Psoriasis: Treatment of patients who are candidates for UV-based or systemic therapy

Patients who are candidates for UV-based or systemic therapy (including oral and biologic agents) have more significant disease, typically affecting more than 5% of the BSA. Some candidates for these therapies may have less than 5% BSA affected but have psoriasis in vulnerable areas such as the face, genitals, hands and feet (palmoplantar disease), scalp, or intertriginous areas and have disease that adversely affects their quality of life. 

In this section, we present clinical scenarios and then use our previously published guidelines to develop the most appropriate approach. We will address the use of both UVB phototherapy and photochemotherapy with PUVA, and the treatment of patients with palmoplantar disease, erythrodermic psoriasis, and multiple comorbidities. In daily practice as compared with clinical trials, in which patients are frequently excluded for a variety of pre-existing or current illnesses or cancer, there are numerous scenarios that may arise making it important for the clinician to become familiar and comfortable using multiple different therapeutic modalities.

Conclusion: Approach to patients with moderate to severe psoriasis without PsA.

Navigate section 6 of the psoriasis guideline: Case-based review

Citation note

Menter A, Korman NJ, Elmets CA,Feldman SR, Gelfand JM, Gordon KB, Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011 Jul;65(1):137-74. 

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