Managing Psoriasis with Systemic Therapies

Indications for Systemic Therapy

The British Medical Journal recommends escalating to systemic therapy when body surface area involvement exceeds 5%, there is an inadequate response to optimized topical therapy after 8 weeks, or failure of adequate trial of topical treatment 1
The American Academy of Dermatology suggests that generalized pustular or erythrodermic psoriasis is an indication for systemic therapy 6
Severe psoriatic arthropathy is also an indication for systemic therapy, according to the British Medical Journal 1

The British Medical Journal recommends monitoring complete blood count as part of pretreatment assessment and during therapy for cyclosporine, hydroxyurea, and azathioprine 1

The American Academy of Dermatology recommends applying clobetasol propionate 0.05% or betamethasone dipropionate 0.05% twice daily for 2-4 weeks maximum to thick plaques, achieving 58-92% efficacy 2
The guideline society recommends combining topical corticosteroids with calcipotriol (vitamin D analog) for synergistic effect 2

The guideline society recommends conducting clinical review every 4 weeks during active treatment with no unsupervised repeat prescriptions for high potency agents 3
The society also recommends limiting moderate potency corticosteroid use to maximum 100g per month 3

The American Academy of Dermatology recommends narrow-band UVB phototherapy as first-line for moderate to severe psoriasis in pregnant women, avoiding systemic agents 6
The British Medical Journal states that methotrexate is absolutely contraindicated during pregnancy and breastfeeding, and conception must be avoided for at least one menstrual cycle after stopping in women 1