Fast Five Quiz: Psoriasis

William James, MD


November 08, 2021

The 2021 AAD guidelines address topical therapies, including the following:

  • Topical corticosteroids are recommended for plaque psoriasis in nonintertriginous areas.

  • Steroid-sparing agents (eg, vitamin D analogues, tazarotene, and calcineurin inhibitors, alone or in combination with steroids) confer lower risk for steroid-induced adverse effects; alternate use with steroids is key to long-term management.

  • Other topical agents (eg, salicylic acid, emollients, anthralin, coal tar) can be use alone or in combination with topical steroids.

  • Topicals combined with biologic or systemic therapies help increase the overall efficacy of therapy.

The guideline provides recommendations and efficacy and safety information on 12 oral systemic, nonbiologic medications, as follows:

  • Methotrexate: moderate to severe psoriasis in adults

  • Apremilast: moderate to severe psoriasis in adults

  • Cyclosporine: severe, recalcitrant psoriasis; in addition, erythrodermic, generalized pustular psoriasis and/or palmoplantar psoriasis

  • Acitretin: monotherapy or combination therapy with psoralen and ultraviolet A (PUVA) or with ultraviolet light B (UVB); do not use in patients who are pregnant or intend to become pregnant or who are nursing

  • Other nonbiologics (not approved by the US Food and Drug Administration for psoriasis): tofacitinib, hydroxyurea, mycophenolate mofetil, azathioprine, leflunomide, tacrolimus, and thioguanine

The following phototherapy options are discussed in the guideline, with regard to dosing regimen, efficacy, and adverse effects:

  • Narrowband UVB

  • Broadband UVB

  • Targeted UVB: Excimer laser, excimer light, targeted narrowband UVB light

  • PUVA: topical, oral, bath

  • Photodynamic therapy

  • Grenz ray

  • Climatotherapy

  • Visible light

  • Goeckerman therapy (not a form of phototherapy)

  • Pulsed dye laser

Read more on psoriasis guidelines.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Psoriasis.

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