Psoriasis

Use at a glance

• Topical steroid ± vitamin-D analog for limited disease

Treatment options

• Phototherapy for broader skin involvement

Practical pearls

• IL-17/IL-23 inhibitors are highly effective
• Screen for psoriatic arthritis

Choosing treatment

• Moderate–severe disease → biologic or systemic drug
• Methotrexate/cyclosporine remain selected options

Key points

• Mild–moderate: topical corticosteroids 1st; vitamin D analogs, tazarotene, tapinarof, roflumilast as alternatives/add-ons
• UV phototherapy: widespread or topical-refractory mild–moderate disease
• Moderate–severe → systemic therapy; biologics most effective
• IL-17A, IL-17RA, IL-17A/F, IL-23 antagonists > some TNF inhibitors and ustekinumab (IL-12/23)
• Methotrexate effective; cyclosporine ≥ methotrexate but limit to ≤1 yr
• Acitretin effective; significant mucocutaneous toxicity
• Apremilast, deucravacitinib: costly oral alternatives

Nonpharmacologic therapies

• UV phototherapy
• Narrow-band UVB
• Broad-band UVB
• PUVA
• Excimer laser

Pearls

• Ointments most effective topical vehicle; alcohol foams sting
• Narrowband UVB beats broadband; PUVA raises skin cancer risk
• IL-17 inhibitors can trigger or worsen inflammatory bowel disease
• Etanercept least effective TNF inhibitor for skin clearance
• Screen for TB before any biologic

Self-check

• What is used for limited psoriasis?
  Topical steroid ± vitamin-D analog.
• What treats moderate–severe psoriasis?
  Biologic or systemic drug.

Drugs used for this (23)

All clinical uses · Open Psoriasis in the interactive console ↗