What is the treatment approach for all patients?
Assess disease severity: e.g., based on estimated body surface area (BSA) affected.
Provide supportive care.
Describe the treatment for mild psoriasis (below 3–5% body surface area) involvement
Topical pharmacotherapy (e.g., corticosteroids, calcipotriene, retinoids) and/or targeted phototherapy
Systemic agents if treatment response is insufficient
Describe the treatment for moderate to severe psoriasis (above 3–5% BSA involvement)
Systemic pharmacotherapy
And/or phototherapy
Narrowband UVB therapy
PUVA therapy
Consider adjunctive topical pharmacotherapy.
Describe the topical fist-line therapy.
Topical corticosteroids (first-line)
Face, neck, or skin folds (i.e., areas with sensitive/thin skin): low-potency (e.g., hydrocortisone 1%)
Scalp, trunk, and extremities
Medium-potency (e.g., triamcinolone 0.1%)
High-potency (e.g., fluocinonide 0.05%)
Describe topical calcineurin inhibitors.
Topical calcineurin inhibitors: e.g., tacrolimus 0.03 % or 0.1%, or pimecrolimus 1%
Alternative to steroids for areas with sensitive/thin skin
May be used for maintenance after > 4 weeks of steroid use
Describe the additional therapy.
Additional therapy: the following agents may be used in combination with topical corticosteroids
Vitamin D analogues: e.g., calcipotriene/calcipotriol
Keratolytics: retinoids (e.g., tazarotene), or salicylic acid
Tar preparations, e.g., 1% coal tar lotion
Anthralin
Describe the systemic pharmacotherapy.
Principles of systemic therapy
Management should be specialist guided
Before therapy initiation, obtain baseline laboratory studies (e.g., BMP, CBC, liver chemistries).
Common indications
Moderate to severe psoriasis
Mild psoriasis with insufficient response to topical agents
Treatment options
Biologics
IL-17 inhibitors, e.g., brodalumab, secukinumab
IL-23 inhibitors, e.g., ustekinumab , guselkumab
TNF-α inhibitors, e.g., etanercept, adalimumab, infliximab
Other medications
Methotrexate PLUS folic acid to reduce the adverse effects
Cyclosporine
Apremilast
Describe the supportive care.
Provide topical treatment with ointments (e.g., petroleum jelly) and moisturizers to prevent moisture loss.
Counsel on reducing alcohol consumption and smoking cessation.
Provide management for any comorbid mental health conditions (e.g., MDD, anxiety).
Zuletzt geändertvor 2 Jahren