Off-label use is common in dermatology, and is inevitable for rare cutaneous diseases such as perforating dermatosis. Allopurinol is traditionally considered to be a drug for hyperuricemia only, but the recent demonstration of its efficacy in congestive heart failure has spurred renewed interest in its application in other clinical specialties. In dermatology, allopurinol is best known for its severe cutaneous adverse reactions. Recent genomic studies conducted in Taiwan have discovered useful HLA markers for determining the susceptibility of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with allopurinol. Allopurinol has also been used in a number of dermatologic disorders including acquired reactive perforating collagenosis, sarcoidosis, psoriasis and granulomas caused by methacrylate microspheres, silicon and tattoos. Allopurinol may express its therapeutic effects via its antioxidation or anti-inflammatory properties, or its ability to improve vascular function.
Many controlled studies have been conducted to prove the safety and efficacy of biologics in the treatment of psoriasis. However, only limited data are available in Asia-Pacific region. Open label studies of efalizumab and alefacept have been conducted in Taiwan. A placebo controlled trial of adalimumab had been done in Japan. For etanercept, the only published data in Asia-Pacific region was a retrospective study in South Korea. Two placebo-controlled studies were conducted for ustekinumab. The safety profile was in consistent with the results published in the pivotal studies but the therapeutic efficacy of the biologics seems to be somewhat less significant in Asia-Pacific region. A higher incidence of arthritis was observed during the efalizumab trial. Besides, a higher incidence of drug directed antibodies was found for efalizumab and infliximab. This review article will detail on the published data in Asia-Pacific region of the six biologics indicated for the treatment of psoriasis, namely alefacept (Amevive), efalizumab (Raptiva), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) and ustekinumab (Stelara).
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