What are the treatment options for a psoriasis flare-up?

From the Guidelines

To treat a psoriasis flare-up, start with topical corticosteroids like betamethasone or clobetasol applied to affected areas 1-2 times daily for 2-4 weeks, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1.

Treatment Options

When considering treatment options for a psoriasis flare-up, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. The most recent and highest quality study, published in 2020, suggests that topical therapies, such as vitamin D analogues and corticosteroids, may be effective and sufficient for managing limited disease and offer the additional benefit of fewer significant adverse effects due to the lack of systemic exposure 1.

• Topical corticosteroids are a first-line treatment for mild to moderate psoriasis flare-ups
• Phototherapy with narrow-band UVB light can be considered for more severe flares
• Oral medications like methotrexate or biologics such as adalimumab may be necessary for moderate to severe cases

Lifestyle Modifications

Lifestyle modifications can help manage flares:

• Reduce stress
• Avoid skin injuries
• Quit smoking
• Maintain a healthy diet
• Identify and avoid triggers specific to you, such as certain foods or environmental factors These treatments work by reducing inflammation, slowing skin cell growth, and modulating the immune response. Corticosteroids suppress immune activity locally, while systemic medications target the overactive immune response throughout the body. Consistent treatment and lifestyle management are key to controlling psoriasis flares effectively, as supported by the guidelines of care for the management and treatment of psoriasis with traditional systemic agents 1.

From the FDA Drug Label

The initial dose of cyclosporine [MODIFIED] should be 2.5 mg/kg/day. Cyclosporine [MODIFIED] should be taken twice daily, as a divided (1.25 mg/kg b.i.d.) oral dose. Patients should be kept at that dose for at least 4 weeks, barring adverse events. If significant clinical improvement has not occurred in patients by that time, the patient's dosage should be increased at 2 week intervals. Based on patient response, dose increases of approximately 0. 5 mg/kg/day should be made to a maximum of 4 mg/kg/day. Patients generally show some improvement in the clinical manifestations of psoriasis in 2-weeks. Satisfactory control and stabilization of the disease may take 12 to 16 weeks to achieve Results of a dose-titration clinical trial with cyclosporine [MODIFIED] indicate that an improvement of psoriasis by 75% or more (based on PASI) was achieved in 51% of the patients after 8 weeks and in 79% of the patients after 16 weeks. Treatment should be discontinued if satisfactory response cannot be achieved after 6 weeks at 4 mg/kg/day or the patient's maximum tolerated dose

Treatment options for a psoriasis flare-up include:

• Cyclosporine (PO) with an initial dose of 2.5 mg/kg/day, taken twice daily
• Dose increases of approximately 0.5 mg/kg/day can be made at 2-week intervals, up to a maximum of 4 mg/kg/day
• Treatment with cyclosporine can be effective in achieving satisfactory control and stabilization of the disease, with improvement in psoriasis by 75% or more (based on PASI) achieved in 51% of patients after 8 weeks and in 79% of patients after 16 weeks 2
• Topical corticosteroids, such as clobetasol propionate, can also be used to treat psoriasis, but careful patient supervision is recommended due to the risk of systemic absorption and reversible HPA axis suppression 3

From the Research

Treatment Options for Psoriasis Flare-up

The treatment options for a psoriasis flare-up can be divided into several categories, including:

• Topical therapies: These are commonly used for mild to moderate psoriasis and include corticosteroids, calcipotriene, tazarotene, and anthralin 4, 5, 6.
• Phototherapy: This is often used for moderate to severe psoriasis and can be used alone or in combination with other treatments 4, 7.
• Systemic therapies: These are used for severe or recalcitrant psoriasis and include medications such as acitretin, methotrexate, and cyclosporine 4, 7.
• Biologic agents: These are reserved for severe or unremitting cases of psoriasis, especially those with psoriatic arthritis 7, 8.

Factors to Consider When Selecting a Treatment

When selecting a treatment for a psoriasis flare-up, several factors should be considered, including:

• Disease severity: The severity of the psoriasis will help determine the most appropriate treatment option 4, 7.
• Patient expectations: The patient's expectations for improvement should be taken into account when selecting a treatment 4.
• Risk-benefit ratio: The potential benefits and risks of each treatment option should be carefully considered 4, 7.
• Patient lifestyle and preferences: The patient's lifestyle and preferences should be taken into account when selecting a treatment, including the location of the psoriasis lesions and the potential impact on daily activities 5, 6.

Specific Treatment Recommendations

Specific treatment recommendations for psoriasis include:

• Topical corticosteroids as a first-line treatment for mild to moderate psoriasis 5, 6.
• Phototherapy as a second-line treatment for moderate to severe psoriasis 7.
• Systemic therapies such as acitretin, methotrexate, and cyclosporine for severe or recalcitrant psoriasis 4, 7.
• Biologic agents such as etanercept, adalimumab, and infliximab for severe or unremitting cases of psoriasis 8.