Treatment Options for Psoriasis Exacerbation

First-Line Treatment Options

The British Journal of Dermatology recommends switching to an alternative biologic therapy when the current treatment fails to achieve minimum response criteria or loses its effectiveness over time 1
For mild psoriasis, the Journal of the American Academy of Dermatology suggests high-potency topical corticosteroids are effective for short-term management of exacerbations 4
The combination of calcipotriene and betamethasone dipropionate provides superior efficacy compared to either agent alone with a good safety profile for up to 52 weeks, according to the Journal of the American Academy of Dermatology 3

The British Journal of Dermatology recommends ustekinumab as a first-line biologic agent for adults with psoriasis 1
Adalimumab is recommended as a first-line biologic agent, particularly when psoriatic arthropathy is a consideration, by the British Journal of Dermatology 1
Secukinumab can be considered as a first-line biologic agent in adults with psoriasis, with or without psoriatic arthritis, according to the British Journal of Dermatology 1

The British Journal of Dermatology suggests the following dose-escalation strategies for biologic agents:

Biologic agent	Suggested dose-escalation strategy
Ustekinumab 45 mg every 12 weeks (<100 kg)	Ustekinumab 90 mg every 12 weeks
Ustekinumab 90 mg every 12 weeks (>100 kg)	Ustekinumab 90 mg every 8 weeks
Adalimumab 40 mg every other week	Adalimumab 40 mg weekly
Etanercept 50 mg once weekly	Etanercept 50 mg twice weekly
Infliximab 5 mg/kg every 8 weeks	Infliximab 5 mg/kg every 6 weeks

The Journal of the American Academy of Dermatology recommends adding topical therapies to biologic treatment to enhance efficacy, such as class 1 topical corticosteroids added to standard dose etanercept for moderate to severe psoriasis 7
Calcipotriene/betamethasone added to standard dose adalimumab can accelerate clearance of psoriatic plaques, according to the Journal of the American Academy of Dermatology 7

The Journal of the American Academy of Dermatology suggests that stress reduction techniques, including meditation and cognitive behavioral therapy, can improve psoriasis severity in some patients 8
Oral curcumin supplementation may benefit patients with psoriasis as adjunctive therapy, according to the Journal of the American Academy of Dermatology 8

The British Journal of Dermatology recommends considering the pharmacology of both drugs, the patient's clinical circumstances, and the patient's views on risks and benefits when transitioning between therapies 1

The British Journal of Dermatology suggests evaluating for modifiable factors contributing to poor response, considering dose escalation of current biologic, and switching to alternative biologic agent if inadequate response 1
For severe or refractory cases, infliximab can be considered for very severe disease, and consultation with a specialist with expertise in biologic therapy is recommended, according to the British Journal of Dermatology 1