Treatment Options for Non-Plaque Psoriasis Subtypes

Introduction to Non-Plaque Psoriasis Subtypes

The American Academy of Dermatology recommends biologics like ustekinumab for moderate-to-severe cases of pustular and erythrodermic psoriasis, while topical therapies and phototherapy are preferred for guttate and inverse psoriasis 1, 2

Guttate psoriasis is characterized by dew-drop-like, 1-10mm salmon-pink papules with fine scale, typically found on the trunk and proximal extremities 2
First-line treatment options for guttate psoriasis include low concentrations of topical coal tar and dithranol due to the lower tolerance of erupting guttate psoriasis to topical treatments 3, 4
Ultraviolet B (UVB) phototherapy is especially helpful and has the most robust evidence for efficacy in treating guttate psoriasis 3

Inverse psoriasis affects skin folds with erythematous plaques that have minimal scale due to the moist nature of these areas 5, 6
Low to moderate potency topical corticosteroids are preferred to avoid skin atrophy in inverse psoriasis 7, 8

Ustekinumab at 90mg dose has shown 67% clearance rate compared to 9% with 45mg dose in patients with palmoplantar pustular psoriasis 1
Ustekinumab is recommended as monotherapy for moderate-to-severe pustular psoriasis (strength of recommendation C) 1

Ustekinumab is recommended as monotherapy for moderate-to-severe erythrodermic psoriasis (strength of recommendation C) 1
Cyclosporine, infliximab, and acitretin are suggested treatments by the American Academy of Dermatology for erythrodermic psoriasis 8

Assessment for treatment selection should include patient symptoms, impact on quality of life, response to previous localized therapy, body surface area affected, and presence of incapacity or disability 7, 9
Systemic treatment options for moderate-to-severe cases include traditional systemics, biologics, and small molecule inhibitors 8
Phototherapy should be supervised by adequately trained personnel with regular equipment calibration 3, 4

Avoid systemic corticosteroids in psoriasis as they can cause disease flare during taper 8
Commercial sunbeds (emitting UVA) are rarely effective in psoriasis and may cause significant side effects; their use is not recommended 3, 4