From the Guidelines
The most appropriate first-line systemic treatment for a patient with moderate to severe plaque psoriasis who has failed topical therapy is Methotrexate, as it is generally well-tolerated, cost-effective, and has a long history of use in psoriasis treatment. When considering treatment options for psoriasis, it is essential to prioritize morbidity, mortality, and quality of life as the primary outcomes. The treatment of psoriasis should be based on the severity of the disease, patient preferences, and potential side effects of the treatment options. Some key points to consider when treating psoriasis include:
- The use of topical medications as first-line therapy for mild to moderate psoriasis
- The consideration of systemic treatments, such as methotrexate, cyclosporine, and biologic agents, for moderate to severe psoriasis
- The importance of monitoring for potential side effects and comorbidities, such as liver disease and psoriatic arthritis
- The need for patient education and counseling on treatment options, potential side effects, and the importance of adherence to treatment plans.
In terms of specific treatment options, Methotrexate is typically considered the first-line systemic treatment for moderate to severe plaque psoriasis 1. The typical starting dose for methotrexate in psoriasis is 7.5-15 mg once weekly, with gradual dose escalation as needed. Regular monitoring of liver function tests and complete blood count is essential. Folic acid supplementation (1-5 mg daily) is recommended to reduce side effects. Patients should be counseled on the importance of avoiding alcohol and the need for reliable contraception, as methotrexate is teratogenic.
Other treatment options, such as cyclosporine and biologic agents, may be considered for patients who have failed methotrexate or have contraindications to its use. Cyclosporine is usually reserved for short-term use due to potential side effects, particularly nephrotoxicity. Biologic agents, such as adalimumab, are typically used after failure of traditional systemic therapies due to their higher cost and potential for serious side effects. Acitretin, a retinoid, is less commonly used as first-line therapy and is often more effective when combined with other treatments.
Overall, the treatment of psoriasis should be individualized and based on the specific needs and preferences of each patient. By prioritizing morbidity, mortality, and quality of life, and considering the latest evidence-based treatment options, healthcare providers can help patients with psoriasis achieve optimal outcomes and improve their overall quality of life 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Professional Multiple-Choice Questions (MCQs) with Answers and Explanations Regarding Psoriasis
- What is the most appropriate initial treatment for patients with less than 20% body surface involvement of psoriasis?
- A) Phototherapy
- B) Systemic therapies
- C) Topical therapy
- D) Biologics Answer: C) Topical therapy 2
- Which of the following topical therapies is effective in mild to moderate psoriasis and has a fixed combination with a corticosteroid?
- A) Calcipotriene
- B) Tazarotene
- C) Anthralin
- D) Vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate) Answer: D) Vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate) 3
- What is the primary cause of psoriasis?
- A) Genetic component
- B) Environmental factors
- C) Immune response
- D) All of the above Answer: D) All of the above 4
- Which of the following is a common comorbidity of psoriasis?
- A) Psoriatic arthritis
- B) Type 2 diabetes mellitus
- C) Cardiovascular disease
- D) All of the above Answer: D) All of the above 4
- What is the recommended treatment for mild-to-moderate psoriasis according to current treatment guidelines?
- What is an important factor in optimizing patient adherence to topical therapy for psoriasis?
- A) Clinical effectiveness
- B) Fast onset of action
- C) Tolerability
- D) All of the above Answer: D) All of the above 5
- Which of the following is a steroid-sparing agent used in the treatment of psoriasis?
- A) Coal tar
- B) Anthralin
- C) Calcineurin inhibitors
- D) All of the above Answer: D) All of the above 6