Clinician's Guide in Psoriasis Treatment

Title: A clinician's paradigm in the treatment of psoriasis.
Author: Lebwohl M
Publication: J Am Acad Dermatol. 2005 Jul;53(1 Suppl 1):S59-69.

Psoriasis is a chronic inflammatory disease that affects the skin, scalp and joints. It ranges from mild to severe forms, and patients with moderate to severe forms of the disease have a significant deterioration in their quality of life.

The goal of psoriasis treatment is to:

  • Rapidly control the disease process
  • Decrease the total area of the skin that is affected
  • Decrease the plaque lesions
  • Achieve and maintain remission
  • Minimize side effects
  • Improve patient’s quality of life.

Treatment of psoriasis depends on the severity of the disease, and whether it is for controlling an acute attack or for long-term maintenance.

Treatment for mild psoriasis includes topical applications of:

  • Corticosteroid
  • Calcipotriene (synthetic topical form of vitamin D)
  • Tazarotene (vitamin A derivative)
  • Topical tars (usually coal tar)
  • Anthralin (a synthetic compound with anti-proliferative and anti-inflammatory effects on the skin)
  • Keratolytics (agents that promote keratolysis or shedding of the horny layer of the skin)

Treatment of moderate to severe psoriasis includes systemic agents, such as:

  • Methotrexate (a drug that interferes with the production and maintenance of DNA)
  • Acitretin (a form of vitamin A)
  • Cyclosporine (an immunosuppressant or drug that decreases the effect of the body’s immune system)
  • Biologic agents (drugs derived from living organisms or cell cultures, such as injectable antibodies)

These treatments can be done using combination, rotational (switching between two or more therapies) or sequential regiments.

The author noted that because the goal of the treatment differs from controlling acute attacks to maintenance of long-term remission, each patient should have an individualized treatment plan.

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