[Evaluation of dermatological services implemented in the primary care setting].

large series have been published and no treatment protocol has been established. Systemic therapies such as retinoids, methotrexate, and cyclosporine, among others, either alone or in combination, have traditionally achieved mixed results.5 However, the market introduction of biological therapies provided new options for the treatment of this variant of psoriasis. Experience with biological therapy for the treatment of erythrodermal psoriasis is limited to the use of etanercept and infliximab (Table). Infliximab has been used in 2 isolated cases,6,7 and a small series of 4 patients,8 whereas etanercept has only been analyzed in a prospective study of 10 patients.9 The clinical response was good in the patients treated with infliximab, although in 4 out of 6 the degree of response was not reported. In addition, except for 1 case,6 the others were receiving methotrexate at the same time. The response was good in 80 % of patients treated with etanercept (50 % with a PASI 75 response and 30 % with PASI 50 response), but no other concomitant medications. It is difficult to draw comparative conclusions between infliximab and etanercept, due to the limited number of case studies published, as well as the different doses and the use of concomitant treatments. However, etanercept and infliximab appear to be clearly superior to classic systemic therapy for psoriatic erythroderma, due to their fast action, greater efficacy, and few adverse effects. More cases are nevertheless needed to establish the most appropriate dosage and treatment.