Therapeutic update of biologics and small molecules for scalp psoriasis: a systematic review

Abstract

Scalp psoriasis represents the most common difficult-to-treat area in psoriasis patients. Its presence is linked to severe discomfort and impairment of quality of life given the associated symptoms (most of all, scaling and pruritus) and the location in a highly visible area, thus a prompt treatment is required. Its management may be challenging as the scalp is quite sensitive to long-term treatment with topical corticosteroids and usually resistant to topical and systemic agents. Likely, the currently available therapeutic armamentarium has been enriched with biologicals and small molecules that revolutionized psoriasis treatment and that of scalp psoriasis. Nevertheless, the lack of international dedicated guidelines pushed us to perform a comprehensive review on the efficacy and safety of biologics and small molecules on scalp psoriasis with the aim to put the basis for a therapeutic algorithm. After reviewing all the available evidence on the short-term and long-term efficacy of biologics and small molecules on scalp psoriasis the use of the newest biologics (anti-IL-17 and anti-IL-23) seems to be linked to the highest clinical performances in controlling scalp psoriasis. However, head-to-head comparisons between different biologics or biologics and small molecules are lacking. Hence, treatment selection should always be individualized.

Psoriasis in areas difficult to treat and biological therapy

“…According to systematic reviews regarding available biological drugs and small molecule drugs, the best control of symptoms of scalp psoriasis is provided by interleukin-17 (IL-17) inhibitors (ixekizumab, secukinumab, brodalumab) and interleukin-23 (IL-23) inhibitors (rizankizumab, guzelkumab) [15,16]. This study confirms these observations, and indicates that they can also be applied to psoriasis in other special areas.…”

“…Według przeglądów systematycznych dotyczących dostępnych leków biologicznych i substancji drobnocząsteczkowych najlepszą kontrolę objawów łuszczycy głowy owłosionej zapewniają inhibitory interleukiny 17 (IL-17) (iksekizumab, sekukinumab, brodalumab) i interleukiny 23 (IL-23) (rizankizumab, guzelkumab) [15,16]. Niniejsze opracowanie potwierdza te spostrzeżenia, które można odnieść także do łuszczycy w innych szczególnych miejscach.…”

Anti‐IL17 and anti‐IL23 biologic drugs for scalp psoriasis: A single‐center retrospective comparative study

“…Scalp psoriasis is the most frequent hard‐to‐treat site, often causing pruritus and a massive impairment on patients' quality of life 2 . Patients' compliance to topical therapies is controversial and classical systemic therapies are known for side effects that do not suggest a long‐term usage 3 .…”

Ixekizumab in scalp psoriasis: Clinical, dermoscopical, and in vivo reflectance confocal microscopy evaluation

“…1 The scalp is the most commonly affected area and is often resistant to therapy. 2,3 Nowadays biologics have shown promising results for psoriasis including scalp lesions. 3,4 In vivo reflectance confocal microscopy (RCM) is a noninvasive technique that allows real-time, high-resolution visualization of the skin.…”