Advances in psoriasis treatment.

Psoriasis is a complex disorder that negatively impacts quality of life. Treatment strategies must address both psychosocial and physical aspects of the disease. Psoriasis can be categorized into localized and generalized forms for treatment purposes. In either case, the treatment plan should include obtaining rapid control of the disease and maintaining that control. For localized disease, recent data support the combined use of topical corticosteroids with a noncorticosteroid agent (topical calcipotriene or tazarotene). For generalized disease, UVB phototherapy is an effective treatment that permits both rapid control and long-term maintenance. Use of low doses of acitretin (25mg qd or qod) potentiates both UVB and PUVA therapy. For patients unresponsive to phototherapy or who are not able to come on a regular basis, methotrexate is an effective alternative. Cyclosporine is useful, especially for short-term use in settings of acute exacerbation, but should be replaced by other modalities for long-term maintenance. Other agents that have a place in treatment of generalized psoriasis include hydroxyurea and mycophenolate mofetil.