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Therapy treatment options for psoriasis: topical and systemic

Maryann Mikhail and Noah S Scheinfeld

Psoriasis is a common disease in the western world, with a prevelence of between 1 and 3%. It has a variety of manifestions the most common of which being erythematous, scaly, well-demarcated plaques. Limited disease can be treated with topical therapies. The mainstay of topical treatment is topical corticosteroids. Topical tar preparations are effective but messy. Calcipotriol and tazoratene are also useful topical therapies and can be combined with topical corticosteroids. Moderate disease is treated effectively with oral methotrexate and phototherapy with ultraviolet B, narrow band ultraviolet B (311 nm) or psoralen (oral, topical or bath) and ultraviolet A. Other standard oral therapies include acetretin and cyclosporin. Acetretin can be combined with ultraviolet therapy. There are new monoclonal antibody therapies termed biologic therapies that include alefecept, etanercept and efalizumab. Other biologic therapies exist but have yet to be approved. Psoriasis is a treatable but not curable skin disease with a variety of treatment options.