Why Is This Medication Prescribed
Ustekinumab injection is used to treat moderate to severe plaque psoriasis in adults and children 6 years or older who may benefit from medications or phototherapy . It is also used alone or in combination with methotrexate to treat psoriatic arthritis in adults. Ustekinumab injection is also used to treat Crohns disease in adults. Ustekinumab injection is also used to treat ulcerative colitis in adults. Ustekinumab injection is in a class of medications called monoclonal antibodies. It works by stopping the action of certain cells in the body that cause the symptoms of plaque psoriasis, psoriatic arthritis, Crohns disease, and ulcerative colitis.
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When To See A Doctor
Nail psoriasis is not contagious, and treatment can reduce or help control the symptoms.
If the nails show symptoms of psoriasis or a fungal infection, see a doctor. This is especially important for people who already have a type of psoriasis.
A person may have to try several treatments before finding one that works.
Symptoms can take time to improve, and they may take up to a year to clear. One reason for this is that the nail plate grows very slowly. The symptoms may also return at a later date.
With new drugs appearing on the market, more effective treatments for nail psoriasis may be on the horizon.
What Does Nail Psoriasis Look Like
Nail psoriasis can affect your fingernails and toenails and will often manifest in these ways:
- Discoloration. Your nails are starting to brown, yellow or turn completely white.
- Damaged nail surface. You will notice lines, cracks, pits, holes or ridges. Basically, any nail surface that isnt smooth.
- Lifted nails. With nail psoriasis, white debris can begin to form under your nail, pushing it up and away from your skin. This is usually painful.
- Thinning or thickening texture. If your nails feels brittle or too thick, this can be the buildup of psoriatic skin cells under the nails, or it can be a fungal infection that can more easily invade the already-lifted nail. You will need a culture to determine the best treatment.
- Nail separation. Again, pretty painful. Depending on the severity of your nail psoriasis, your nail may start to separate itself from the nail bed.
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Who Gets Nail Psoriasis
Nail psoriasis affects 90% of patients with chronicplaque psoriasis at some time in their life. It is more common in adults with a prevalence of up to 80%, compared to children in whom it has been reported in 713%. In the absence of skin or joint disease, psoriatic nail disease has been described in 510% of adults.
Psoriatic nail disease may be a risk factor the development of psoriatic arthritis and is often associated with prolonged severe cutaneous psoriasis.
Nail psoriasis can affect all races and age groups, and both sexes, although a male predominance has been reported in one large case series.
Who Can Take Biosimilars
All biologics, including biosmilars, are typically prescribed for people with more advanced disease, including individuals with moderate-to-severe psoriasis and active PsA. But each of the three approved biosimilars are indicated for different groups within this population.
You should not take biosimilars if:
- Your immune system is significantly compromised
- You have an active infection
Screening for tuberculosis or other infectious diseases is required before starting treatment with all biologics, including biosimilars.
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What Causes Nail Psoriasis
Psoriasis is a multifactorialsystemic disease including inflammation and epidermalhyperproliferation.
Nail psoriasis can involve the nail bed, nail matrix, hyponychium, and nail folds.
- Activation of the antimicrobialpeptide LL-37 by Candida and the cytokine overflow theory
- Increased expression of interleukin-10 in the affected nail bed compared to downregulation of IL-10 in psoriatic skin lesions
- Koebnerisation of psoriasis in onychomycosis or nail trauma.
Treat Your Nails To Some Tlc
Whatever treatment you receive, its important to avoid irritating or injuring your nails. Irritation and injury can drive the inflammation that drives psoriasis, explains Dr. Kassouf.
Avoid picking at your nails and manipulating them, and steer clear of harsh chemicals, such as those found in acetone and non-acetone nail polish removers.
Follow these nail-care tips at home, too:
- Keep your fingernails and toenails trimmed short and filed evenly .
- If you have damaged nails, wear gloves when cleaning or doing work around the house.
- Always wear socks with shoes and make sure your shoes fit properly, so as not to irritate toenails further.
The progress for your nails may be slow. It can take three to six months before you see any improvement, Dr. Kassouf says. But most people do improve with the therapies available today.
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What Is Systemic Treatment For Psoriasis
You may have heard your provider talk about systemic psoriasis treatment, as opposed to treating with topicals or light therapy. Systemic therapy means that the treatment gets where it needs to go through systemic circulation throughout the body, as opposed to putting a cream or a light directly on the affected area. In the case of psoriasis treatment, systemic therapies include oral treatments, injectables, and IV infusions, according to the National Psoriasis Foundation.4
What Treatments Are Available For Nail Psoriasis
There are many treatments for nail psoriasis. Your treatment plan may include one or more of the following.Treatment you apply to the nails: This can be helpful for mild or early nail psoriasis. Nails grow slowly, so youll need to apply these treatments for several months, often once or twice a day. Because nail psoriasis can be stubborn, you may need to use more than one treatment. Sometimes, two medicines are combined to give you a faster response.
Treatment that you apply to your nails includes the follow.
A potent or very potent corticosteroid: This can be helpful for most signs and symptoms of nail psoriasis. Its safe to use this medicine once or twice a day for up to nine months.
Calcipotriol: In one study, researchers found this to be as effective as a potent corticosteroid at treating the buildup beneath the nail.
Tazarotene: This treatment can be especially helpful for treating pitting, a separating nail, and discoloration.
If you need stronger treatment, your dermatologist may recommend treatment given in a dermatologist office or clinic. This treatment may include one of the following.
Psoriasis medicine that can help clear the skin and nails includes:
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Best Biologic For Pustular Psoriasis
Systemic retinoids are appropriate treatment for patients with moderate-to- severe psoriasis, particularly those with difficult to treat as in palmoplantar, pustular, and erythrodermic varieties.
In this phase 2, randomized, double-blind, placebo-controlled, dose-ranging study, we assessed the efficacy and safety of brodalumab , a human antiinterleukin-17receptor monoclonal.
It is imperative that dermatology nurses learn more about the basic immunology of psoriasis and PsA and.
Recently, etanercept, a systemic biologic therapy, received an indication from the.
There are several types of psoriasis: plaque, guttate, inverse, pustular, and erythrodermic.
A new generation of biologic response modifiers are also available. If psoriasis is extensive.
Biologic therapy has not yet been approved for the treatment of generalized pustular psoriasis and erythrodermic psoriasis, but its clinical application has been reported in China as well as in other countries. 2327 If biologic drugs are needed, a comprehensive evaluation should be carried out according to the personal situation.
Brodalumab, an AntiInterleukin-17Receptor Antibody for Psoriasis In this phase 2, randomized, double-blind, placebo-controlled, dose-ranging study, we assessed the efficacy and safety of brodalumab , a human antiinterleukin-17receptor monoclonal.
The New England Journal of Medicine is a weekly general medical journal that publishes new medical research and review articles, and.
Nail Psoriasis Quick Guide
Learn more about the signs of nail psoriasis, Treatment options and get tips for caring for your nails without making your nail psoriasis worse.
Betteridge, N., Boehncke, W. H., Bundy, C., Gossec, L., Gratacos, J., & Augustin, M. . Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol, 30, 576-585. doi:10.1111/jdv.13306
Jiaravuthisan, M. M., Sasseville, D., Vender, R. B., Murphy, F., & Muhn, C. Y. . Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol, 57, 1-27. doi:10.1016/j.jaad.2005.07.073
Merola, J. F., Li, T., Li, W. Q., Cho, E., & Qureshi, A. A. . Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol, 41, 486-489. doi:10.1111/ced.12805
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Comparative Studies With Systemic Therapies
The efficacy of biologics has not only been a matter of research but differences in the occurrence of adverse events have also been investigated. A prospective, randomized, open-label study compared the incidence of onychomycosis in 315 patients with nail psoriasis treated with infliximab, etanercept, and adalimumab, and a statistically positive association between fungal infections and the use of infliximab was shown . At the end of week 24, 33 % of patients receiving infliximab had a positive fungal culture. In patients receiving etanercept and adalimumab, and controls, this percentage was 15.5, 13.3, and 13.9 %, respectively. On the other hand, NAPSI improved more in infliximab-treated patients than in patients receiving etanercept and adalimumab .
The preliminary conclusions that can be drawn from these studies are that conventional therapies are less powerful and are slower-acting treatments for nail psoriasis than biologics, possibly with the exception of cyclosporine. No single biologic appears to be superior above another biologic. Evidence suggests that infliximab may act faster, but after 1 year of treatment these potential differences have vanished. On the other hand, the use of infliximab may result in higher percentages of onychomycosis.
Miscellaneous Systemic Therapies: Fumaric Acid Esters Sulfasalazine And Leflunomide
Fumaric acid esters , sulfasalazine, and leflunomide have also been reported to be effective in nail psoriasis however, based on the current knowledge, they cannot be advised for this indication. FAEs have been used for the treatment of chronic PP since 1959. The commercially available form, containing mainly dimethylfumarate, is currently a first-line systemic therapy for severe chronic PP in several European countries it is not effective in PsA. The general opinion is that it has little efficacy in nail psoriasis, but one case has been reported in which it was effective both on nail bed and nail matrix psoriasis . Side effects are frequent in patients using FAEs, such as episodes of flushing, abdominal pain, and a decrease in lymphocyte count.
Sulfasalazine is an aminosalicylate used as a traditional disease-modifying antirheumatic drug for the treatment of peripheral involvement in PsA. Sulfasalazine is metabolized by gut flora into sulfapyridine and 5-aminosalicylic acid, which act as anti-inflammatory agents. The role of sulfasalazine in cutaneous psoriatic lesions and nail psoriasis is not generally accepted. One case has been reported on the use of sulfasalazine in the treatment of psoriatic nail lesions . After 3 months, nail lesions started to recede and disappeared progressively. No other cases have been reported in literature.
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What Are The Side Effects Of Taking A Biologic
Each PsA biologic is different. Each has its own potential side effects.
However, there are also similarities in this class of drugs. The most common side effect for all biologics is an increased risk of unusual, or opportunistic, infections.
In addition, TNF-alpha inhibitors may cause new or worsening heart failure.
If you and your doctor decide to try this course of treatment with a biologic, you may experience flu-like symptoms or respiratory infections.
Since biologics are given by injection or via an intravenous solution, you may also experience discomfort where the needle pokes your skin.
Biologics may lead to more serious side effects, such as blood disorders or cancer.
For these reasons, its a good idea to maintain a strong relationship with your doctor that focuses on open communication.
Together, you can talk about and decide on whether a biologic is the right treatment for your psoriatic arthritis.
Biologics are recommended for those living with moderate to severe PsA. But some people arent candidates for biologics.
Thats because the drugs side effects may do more harm than good.
People with compromised immune systems or active infections shouldnt take biologics for their PsA. These drugs suppress the immune system and can be unsafe if yours is already compromised in some way.
The cost and out-of-pocket expenses for biologics can also be a barrier for some people.
What Are The Risks Of Biosimilars
The risks and side effects of biosimilars are the same as those associated with their biologic reference product. Anyone considering taking a biosimilar should talk with their health care provider about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits.
Biologics and biosimilars act on cytokines, which are specific proteins released by the immune system that can cause inflammation. Biologics suppress the function of the overactive immune system. When on a biologic or biosimilar, you may have a higher risk of infection. If you develop any signs of an infection, contact your health care provider right away.
Signs of infection include:
- Damp, sticky feeling or sweating
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How Should This Medicine Be Used
Ustekinumab comes as a solution to inject subcutaneously or intravenously . For the treatment of plaque psoriasis and psoriatic arthritis, it is usually injected subcutaneously every 4 weeks for the first two doses and then every 12 weeks for as long as treatment continues. For the treatment of Crohns disease and ulcerative colitis, it is usually injected intravenously for the first dose and then given subcutaneously every 8 weeks for as long as treatment continues.
You will receive your first subcutaneous dose of ustekinumab injection in your doctors office. After that, your doctor may continue to give you injections or allow you to inject ustekinumab injection yourself or have a caregiver perform the injections. Ask your doctor or pharmacist to show you or the person who will be performing the injections how to inject ustekinumab. Before you use ustekinumab injection yourself the first time, read the written instructions that come with it.
If your medication comes in a prefilled syringe or vial, use each syringe or vial only once and inject all the solution in the syringe. Even if there is still some solution left in the syringe or device, do not use it again. Dispose of used needles, syringes, and devices in a puncture-resistant container. Talk to your doctor or pharmacist about how to dispose of the puncture-resistant container.
Do not shake a prefilled syringe or vial that contains ustekinumab.
Relationship Between Biosimilars And Biologics
Biosimilars are highly similar to their biologic reference product. All biologics, including biosimilars:
- Target specific parts of the immune system rather than impacting the entire immune system
- Are given as an injection or IV infusion
To be approved as a biosimilar for a particular reference biologic, the biosimilar must be:
- Highly similar to the reference product and cannot have any clinically meaningful differences in terms of safety or efficacy
- Approved for the indication and condition for which the reference product is approved
- Be given the same form and in the same dosage as the reference product
- The same mechanism of action as the reference product, which means it works the same way in the body
An interchangeable biosimilar must meet the biosimilar standard plus an additional standard that the treatment will produce the same clinical result as the reference product in any given patient. If a biosimilar is approved as interchangeable, a pharmacist may substitute it without letting your prescribing health care provider know, in some states.
Keep in mind that biosimilars are not exact copies of their biologic reference product. Biologics are large and complex molecules from living sources that cannot be exactly copied.
Many considerations go into a treatment decision. Always speak with your health care provider about the potential risks and benefits of a treatment recommendation.
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Ustekinumab Injection May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- swelling of the face, eyelids, tongue, or throat
- difficulty breathing
- tightness in the chest or throat
Ustekinumab injection may increase the risk that you will develop cancer. Talk to your doctor about the risks of using this medication.
Ustekinumab injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administrations MedWatch Adverse Event Reporting program online or by phone .
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store ustekinumab vials and prefilled syringes in the refrigerator, but do not freeze them. Keep the vials and prefilled syringes upright in their original cartons to protect them from light. Dispose of any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDAs Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
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