Psoriasis: Current perspectives with an emphasis on treatment

An individualized treatment regimen is necessary for each patient with psor iasis because of the diverse nature of the disease. The manifestation of ps oriasis, the severity and extent of the lesions, and the medical history an d lifestyle of the patient are important factors that determine the selecti on of treatment, but in general therapies with the fewest side effects are preferred. First-line topical treatments are corticosteroids, calcipotriene , and tazarotene. If topical treatments are unsuccessful, phototherapy with ultraviolet B or photochemotherapy with psoralens plus ultraviolet A (PUVA ) are the next choices. If psoriasis fails to respond to an adequate trial of topical therapy or phototherapy, systemic therapies including methotrexa te, acitretin, or cyclosporin should be initialed. Because the regimens inv olved in systemic and phototherapy are complex and require frequent dose ad justments and specialized equipment, the patient should be referred to a de rmatologist when topical therapy is not effective. Am J Med. 1999;107;595-6 05. (C) 1999 by Excerpta Medica, Inc.