Systemic Therapy for Psoriasis

Melvin Lee, MD; Robert E. Kalb, MD


Dermatology Nursing. 2008;20(2):105-111. 

In This Article

Abstract and Introduction

Psoriasis therapy has changed dramatically in the past decade with the introduction of biologic therapy. The treatment of moderate to severe psoriasis is reviewed. Phototherapy, conventional systemic therapy, and biologic therapy are discussed including practical tips for administering each agent. Overall approaches to treatment are discussed along with special circumstances where individual therapies have advantages.

Psoriasis is a common chronic inflammatory disorder primarily affecting the skin. Clinical manifestations range from a few small scaly plaques to involvement of nearly the entire skin surface. Psoriasis is frequently associated with arthritis. In addition patients with severe psoriasis have a higher risk of myocardial infarction (which may be related to the systemic inflammation induced by Th1 cytokines) and lymphoma (Gelfand, Neimann, et al., 2006; Gelfand, Shin, et al., 2006). Physicians in the past have typically based their decision to prescribe systemic therapy on the amount of body surface area involved. A more recent clinical consensus from the medical board of the National Psoriasis Foundation suggests a two-tiered approach (treat topically or treat systemically) based on multiple factors including body surface area involved and the quality of life (Pariser et al., 2007). The use and selection of an appropriate systemic therapy for psoriasis are discussed.


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