Numerous topical and systemic therapies are available for the treatment of the cutaneous manifestations of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response 1. Established therapies such as methotrexate and phototherapy continue to play a role in the management of moderate to severe plaque psoriasis. However, these drugs appear to be particularly effective in the treatment of pustular psoriasis, and we consider them first line therapy. Topical treatment modalities continue to be the first line therapy for childhood psoriasis. This paper summarizes the general topical treatments available including their clinical use, benefits, cost, and side-effects. Keywords: psoriasis, children, phototherapy, photochemotherapy. In moderate and severe cases, topical medications are often insufficient to control the disease. It is in these situations when other treatment modalities such as systemic immunomodulators, biologics, phototherapy, or photochemotherapy may be considered.
Until recently, the mainstays of topical therapy have been corticosteroids, tars, anthralins and keratolytics. Topical corticosteroids remain one of the most widely used treatment modalities for psoriasis. If the patient has an irritant response, treatment with coal tar may continue, but with a lower concentration. 22 Like corticosteroids, calcipotriene can be considered a first-line agent and is available as an ointment, cream or solution. Management of Childhood Psoriasis: Are photo- and photochemotherapy appropriate treatments for children and adolescents with psoriasis? Therapeutic modality should consider the patient’s and the parents’ attitude toward the disease; the type, severity, extent, and sites of psoriasis; as well as safety concerns and accessibility of treatment. CorticosteroidsCorticosteroids remain among the first line agents in the topical treatment of psoriasis in all age groups. Since late 1950s, MTX is the gold standard therapy in psoriasis and in era of biological treatments, it continues to be an agent with which other systemic psoriasis medications are compared.
Although topical treatments are sufficient for many patients, some need additional systemic drugs. TREATMENT OF PSORIASIS Topical therapy Phototherapy Systemic therapy Climatotherapy. Can be used when other modalities fail to achieve desirable response. Continue to download. Treatment modalities comprise topical therapies, phototherapy and systemic agents.
Topical Psoriasis Therapy
MF may be mistaken for psoriasis, chronic dermatitis from allergy or irritants, or chronic fungal infections. Commonly, multiple treatments may be used together, which is called Combined Modality Therapy. Topical chemotherapy is a common first line therapy in patch or plaque lesions. There is no systemic absorption, so the use of contraception in child-bearing women is not required, as it is for the pill form of Targretin. The prevalence of psoriasis in children is much lower, somewhere between 0.5 and 1. The focus of this advisory committee meeting is the treatment of moderate to severe psoriasis, thus treatments for less severe forms of the disease will not be discussed. They are often first-line treatment for mild to moderate psoriasis as well as in sites such as the flexures and genitalia. Aetna considers psoralens and ultraviolet A light (PUVA) treatments medically necessary for the following conditions after conventional therapies have failed:. UVB phototherapy medically necessary for morphea if first-line therapies (e.g. systemic corticosteroids and methotrexate) have failed, psoriasis, atopic dermatitis (atopic eczema), early-stage mycosis fungoides, and polymorphous light eruption. The use of UVA tanning salon treatments in the therapy of psoriasis is usually unsuccessful and is extremely unwise with concomitant psoralen and drug therapy. The authors concluded that the findings of this study showed that phototherapy is an effective and well-tolerated treatment modality in children. Continue. The usual dosage for topical steroids is twice per day for 2 weeks, but this can range depending on the severity and location of the psoriasis and the strength of the steroid used. Using UV light is probably one of the safest and oldest modalities for the treatment of psoriasis. UVB light and is considered first-line treatment for extensive plaque psoriasis, especially if the plaques are thin and the patient is young. Systemic treatments used to treat psoriasis are summarized in Table 5. Figure 1: Topical therapy for management of psoriasis. Corticosteroids remain first-line treatment in the management of all grades of psoriasis, both as monotherapy or as a complement to systemic therapy. Lower-potency corticosteroids are particularly recommended to apply on the face, groin, axillary areas, and in infants and children, whereas mid- and higher-potency corticosteroids are commonly used as initial therapy on all other areas in adults. Objective To characterize patterns of childhood psoriasis health care delivery from 1979-2007. Phototherapy treatments were not assessed in this study because NAMCS data on procedural therapy may not be comparable with data on medication therapy. Treatment modalities differed by patient age and physician specialty. Topical corticosteroids remain a first-line treatment for most presentations of psoriasis in children and adults, and, consistent with this, potent topical corticosteroids were the most commonly prescribed medications for children during the 28-year period of our study.
Biologic Systemic Therapy For Moderate-to-severe Psoriasis: A Review
Benzoyl peroxide is a first-line agent that not only effectively fights Propionibacterium acnes, but also discourages the development of antibiotic resistance. Milk remains an important source of calcium and vitamin D for Americans, especially children, the panel said.