skin area, and characteristics of the patients’ quality of life. It is concluded that PTD may be recommended for the introduction in the system of treatment of psoriatic patients.

psoriasis, photodynamic therapy, monoclonal antibodies, biological therapy, ustekinumab, indices of the prevalence and severity of the psoriatic process, the size of the affected skin area, quality of life