From the Guidelines
The treatment approach for infected psoriasis involves a combination of antimicrobial therapy and psoriasis management, prioritizing the use of topical corticosteroids, vitamin D analogs, or systemic medications depending on severity, 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.
Key Considerations
- Infected psoriasis requires a dual approach, addressing both the infection and the underlying psoriasis.
- Antimicrobial therapy should be guided by bacterial cultures, with empiric antibiotics such as cephalexin, dicloxacillin, or clindamycin used while awaiting results.
- For MRSA coverage, consider trimethoprim-sulfamethoxazole or doxycycline, and use topical antibiotics like mupirocin for limited areas.
- A 7-10 day course of antibiotics is typically sufficient, but may be extended based on clinical response.
- Psoriasis management should be tailored to the individual patient, taking into account efficacy, side effects, availability, ease of administration, comorbidities, family history, and coexisting diseases, as outlined in the guidelines of care for the management of psoriasis and psoriatic arthritis 1.
Treatment Options
- Topical corticosteroids and vitamin D analogs are commonly used for mild to moderate psoriasis.
- Systemic medications, such as methotrexate, cyclosporine, and acitretin, may be necessary for more severe cases, with careful consideration of their benefits and risks, as discussed in the guidelines for the management of psoriasis with traditional systemic agents 1.
- Biologic therapy may also be effective, but its use should be carefully weighed against potential disadvantages, such as high costs and adverse events, and considered for tapering when a state of stable low disease activity or clinical remission is reached, as reviewed in the scoping review on dose tapering of biologics in patients with psoriasis 1.
Wound Care
- Good wound care is essential, including gentle cleansing with mild soap and water, avoiding harsh scrubbing, and keeping the affected areas clean and dry.
- Temporarily discontinuing immunosuppressive psoriasis treatments until the infection resolves is crucial to prevent further complications.
- By addressing both the infection and the underlying psoriasis, and prioritizing wound care, the treatment approach can help prevent recurrence and promote healing, ultimately improving morbidity, mortality, and quality of life outcomes for patients with infected psoriasis.
From the Research
Infected Psoriasis Treatment Approach
- The treatment of infected psoriasis involves a combination of topical and systemic therapies, as well as phototherapy 2.
- Topical therapies, such as vitamin D analogs and corticosteroids, are the mainstay of treatment for mild to moderate psoriasis, while phototherapy and systemic agents are used for more severe cases 2.
- In cases of infected psoriasis, antibiotics may be necessary to treat the underlying infection, with macrolides and rifampin showing promise in reducing psoriasis symptoms 3.
- The role of infection in psoriasis is complex, with different infectious factors contributing to the development and maintenance of the disease, including bacterial, viral, and fungal infections 4.
Treatment Options
- Topical therapy is the mainstay of treatment for psoriasis, with limited adverse effects 5.
- Biological therapy has revolutionized the treatment of psoriasis, offering improved efficacy and reduced adverse events 5.
- Nanoformulations and phyto-pharmaceuticals are emerging as potential treatment options, offering improved anti-psoriatic effects and reduced side effects 5.
- The goal of treatment is to control clinical symptoms, reduce systemic disease potential, and improve patient quality of life, with a target of 1% or less body surface area involvement 2.
Considerations
- The treatment of infected psoriasis requires a comprehensive approach, taking into account the underlying infection, as well as the patient's overall health and quality of life 6.
- The manipulation of skin microbiota is a promising area of research, with potential implications for the treatment of psoriasis 4.
- A rationalized, cost-effective, and patient-compliant therapy is necessary for effective management and complete cure of psoriasis 5.