Management of psoriatic patients in biologic treatment associated with infectious comorbidities

INTRODUCTION: Psoriasis is a chronic inflammatory disease affecting about 2% of population, involving both acquired and innate immunity. Psoriasis affects mainly skin, presenting multiple co-morbidities; among them infective ones. Re-activation of tuberculosis or viral hepatitis (HBV and HCV) still represents a therapeutic challenge in patients receiving treatment with biological drugs, as well as HIV infection. For this reason, a multidisciplinary approach with global treatment resulting from active collaboration of different specialists is highly recommended. AIM: To investigate the most common infective diseases as co-morbidities associated with psoriasis and to provide algorithms for screening, follow-up and therapeutic management in psoriatic patients. MATERIAL AND METHODS: We examined the main infectious comorbidities that can affect moderate to severe psoriatic patients, influencing the therapeutic choice as during the biological treatment both viral and tuberculosis re-activation may occur. We have therefore evaluated the main diseases (TB, Hepatitis B and C, HIV) and the monitoring of patients during treatment with biological agents. RESULTS: Regular monitoring of psoriatic patients is recommended during long-term treatment with biological drugs in order to identify cases of re-activation of the latent infective agent or de novo acquired infection. CONCLUSIONS: Here we report the state of art regarding management of psoriatic patients with these co-morbidities suggesting a specific screening and management for infectious diseases in patients with moderate to severe plaque psoriasis.