Version May 2024
| Patients with: | HBV infection | HCV infection | HIV | Latent TB | Malignancy |
| Phototherapy | Preferred therapy: UVB generally considered safe and treatment of choice; severe liver disease is a relative contraindication for PUVA | Preferred therapy: UVB generally considered safe and treatment of choice; severe liver disease is a relative contraindication for PUVA | Preferred therapy | Preferred therapy | A preferred therapy for patients with internal malignancies. Use narrowband UVB phototherapy with caution in patients with history of skin cancer. PUVA phototherapy is not recommended for patients with a history of skin cancer. |
| Methotrexate | Not recommended | Not recommended | Use with caution, primarily reserved for refractory cases | Use with caution | Risk-benefit ratio should be considered; consult with oncologist. |
| Acitretin | Not recommended | Not recommended | Preferred therapy | Preferred therapy | Preferred therapy. |
| Apremilast | Preferred therapy | Preferred therapy | Preferred therapy | Preferred therapy | Short-term data do not suggest an increased risk of malignancy. Risk-benefit ratio should be considered; consult with oncologist. |
| Cyclosporine | Use with caution | Use with caution | Use with caution, primarily reserved for refractory cases | Use with caution | Risk-benefit ratio should be considered; consult with oncologist. |
| TNF inhibitors (adalimumab, etanercept, infliximab) | Not recommended | Preferred therapy | Use with caution, primarily reserved for refractory cases | Use with caution (potentially greater risk of TB reactivation compared with other classes of biologics) | No increased risk of internal malignancy in psoriasis population. Risk-benefit ratio should be considered; consult with oncologist. |
| IL-12/IL-23 inhibitor (ustekinumab) | Preferred therapy | Preferred therapy | Use with caution, primarily reserved for refractory cases | Preferred therapy as long as patient is concurrently treated for latent TB | No increased risk of internal malignancy in psoriasis population. Risk-benefit ratio should be considered; consult with oncologist. |
| IL-17A and IL-17RA inhibitors (secukinumab, ixekizumab, brodalumab) | Use with caution | Use with caution | Use with caution, primarily reserved for refractory cases | Preferred therapy as long as patient is concurrently treated for latent TB | Short-term data do not suggest an increased risk of malignancy. Risk-benefit ratio should be considered; consult with oncologist. |
| IL-23 inhibitors (guselkumab, tildrakizumab, risankizumab) | Use with caution | Use with caution | Use with caution, primarily reserved for refractory cases | Preferred therapy as long as patient is concurrently treated for latent TB | Short-term data do not suggest an increased risk of malignancy. Risk-benefit ratio should be considered; consult with oncologist. |
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