Topical and systemic therapies for moderate-to-severe psoriasis

Abstract

Topical therapies are the most commonly prescribed agents for psoriasis, owing to their accessibility, relative safety, and rapid onset of action. However, topical therapies, such as corticosteroids, vitamin D analogs, tazarotene, and non-steroidal immunomodulators, have signifi cant limitations. Their use as monotherapy for the treatment of moderate-to-severe psoriasis has largely been replaced by newer, more effective systemic therapies. Nevertheless, topical medications can be highly effective when used appropriately for mild psoriasis or as adjunctive therapy for other systemic treatments. Phototherapy, one of the oldest forms of treatment, remains an important and highly effi cacious treatment for psoriasis. Oral systemic medications used in the treatment of moderate-to-severe psoriasis include methotrexate, cyclosporine, and acitretin. Newer oral medications and off-label medications such as apremilast, tofacitinib, and hydroxyurea round out the list of treatments that can be used to manage challenging psoriasis patients.