Treatment Algorithms for Psoriasis

Disease Classification and Assessment

• The American Academy of Dermatology categorizes psoriasis severity as mild or moderate-to-severe based on objective and subjective measures, including body surface area (BSA), Psoriasis Area and Severity Index (PASI), and Dermatology Life Quality Index (DLQI) 2
• Assessment should include both patient perception of disability and objective assessment of extent and severity, according to the British Medical Journal 3

Treatment Algorithm for Mild Psoriasis

• The American Academy of Dermatology recommends first-line topical therapy for mild psoriasis, including topical corticosteroids, vitamin D analogs, and combination products 3, 4, 5
• The British Medical Journal suggests second-line options for mild psoriasis, including topical tazarotene, coal tar preparations, dithranol, and salicylic acid 3, 4

Treatment Algorithm for Moderate-to-Severe Psoriasis

• The American Academy of Dermatology recommends phototherapy as a first-line treatment for moderate-to-severe psoriasis, including narrowband UVB and PUVA 1, 5, 6
• The Annals of the Rheumatic Diseases suggest traditional systemic agents, including methotrexate, cyclosporine, and acitretin, for moderate-to-severe psoriasis 1, 7, 8

Special Clinical Scenarios

• The American Academy of Dermatology recommends treatment for psoriatic arthritis, including NSAIDs, DMARDs, and TNF inhibitors 8
• The Journal of the American Academy of Dermatology suggests treatment for erythrodermic psoriasis, including cyclosporine, infliximab, and acitretin 5

Treatment Goals and Monitoring

• The British Medical Journal recommends monitoring requirements for systemic agents, including methotrexate, cyclosporine, and acitretin 5, 7, 6

Common Pitfalls and Caveats

• The Annals of the Rheumatic Diseases warn against systemic corticosteroids in psoriasis, as they can cause disease flare during taper 9
• The British Medical Journal advises against combination of systemic agents due to additive toxicity 7