What are the clinical features and management of plaque psoriasis?

From the Guidelines

Plaque psoriasis should be managed with a stepped approach, starting with topical therapies for mild disease, progressing to phototherapy for moderate disease, and utilizing systemic treatments, including biologics like etanercept, for severe cases, as this approach has been shown to effectively reduce morbidity and improve quality of life 1. The clinical features of plaque psoriasis include well-demarcated, erythematous plaques with silvery scales typically found on extensor surfaces, scalp, and trunk.

• Key characteristics of plaque psoriasis include:
  • Erythematous plaques with silvery scales
  • Typically found on extensor surfaces, scalp, and trunk
  • Can be associated with psoriatic arthritis and other comorbidities Management of plaque psoriasis depends on the severity of the disease, with mild cases often treated with topical therapies such as:
• Corticosteroids (e.g., betamethasone dipropionate 0.05% applied twice daily)
• Vitamin D analogs (e.g., calcipotriene 0.005% ointment)
• Calcineurin inhibitors For moderate-to-severe disease, phototherapy with narrowband UVB three times weekly for 2-3 months is effective, and systemic treatments such as methotrexate, cyclosporine, and acitretin may be used.
• Biologics, including TNF inhibitors like etanercept, have been shown to be highly effective in treating severe plaque psoriasis, with etanercept demonstrating clinical effectiveness in achieving clearance or near clearance of disease in 38% and 54% of patients after 12 weeks of treatment at 25 mg and 50 mg twice weekly, respectively 1. Treatment with etanercept should be initiated at 25 mg subcutaneously, twice weekly, with the option to increase to 50 mg twice weekly based on individual patient response and clinical need 1. Regular monitoring for treatment efficacy and side effects is essential, with treatment adjustments made as needed to optimize outcomes and minimize morbidity and mortality.

From the Research

Clinical Features of Plaque Psoriasis

• Plaque psoriasis is a chronic inflammatory skin disease characterized by erythematous lesions covered with silvery scales 2
• It is the most common form of psoriasis, affecting approximately 1-3% of the Caucasian population 3
• Clinical features include redness, thickness, and scaling of the skin 4, 5

Management of Plaque Psoriasis

• First-line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid, and topical retinoids 5
• Topical corticosteroids are the primary treatment strategy for most mild to moderate cases of psoriasis 2
• Combination therapy with calcipotriene and betamethasone dipropionate is an effective treatment for plaque psoriasis, offering better efficacy, safety, and ease of use compared to separate product monotherapies 6, 3
• Vitamin D analogues and potent corticosteroids have been shown to be effective in treating plaque psoriasis, with combined treatment with vitamin D and corticosteroid performing significantly better than vitamin D alone or corticosteroid alone 4, 5

Treatment Options

• Topical treatments available for plaque psoriasis include:
  • Vitamin D analogues (e.g. calcipotriol) 6, 3, 4, 5
  • Topical corticosteroids (e.g. betamethasone dipropionate) 6, 3, 4, 2, 5
  • Tar-based preparations 5
  • Dithranol 5
  • Salicylic acid 5
  • Topical retinoids 5
• Combination therapy with calcipotriol and betamethasone dipropionate is available in various formulations, including ointment, gel, suspension, foam, and cream 6