Psoriasis: an update on topical and systemic therapies.

Psoriasis is an immune-mediated inflammatory disease with a genetic predisposition. Although manifesting predominantly as a hyperproliferative skin disorder, psoriasis is a systemic disease associated with a range of comorbidities including arthritis, cardiovascular disease and depression. Educating the patient that psoriasis is chronic and that there are possible comorbidities is paramount. Patients with a limited number of plaques and no systemic symptoms may be managed with intermittent use of topical therapies. Those with more extensive or debilitating disease may require phototherapy or systemic medicines such as methotrexate or one of the newer targeted therapies. Newer systemic therapies, including oral medicines and injectable biologics, can only be used following unsuccessful treatment with traditional therapies such as methotrexate and phototherapy. Biologic therapies for psoriasis offer the possibility of near-complete symptom resolution in people with psoriatic disease.