# Pathophysiologyiology and Treatment of Soriasis: From Clinical Practice to Basic Research
## 4 Diagnosis and Clinical Treatment of Psoriasis
### Clinical Treatment of Psoriasis
#### 4.2.2 Injectable Medications for Psoriasis  
General psoriasis injections use medications such as methotrexate, azathioprine, and hydroxyurea [103]. They are fast acting, give relatively accurate doses, reduce the frequency of administration for patients, and are relatively more affordable. However, there are inevitable side effects associated with the injections, such as redness, swelling, and itching at the injection site. [PERSON] et al. reported a case of a 53-year-old woman with a 2-month history of recurrent cutaneous lesions appearing a few days after methotrexate (MTX) injections. Dermatological examination revealed several 4-5 cm painful, erosive, erythematus-violaceous plaques with delicate crusting on the surface located on the lower abdomen [73]. Moreover, due to the lack of targeting of these agents, they may damage the normal tissues of the body [104]. Due to the side effects, hydroxyurea (HU) is no longer widely used for the treatment of psoriasis. The primary side effects of HU include relatively common and benign reactions such as hyperpigmentation, xerosis, and skin atrophy. However, more serious cutaneous complications, including leg ulcers and nonmelanoma skin cancers, can occur in a significant number of patients [74]. Azathioprine, a relatively safe immunosuppressiveant, was used to treat a 54-year-old Caucasian male with ANCA-associated vasculitis presenting with hemoptysis, arthralgia, impaired kidney function, active urine sediment, and a positive p-ANCA titer. Two weeks after starting azathioprine, the patient developed a painful erythematas muclopapular rash and fever. A skin biopsy confirmed classical features of [PERSON]'s syndrome [75]. Therefore, in order to obtain better therapeutic results, biological agents were developed. Biologics are a class of targeted therapies used in the treatment of psoriasis, designed to alleviate inflammation and skin symptoms by interfering with specific immune pathways [105]. The main types of biologics used for psoriasis include TNF-\(\alpha\) inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, IL-17A inhibitors, and IL-36R inhibitors. Biologics offer high efficacy and favorable safety profiles, providing rapid improvement in skin symptoms and reducing the impact of the disease on patients' quality of life. Due to their targeted mechanism of action, biologics generally have fewer side effects compared to traditional therapies. However, biologics may increase the risk of infection, and their long-term efficacy and safety require further investigation. Additionally, patients may develop anti-drug antibodies, potentially reducing treatment effectiveness over time. [PERSON] et al. reported a patient with [PERSON]'s disease who developed infliximab-induced psoriasis s vulgaris after starting infliximab treatment [78]. [PERSON] summarized the most common side effects of Adalimumab are injection site reactions. It significantly increases the risk of serious infections, including tuberculosis reactivation, deep fungal infections, and atypical infections, with a two-fold risk of severe infections reported in the Premier trial. Rare side effects include the worsening or onset of congestive heart failure, lupus-like syndrome, lymphoma, significant cytopenias, multiple sclerosis or other neurological disorders, pancytopenia, and elevated transaminases [79]. A 20-week interim analysis of a postmarketing surveillance study was conducted to evaluate the safety and effectiveness of guselkumab in 411 and 245 patients, respectively, who were treated between May 2018 and October 2020 in Japan. Adverse drug reactions (ADRs) were reported in 6.6% of patients, with serious ADRs in 2.2%. The most common ADRs were classified under \"Infections and infestations\" (2.4%), with nasopharyngeal being the most frequent (0.7%) [81]. Secukinumab, the first IL-17A inhibitor approved for moderate-to-severe psoriasis, is generally well-tolerated with a favorable safety profile.