Chapter 053. Eczema and Dermatitis (Part 8) The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation. Cyclosporine and other immunosuppressive agents can be very effective in the treatment of psoriasis, and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles (Table 53-4). Experience with these agents is limited and information regarding combination therapy and adverse events continues to emerge. Use of TNF-α inhibitors may worsen congestive heart failure (CHF), and they should be used with caution in those at risk of or known to have CHF. Further, none of the immunosuppressive agents used in the treatment of psoriasis should be initiated if the patient has a severe infection; patients on such therapy should be routinely screened for tuberculosis. Malignancies, including a risk or history of certain malignancies, may limit the use of these systemic agents. Table 53-4 Biologics Approved for Psoriasis or Psoriatic Arthritis Administration Agent Mecha nism of Action Indic ation R oute Frequ ency Warnin gs Aleface pt Anti- CD-2 Ps I M Once weekly x 12 weeks; may repeat Lympho penia, potential for increas ed malignancies, serious infections Etanerc ept Anti TNF-α Ps, PsA S C Once or twice weekly Serious infections, neurologic events, hematologic events, potential for increased malignancies Efalizu mab Anti CD-11a Ps S C Once weekly Serious infections, potent ial for increased malignancies, thrombocytope nia, hemolytic anemia, psoriasis worsening Adalim umab Anti TNF-α PsA S C Every other week Serious infections, neurologic events, potential for increased malignancies, hypersensitivit y reactions, hematologic events Inflixi mab Anti TNF-α PsA IV Initial infusion followed by infusions at week 2, 6, then every 8 weeks Serious infections, hepatotoxicity, hematologic events, hypersensitivit y reactions, neurologic events, potential for increased malignancies Ps, psoriasis; PsA, psoriatic arthritis; IM, intramuscular; SC, subcutaneous; TNF, tumor necrosis factor. . Chapter 053. Eczema and Dermatitis (Part 8) The evidence implicating psoriasis as a T cell–mediated disorder has directed therapeutic efforts to immunoregulation. Cyclosporine and other. agents is limited and information regarding combination therapy and adverse events continues to emerge. Use of TNF-α inhibitors may worsen congestive heart failure (CHF), and they should be. the treatment of psoriasis, and much attention is currently directed toward the development of biologic agents with more selective immunosuppressive properties and better safety profiles (Table