Most cases are not severe enough to affect general health and are treated in the outpatie. Widespread pustular disease requires aggressive treatment, which may include hospitalization. Although topical vitamin D analogs are effective as monotherapy for some patients, a systematic review found that combination therapy with a topical corticosteroid is more effective than either treatment alone 24. Acitretin may work well in certain patients (e.g., those with palmoplantar psoriasis or pustular psoriasis) or as an adjunct treatment to phototherapy. All biologies when used as monotherapy, may lose response over time. Since most chronic plaque psoriasis patients will develop some form of scalp psoriasis, effective scalp products are important for the long-term care of the patient. Severe plaque type psoriasis: The efficacy of acitretin in chronic plaque psoriasis as a monotherapy is below methotrexate and cyclosporine. A recent systematic review of efficacy of oral retinoids as single agent or combined therapy in plaque-type psoriasis (PV), nail psoriasis and localized and generalized pustular psoriasis: Initial and optimal dosage; was compiled by Sbidian et al. Retinoids as single agent therapy appeared to show limited efficacy in PV, whereas good clinical efficacy was reported in pustular forms, which may, however, spontaneously remit. Thus response to acitretin, either as adjuvant therapy monotherapy, is comparable with the response to oral agents currently approved for CTCL.
Psoriasis is categorized as localized or generalized, based on the severity of the disease and its overall impact on the patient’s quality of life and well-being. The primary lesion is a well-demarcated erythematous plaque with a silvery scale. The less common forms of psoriasis include pustular (localized and generalized) and erythrodermic variants. Psoriatic plaques that fail to respond to topical therapy may be improved by administration of intralesional corticosteroid injections. Psoriasis is a common papulosquamous skin disease that may be associated with a seronegative spondyloarthropathy. A typical lesion is a well-demarcated, red-violet plaque with adherent white silvery scales (Fig. It is characterized by sterile pustules, which may be generalized or localized to the palms and soles. When psoriasis requires systemic therapy, cyclosporine (CsA) is one of the most effective and rapidly acting drugs. Short-term treatment (4 8 weeks) with CsA may be useful to obtain rapid control of particularly severe forms, such as generalized pustular psoriasis, thanks to the rapid onset of action of the drug 33. In case of relapse, patients may undertake a new cycle using the last most effective and best tolerated dose of CsA 19. Based on these premises, a well-known sequential regimen suggests the initial use of CsA monotherapy, and, once psoriasis control is obtained, acitretin is introduced, while CsA is gradually tapered, and then discontinued.
TREATMENT OF PSORIASIS Topical therapy Phototherapy Systemic therapy Climatotherapy. Local corticosteroids 3. MTX decreases inflammation through other mechanisms as well. Type of psoriasis: guttate, plaque, palmoplantar pustular psoriasis, generalized pustular psoriasis, erythrodermic psoriasis. Acitretin Biologics Erythrodermic psoriasis Palmoplantar psoriasis Psoriasis Pustular psoriasis Methotrexate TNF- inhibitor. Moderate-to-Severe Psoriasis that has Failed to Respond to all Currently Approved Therapies for Psoriasis (all TNF Inhibitors, T-Cell Inhibiting Agents, and Acitretin) in Patients who Cannot Receive (a) Methotrexate, due to Excessive ( 10 Drinks per Week) Alcohol Use; and (b) Cyclosporine, due to Either Unmanageable Hypertension or Significantly Reduced Kidney Function. The generalized form may be Von Zumbusch psoriasis, an annular subtype, or the pustular psoriasis of pregnancy known as impetigo herpetiformis. Etanercept has been successful as a monotherapy in treating generalized pustular psoriasis, including in those who are unresponsive to infliximab (grade D evidence) 79. The five major forms are plaque, inverse, guttate, erythrodermic, and pustular psoriasis.
Treatment Of Psoriasis: An Algorithm-based Approach For Primary Care Physicians
Data were sorted by prevalence, age of onset, sex distribution, type, severity, risk factors, and management and treatment. Conclusion: The prevalence of psoriasis in Chinese patients is lower than that in Caucasians. Received 4 May 2014. Pustular psoriasis, psoriasis arthropathica, and erythrodermic psoriasis account for 0. Palmoplantar psoriasis is an uncommon clinical form of psoriasis. Although localized to the palms and soles, it has a considerable impact on the patient’s function and quality of life. In general, the decision to add systemic treatment depended on the patient’s characteristics and comorbidities or was taken when the clinical response was unsatisfactory after 8 to 10 sessions of PUVA therapy. Psoriasis is an inflammatory disease that manifests most commonly as well-circumscribed, erythematous papules and plaques covered with silvery scales. Symptoms are usually minimal, but mild to severe itching may occur. Generalized pustular psoriasis. Skin findings are usually well-circumscribed, erythematous papules and plaques covered with silvery scales. Current Strategies for Treating Erythrodermic and Flaring Psoriasis. Psoriasis is a chronic inflammatory cutaneous disorder that can significantly affect patient quality of life (QoL). Of the conventional systemic agents, acitretin, cyclosporine, and methotrexate are the most commonly used.