From the Guidelines
Treating elbow psoriasis typically involves a combination of topical medications, lifestyle adjustments, and possibly systemic treatments for severe cases, with the most recent guidelines suggesting the use of potent topical corticosteroids as a first-line treatment 1.
Treatment Approach
The treatment approach for elbow psoriasis involves:
- Starting with potent topical corticosteroids like clobetasol propionate 0.05% or betamethasone dipropionate 0.05% applied thinly twice daily for 2-4 weeks to reduce inflammation and scaling.
- For maintenance, transitioning to medium-strength steroids like triamcinolone 0.1% or using non-steroidal alternatives like calcipotriene (vitamin D analog) or tacrolimus ointment to avoid skin thinning.
- Moisturizing frequently with thick emollients containing ceramides, urea, or salicylic acid to soften plaques and reduce cracking.
- Keeping the affected area clean and avoiding scratching or trauma to prevent the Koebner phenomenon (psoriasis developing at injury sites).
- Considering occlusion therapy by applying medication then covering with plastic wrap overnight to enhance penetration for thicker plaques.
Systemic Treatments
If topical treatments fail, phototherapy or systemic medications like methotrexate, cyclosporine, or biologics may be necessary under medical supervision, with the choice of treatment depending on the severity of the disease and the patient's medical history, as outlined in recent guidelines 1.
Lifestyle Adjustments
Lifestyle adjustments, such as maintaining a healthy weight, avoiding triggers like stress and certain medications, and quitting smoking, can also help manage elbow psoriasis, as suggested by recent studies 1.
Recent Guidelines
Recent guidelines, such as those published in 2021, emphasize the importance of individualizing treatment for patients with psoriasis, taking into account the severity of the disease, the patient's medical history, and the potential risks and benefits of different treatments 1.
From the FDA Drug Label
The safety and efficacy of Enbrel were assessed in two randomized, double-blind, placebo-controlled studies in adults with chronic stable PsO involving ≥ 10% of the body surface area, a minimum Psoriasis Area and Severity Index (PASI) score of 10 and who had received or were candidates for systemic antipsoriatic therapy or phototherapy More subjects randomized to Enbrel than placebo achieved at least a 75% reduction from baseline PASI score (PASI 75) with a dose response relationship across doses of 25 mg once a week, 25 mg twice a week and 50 mg twice a week
The etanercept (SQ) drug is used to treat Psoriasis, including elbow psoriasis.
- The recommended dose for adults with plaque psoriasis is 25 mg or 50 mg twice a week.
- Efficacy was assessed using the PASI score, with more subjects achieving a 75% reduction in PASI score compared to placebo.
- The median time to PASI 50 and PASI 75 was approximately 1 month and 2 months, respectively, after starting therapy with 25 or 50 mg twice a week 2.
From the Research
Elbow Psoriasis Treatment Options
- Topical corticosteroids, such as clobetasol propionate, are effective in treating psoriasis, including elbow psoriasis, due to their anti-inflammatory, immunosuppressive, and antimitotic effects 3
- A study found that clobetasol propionate followed by calcipotriol is superior to calcipotriol alone in the topical treatment of psoriasis, with significant improvements in total symptom score 4
- Clobetasol propionate can be used in various dosage forms, including creams and ointments, to deliver the drug to the skin, with the choice of formulation affecting patient compliance 3
Treatment Regimens
- A treatment regimen of clobetasol propionate for 2 weeks followed by calcipotriol for 4 weeks has been shown to be effective in treating plaque psoriasis, with maintained improvement during a 4-week treatment-free observation period 4
- Another study found that a regimen of calcitriol ointment and clobetasol propionate cream is a safe and effective alternative to calcipotriol for the treatment of mild to moderate plaque psoriasis 5
- Topical therapy, including corticosteroids and vitamin D analogues, is a mainstay treatment option for psoriasis, with limited adverse effects 6
Considerations
- The potency of clobetasol propionate is accompanied by local and systemic side effects, such as skin atrophy and hypothalamic-pituitary-adrenal axis suppression, requiring careful patient instruction and consideration of factors by prescribing physicians 3
- Patient conformity and adherence to therapy, as well as psychological aspects, can influence the treatment of psoriasis, highlighting the need for a rationalized, cost-effective, and patient-compliant therapy 6