Therapeutic strategies: rotational therapy and combinations

Long-term management of psoriasis requires an individualized approach. Some treatments such as calcipotriol, methotrexate and acitretin may be used as maintenance treatment for many months. However, most anti-psoriasis treatm ents should be prescribed for restricted periods of time. Rotational treatm ent is a practical approach to reduce the cumulative toxicity of anti-psori asis treatments. The selection of a treatment is based on the clinical pres entation of psoriasis and whether contraindications might exist. Combinatio n treatment is another approach, which is used by the majority of patients. Useful combinations are calcipotriol-acitretin, calcipotriol-cyclosporin, calcipotriol-PUVA, calcipotriol-topical corticosteroids, dithranol-UVB, dit hranol-tar, coaltar-UVB, acitretin-UVB and acitretin-PUVA. Combinations whi ch are contraindicated are coaltar-PUVA, UVB-cyclosporin, PUVA-cyclosporin and methotrexate-acitretin. Combined use of UVB-methotrexate, UVB-PUVA; PUV A-methotrexate; methotrexate-cyclosporin and cyclosporin-acitretin require careful monitoring and might be helpful in patients with severe and recalci trant psoriasis. Depending on the individual presentation of psoriasis, pre vious anti-psoriatic treatments and side-effects, treatment adjustments are made.