Version July 2025
INTRODUCTION —
Psoriasis is a multisystem chronic inflammatory disorder with multiple cutaneous presentations. Chronic plaque psoriasis, the most common presentation of psoriasis, typically presents with inflamed, well-demarcated plaques (picture 1A-H). Overlying coarse scale is usually present with the exception of plaques in intertriginous areas.
Treatment of chronic plaque psoriasis is generally pursued because of the negative effects psoriasis can have on quality of life. The major treatment modalities include topical, systemic, and phototherapeutic interventions. Factors such as clinical presentation, patient comorbidities, patient preference, and treatment availability influence the approach to treatment.
General principles for the management of chronic plaque psoriasis are reviewed here. Other aspects of psoriasis management are reviewed separately.
●Treatment selection for chronic plaque psoriasis in adults
•(See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy".)
●Management of chronic plaque psoriasis in specific populations
•Children (see "Psoriasis in children: Management of chronic plaque psoriasis")
•Pregnant individuals (see "Management of psoriasis in pregnancy")
•Individuals with hepatitis, human immunodeficiency virus (HIV) infection, latent tuberculosis, or malignancy (see "Treatment selection for moderate to severe plaque psoriasis in special populations")
●Management of other psoriasis presentations
•(See "Guttate psoriasis", section on 'Treatment'.)
•(See "Nail psoriasis", section on 'Treatment'.)
•(See "Erythrodermic psoriasis in adults", section on 'Management'.)
•(See "Pustular psoriasis: Management".)
•(See "Treatment of psoriatic arthritis".)
•(See "Treatment of peripheral psoriatic arthritis".)
RATIONALE FOR TREATMENT —
Psoriasis can have a profound negative effect on quality of life. The visibility of psoriasis or associated symptoms (eg, pruritus, pain) may impair activities of daily living, inhibit social interactions, and impair occupational functioning. Increased rates of various psychopathologies, such as poor self-esteem, sexual dysfunction, anxiety, depression, and suicidal ideation, have been reported in patients with psoriasis. (See "Comorbid disease in psoriasis", section on 'Psychosocial effects'.)
There may be additional benefits of treatment. Although further study is necessary to clarify the effects of psoriasis treatment on comorbidities, psoriasis has been associated with cardiovascular disease and metabolic syndrome, and some studies suggest links between reduced negative cardiovascular outcomes and some systemic psoriasis treatments [1]. (See "Comorbid disease in psoriasis", section on 'Atherosclerotic disease'.)
TREATMENT OPTIONS —
There is no curative treatment for chronic plaque psoriasis; however, multiple treatments may improve signs and symptoms of the disease.
Major treatment options include:
●Topical therapies (eg, topical corticosteroids, vitamin D analogs, calcineurin inhibitors, tazarotene, tapinarof, roflumilast) (table 1A)
●Systemic therapies (eg, anti-tumor necrosis factor [TNF]-alpha, anti-interleukin [IL] 17, and anti-IL-23 biologic agents; apremilast; deucravacitinib; methotrexate; acitretin; cyclosporine) (table 1B)
●Phototherapy (eg, narrowband ultraviolet B [NBUVB] phototherapy, psoralen plus ultraviolet A [PUVA] photochemotherapy, targeted phototherapy)
The mechanisms of action for psoriasis therapies vary. (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy" and "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy".)
SELECTING THE PRIMARY MODE OF THERAPY —
Selection of a psoriasis treatment begins with identifying the preferred primary mode of therapy (topical therapy, systemic therapy, or phototherapy) (algorithm 1).
The proportion of the body surface area (BSA) involved and the locations of psoriasis lesions have often been used to loosely define the severity of psoriasis and to assist with treatment selection [2]. However, selection of the most appropriate therapeutic approach involves consideration of multiple factors, such as:
●Extent and location of skin involvement
●Disease complications (physical or psychosocial)
●Patient abilities and preferences
●Patient comorbidities
●Treatment availability/feasibility
●Response to prior therapies
Use of more than one mode of therapy to achieve optimal results may be necessary. Often, patients treated with systemic therapy or phototherapy use topical therapy as adjunctive therapy. Topical adjunctive therapy may help to accelerate or maximize the improvement of thick or treatment-resistant lesions.
Extent and location of skin involvement — The extent and locations of skin involvement influence the feasibility of topical therapy [3]. (See 'Disease extent' below and 'Special sites (eg, scalp, genital, palm, sole, or face involvement)' below and 'Disease in multiple locations' below.)
Topical therapy is often a reasonable initial approach to chronic plaque psoriasis affecting a limited proportion of the BSA. Topical therapies generally have relatively favorable adverse effect profiles compared with systemic therapies and do not require special equipment or frequent office visits like phototherapy. (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy".)
However, the success of topical therapy is highly dependent on long-term adherence to a self-administered, effective treatment regimen. Thus, scenarios in which the extent or location of disease is likely to make topical therapy less practical, less well tolerated, or less effective can support the initial use of systemic therapy or phototherapy. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy".)
Disease extent — Topical therapy is generally most feasible when psoriasis affects a relatively small proportion of the BSA.
Because the feasibility of topical therapy varies among patients, the use of a specific numerical threshold for all patients is not ideal. For scenarios in which numeric criteria are required for medication access, suggested thresholds for considering topical therapy less feasible have generally ranged from 3 to 10 percent BSA [4,5]. In our experience, psoriasis involving more than 3 to 5 percent of the BSA is often appropriate for the consideration of systemic therapy or phototherapy.
More extensive plaque psoriasis can also improve with topical therapy [6]. However, clinical experience suggests that long-term management of extensive skin involvement with topical agents alone can be impractical, physically challenging, or insufficiently effective for many patients.
●Estimating BSA – Different techniques have been used to quickly estimate BSA involvement in the clinical setting. In one technique, the entire palmar surface of the patient's hand, including unspread fingers, is considered approximately 1 percent of the BSA [7]. Another method involves estimating skin involvement based on the approximate BSA of general body areas (eg, head and neck [10 percent], upper extremities [20 percent], trunk [30 percent], lower extremities including buttocks [40 percent]) [2].
Special sites (eg, scalp, genital, palm, sole, or face involvement) — Systemic therapy can be a reasonable alternative to topical therapy when the location of disease inhibits the administration or efficacy of topical therapy despite limited BSA involvement. Similarly, systemic therapy can be a reasonable alternative when the location of psoriasis contributes to a significant negative impact on quality of life.
Examples of site-related factors that may contribute to early consideration of systemic therapy include:
●Application difficulty (eg, perianal skin, genital skin, scalp)
●Increased risk for inadequate response to topical therapy (eg, palms, soles, scalp)
●Associated disabling symptoms or psychosocial effects (eg, face, genitals, palms, soles)
●Sites associated with poor tolerance or increased risk for adverse effects from topical therapy (eg, risk for topical corticosteroid-induced skin atrophy in facial or intertriginous areas)
We often prescribe an initial trial of topical therapy for psoriasis in these areas but have a relatively low threshold for proceeding to systemic therapy when achieving a satisfactory response with topical therapy is difficult.
Disease in multiple locations — Topical therapy can be challenging when there is limited skin involvement but plaques are located in multiple body areas, particularly when the affected areas have different first-line approaches to treatment (eg, palmoplantar disease and intertriginous disease). In this scenario, we typically begin by simplifying the topical routine to the greatest degree feasible. Phototherapy and systemic therapy are reasonable alternatives for patients for whom topical therapy is not acceptable or feasible. (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy", section on 'Simplification of regimen'.)
Complications — Disabling physical complications or profound psychosocial effects from psoriasis can influence the approach to therapy. When rapid, maximal improvement of psoriasis plaques and associated symptoms is necessary, time to onset of drug effect and the likelihood of complete or near complete disease suppression are important considerations in treatment selection. Such scenarios may support the initial use of a highly effective, rapid-acting systemic therapy, often in conjunction with a topical corticosteroid to the worst lesions.
Patient ability and preference — Because treatments for chronic plaque psoriasis are not curative, long-term treatment is typically necessary to maintain improvement. Therefore, selection of a treatment that is tolerable, effective, and feasible for the patient is critical.
Examples of factors that can influence tolerability or feasibility of topical therapy, phototherapy, and systemic therapy include:
●Topical therapy – Topical therapy usually involves frequent, often daily or twice-daily, patient-administered treatment [8]. Physical, social, lifestyle, or psychologic factors may impact the ability to consistently apply treatment.
Topical regimens that a patient considers messy, cosmetically unappealing, uncomfortable, or complicated do not support effective use of treatment. Identification of a topical formulation that is acceptable to the patient and simplification of the topical regimen may improve the feasibility of topical treatment (table 1A). (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy", section on 'Supporting efficacy of topical therapy'.)
●Phototherapy – Phototherapy generally requires frequent clinic visits (eg, two to three times per week) to achieve a satisfactory response to treatment. Home phototherapy is an alternative but is dependent on the ability of the patient to obtain and accommodate home phototherapy equipment. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Phototherapy'.)
●Systemic therapy – The route and dosing frequency of systemic therapy influence tolerability of systemic treatment. Patients may have a strong preference for the route of administration (eg, oral versus subcutaneous injection). Dosing frequency for systemic psoriasis therapy varies widely, from twice-daily dosing to dosing only four times per year (table 1B).
In addition, patient tolerance for specific treatment-related adverse effects varies. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Selecting a systemic agent'.)
Comorbidities — Overlap in the disease indications for some chronic plaque psoriasis therapies can support the selection of a specific therapy for patients with comorbidities. In addition, cautious treatment selection is necessary for patients who have (or have increased susceptibility to) comorbid diseases that may be exacerbated by psoriasis therapies. (See 'Psoriatic arthritis and other diseases with similar treatments' below and 'Diseases that may be exacerbated by psoriasis treatments' below.)
Psoriatic arthritis and other diseases with similar treatments — Most systemic therapies for chronic plaque psoriasis are also effective for psoriatic arthritis and other diseases (eg, inflammatory bowel disease). When both psoriasis and a comorbidity require systemic therapy, it is often appropriate to select a drug with overlapping benefit. However, the clinical presentation influences the preferred approach to treatment. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Patients with psoriatic arthritis'.)
Diseases that may be exacerbated by psoriasis treatments — Phototherapy and some systemic therapies may be inappropriate or require use with caution in patients with certain conditions (eg, photosensitive disorders, chronic infections, malignancy, etc). (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Phototherapy' and "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Systemic therapies' and "Treatment selection for moderate to severe plaque psoriasis in special populations".)
Cost and availability — Cost and other treatment accessibility issues can be limiting factors for use of psoriasis therapies, particularly biologic agents and newer topical and systemic therapies. Examples of less costly topical and systemic therapies in the United States include select topical corticosteroids, topical vitamin D analogs, and oral methotrexate. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Other factors influencing treatment selection'.)
Support organizations, such as the National Psoriasis Foundation, may provide helpful information for patients who experience financial barriers to preferred treatments.
Avoidance of undertreatment — Concern about medication safety must be balanced with the risk of undertreatment of psoriasis, which can lead to inadequate clinical improvement and patient dissatisfaction [9,10]. Undertreatment of psoriasis might also impact outcomes from comorbidities.
Increased understanding of the pathophysiology of psoriasis has contributed to the growing availability of effective, generally well-tolerated treatments.
PATIENT EDUCATION AND COUNSELING —
Although the availability of effective therapies plays an important role in reducing the impact of psoriasis on patient quality of life, psoriasis can still be a challenging disease. The clinician should aim to understand patient concerns, adequately answer questions, and optimize the patient's understanding of the disease and treatments.
●Disease education – Our experience suggests that disease education may support a sense of patient empowerment that enhances treatment adherence and may promote greater patient satisfaction and treatment success. Examples of key concepts we discuss include:
•Chronic plaque psoriasis is a common inflammatory skin condition. Some people are more susceptible to psoriasis due to genetics/family history. (See "Psoriasis: Epidemiology, clinical manifestations, and diagnosis", section on 'Epidemiology' and "Psoriasis: Epidemiology, clinical manifestations, and diagnosis", section on 'Risk factors'.)
•The disease is not contagious.
•The disease can start suddenly and generally persists but often has periods of increased and reduced activity. (See "Psoriasis: Epidemiology, clinical manifestations, and diagnosis", section on 'Clinical course'.)
•People with psoriasis may have increased risk for other diseases, such as psoriatic arthritis, obesity, metabolic syndrome, and atherosclerotic disease. (See "Comorbid disease in psoriasis".)
•Signs of psoriatic arthritis may include joint pain, swelling, stiffness (particularly morning stiffness), or back pain. Because psoriatic arthritis can cause joint damage, it is important to seek medical care if you develop these types of symptoms. (See "Clinical manifestations and diagnosis of psoriatic arthritis", section on 'Major clinical features'.)
•There is no cure for psoriasis, but there are effective treatments that can help suppress the disease.
During the examination, we often touch the patient's psoriasis lesions to physically communicate that the skin disorder is neither repulsive nor contagious.
We provide or encourage patients to have regular health maintenance follow-up to support early identification of comorbidities. (See "Comorbid disease in psoriasis", section on 'Evaluation and management'.)
●Treatment options and goals – We clarify the goals of treatment and discuss treatment options and adverse effects.
Examples include:
•We discuss the absence of a curative treatment for psoriasis and clarify that the primary goal of treatment is to obtain satisfactory control of the disease.
•We review the shared goal of finding treatments that are sufficiently effective, tolerable, and feasible and discuss target goals of treatment. (See 'Response goal' below.)
•We aim to gain a clear understanding of the patient's treatment concerns and preferences. (See 'Patient ability and preference' above.)
•We carefully communicate or demonstrate proper administration of prescribed therapies.
Resources, such as the National Psoriasis Foundation, can be helpful for obtaining written treatment information suitable for patients.
●Psychologic and social support – Chronic plaque psoriasis may affect self-perception and may occur in association with psychologic disorders such as depression [11,12]. Even limited skin disease may contribute to significant psychosocial disability [13]. (See 'Rationale for treatment' above.)
Effective treatment may reduce the psychosocial effects of psoriasis; however, some patients experiencing negative psychosocial effects may also benefit from counseling and/or psychiatric treatment. Psoriasis treatments that provide clear or nearly clear skin and favorable safety have helped ameliorate the psychosocial impact of psoriasis.
RESPONSE ASSESSMENT AND FOLLOW-UP
Follow-up — We typically schedule regular clinical follow-up. In our experience, scheduling in-person, phone, or electronic contact with the patient one week after prescribing a new treatment is helpful for supporting adherence to treatment, particularly for patients treated with topical therapies, given the challenges of long-term adherence to topical treatment [8]. (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy", section on 'Supporting efficacy of topical therapy'.)
Subsequently, we tailor the frequency of follow-up based on the disease status, expected time to response for the prescribed therapy, and necessary monitoring for treatment adverse effects. Often, for patients who have achieved a satisfactory response to a stable treatment regimen, follow-up every 6 to 12 months is reasonable, unless more frequent clinical or laboratory monitoring for adverse effects is required (as for methotrexate or cyclosporine).
At follow-up visits, we:
●Assess the response to treatment through a physical examination (see 'Response evaluation' below)
●Assess patient tolerance of the treatment regimen and address patient concerns
●Perform appropriate assessment for treatment-related adverse effects
●Assess for signs or symptoms of psoriatic arthritis (eg, "sausage digits" [dactylitis], joint pain, joint swelling, morning stiffness, or back pain) [5] (see "Clinical manifestations and diagnosis of psoriatic arthritis", section on 'Diagnosis')
●Ensure that the patient has access to (or provide) appropriate screening for cardiovascular risk factors (obesity, hypertension, diabetes, hyperlipidemia, smoking) or management of these conditions (see "Comorbid disease in psoriasis", section on 'Patient assessment')
●Assess for symptoms of anxiety or depression and other symptoms that may benefit from referral for psychologic support services or psychiatric evaluation (see "Approach to the adult patient with suspected depression")
●Implement treatment adjustments, as needed (see "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy", section on 'Treatment failure or intolerance' and "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Response assessment')
Response goal — Complete resolution of skin lesions and associated symptoms may be considered the ideal outcome for chronic plaque psoriasis therapy. However, incomplete responses and subsequent disease flares are common.
Patient satisfaction is an important practical goal of treatment. Clinicians should take the values and preferences of patients regarding the aggressiveness of treatment seriously. A reasonable skin clearance goal for patients who desire maximum resolution of skin disease is minimal to no skin involvement achieved with a well-tolerated treatment regimen. A patient's tolerance of lesser degrees of improvement may be due to a preference to avoid the risks or inconveniences of certain therapies. Pursuit of maximal lesion clearance often requires treatment adjustments, combination therapy, and consistent long-term therapy.
Uncertainty about treatment goals for psoriasis and the desire to ensure that patients are offered sufficiently effective treatment contributed to the performance of a National Psoriasis Foundation Delphi consensus exercise involving psoriasis experts in 2015 and 2016. Among the participants, the most accepted definition for an acceptable response after three months of treatment was either less than 3 percent body surface area (BSA) involvement or at least 75 percent improvement in BSA involvement compared with baseline [14]. The most accepted definition for a target response at three months was less than 1 percent BSA involvement.
Achievement of ≤1 percent BSA involvement within three months aligns with the Treating to Target guidance from the National Psoriasis Foundation.
Response evaluation — A skin examination is the primary mode for assessing the response of chronic plaque psoriasis to therapy. Assessment of the impact of treatment on associated symptoms (eg, pruritus) and quality of life also informs whether there is a satisfactory response to therapy.
The appropriate timing for assessing the response to therapy varies across treatments. Often, clinically significant improvement is expected within three months of starting treatment. (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy" and "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy".)
●Skin response – In clinical practice, a rough estimate of BSA involvement and visible signs of plaque improvement are often used to assess and record the skin response to therapy [2]. Plaque resolution is generally concluded when erythema, scale, and plaque elevation are absent. Of note, in patients with highly pigmented skin, erythema may be subtle in active disease. (See 'Disease extent' above.)
Postinflammatory pigmentary changes (hypopigmentation or hyperpigmentation) may persist for months or longer after resolution of active psoriasis lesions (picture 2).
More complex and time-consuming methods, such as calculation of the Psoriasis Area and Severity Index (PASI) score, are primarily used in clinical trials [2]. (See "Postinflammatory hyperpigmentation" and "Acquired hypopigmentation disorders other than vitiligo", section on 'Postinflammatory hypopigmentation'.)
●Symptoms and quality of life – The impact of treatment on associated symptoms and quality of life is commonly assessed through verbal questioning of the patient. Use of a visual analog scale or numeric rating scale may also be helpful for following the response of pruritus to treatment [2]. Other assessment methods, such as the Psoriasis Symptom Inventory and Dermatology Life Quality Index, are primarily used in clinical trials [2].
Reasons for treatment failure — Apparent treatment failure can occur due to various factors. Often, these factors can be mitigated through appropriate patient counseling or adjustments in therapy.
●Incorrect diagnosis – Reassessment of the diagnosis can identify patients for whom treatment inefficacy results from an incorrect diagnosis. (See "Psoriasis: Epidemiology, clinical manifestations, and diagnosis", section on 'Diagnosis'.)
●Suboptimal treatment selection – A mismatch between the clinical presentation and the selected treatment can result in an unsatisfactory response to therapy (eg, use of a low-potency topical corticosteroid for thick plaques on the extremity or topical monotherapy for a patient with generalized disease).
●Inadequate administration of therapy – Most often, the patient or a caregiver administers psoriasis therapies. Inadequate improvement may occur when treatment is prematurely discontinued, improperly administered, or taken or applied with suboptimal frequency. Contributing factors may include insufficient patient counseling and selection of a therapy that is not feasible or tolerable due to poor clinician understanding of patient preferences or limitations.
●Resistance to therapy or tapering of therapy – Unsatisfactory responses to standard treatment regimens may occur in the setting of highly active disease or intrinsic or acquired biologic factors that decrease the efficacy of a specific treatment. Treatment adjustments (eg, combination therapy, dose or potency increases, or switching therapy) may be beneficial. (See "Chronic plaque psoriasis in adults: Treatment of disease amenable to topical therapy", section on 'Treatment failure or intolerance' and "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'Adjusting therapy'.)
For patients with disease that has responded satisfactorily to treatment, an inability to taper treatment to a long-term maintenance regimen that minimizes risk for treatment adverse effects may also prompt use of other therapies. For example, although chronic plaque psoriasis generally responds well to topical corticosteroids, near-continuous, long-term use of a high-potency topical corticosteroid to maintain improvement often is not favorable due to the risks of long-term topical corticosteroid treatment. (See "Topical corticosteroids: Use and adverse effects", section on 'Adverse effects'.)
For some biologic therapies, particularly tumor necrosis factor (TNF)-alpha inhibitors, the development of antibodies to the selected drug may reduce treatment efficacy. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy", section on 'TNF-alpha inhibitors' and "Tumor necrosis factor-alpha inhibitors: Induction of antibodies, autoantibodies, and autoimmune diseases", section on 'Anti-drug antibodies'.)
ROLE OF DIET —
There is uncertainty regarding the role of dietary interventions in the treatment of psoriasis. In 2018, based on a systematic review of the literature, the Medical Board of the National Psoriasis Foundation released dietary recommendations for adults with psoriasis [15]. The authors found high-quality evidence to support weight reduction, with a hypocaloric diet as an adjunct to standard medical therapy for adults who are overweight or obese (body mass index [BMI] ≥25) with psoriasis as well as a gluten-free diet in individuals with psoriasis and confirmed celiac disease.
In addition, the board suggested a three-month trial of a gluten-free diet as an adjunct to standard medical therapy in adults with psoriasis who test positive for serologic markers of gluten sensitivity. Universal screening of individuals with psoriasis for gluten sensitivity was discouraged in favor of limiting screening to individuals with a first-degree relative with celiac disease or active gastrointestinal symptoms. There was insufficient evidence of efficacy to recommend supplements, including fish oil, vitamin D, selenium, and vitamin B12, for psoriasis.
Additional study is also necessary to explore the effects of specific dietary patterns on psoriasis [15]. A French web-based questionnaire cohort study found an inverse association between psoriasis severity and the degree of adherence to the Mediterranean diet (a diet high in fruits, vegetables, legumes, cereals, bread, fish, fruit, nuts, and extra virgin olive oil) [16]. However, data are insufficient to confirm a beneficial effect of this diet. (See "Healthy diet in adults", section on 'Mediterranean diet'.)
SOCIETY GUIDELINE LINKS —
Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See "Society guideline links: Psoriasis".)
INFORMATION FOR PATIENTS —
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
●Basics topics (see "Patient education: Psoriasis (The Basics)" and "Patient education: Topical corticosteroid medicines (The Basics)")
●Beyond the Basics topics (see "Patient education: Psoriasis (Beyond the Basics)")
The National Psoriasis Foundation is a nonprofit organization that provides useful information to patients with psoriasis and their clinicians. The website includes information on individual psoriasis treatments. Membership includes access to a newsletter that provides information on current areas of research and new treatments.
National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195
1-800-723-9166
SUMMARY AND RECOMMENDATIONS
●Overview – Chronic plaque psoriasis, the most common clinical presentation of psoriasis, can negatively affect quality of life (picture 1A-H). Although there is no curative treatment, multiple interventions can improve signs and symptoms of the disease. Topical therapy, phototherapy, and systemic therapy are the primary modes of therapy (table 1A-B). (See 'Rationale for treatment' above.)
●Selecting the primary mode of treatment – Our approach to treatment selection begins with determining whether topical therapy alone is appropriate (algorithm 1). Important factors to consider include disease extent and location, disease complications, patient preference and ability, patient comorbidities (eg, psoriatic arthritis), and treatment availability. (See 'Selecting the primary mode of therapy' above.)
•Disease extent – For most patients with chronic plaque psoriasis involving a limited portion of the body surface area (BSA; eg, less than 3 to 5 percent BSA), we suggest initial treatment with topical therapy rather than phototherapy or systemic therapy (Grade 2C). Advantages of topical therapy include a relatively low risk for serious adverse effects and an absence of need for specialized equipment or clinician-administered treatment.
For patients for whom the extent of disease or other factors make successful treatment with topical therapy alone less feasible, we suggest phototherapy or systemic therapy as the primary mode of therapy (Grade 2C). (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy".)
The amount of skin involvement that makes topical therapy less feasible is not strictly defined and may vary among patients. In our experience, topical therapy may be most feasible for disease involving less than 3 to 5 percent of the total BSA. (See 'Disease extent' above.)
•Scalp, genital, palmar, plantar, or facial involvement – For some patients with limited skin involvement, the location of disease (eg, scalp, genitals, palms, soles, or face) can make successful topical therapy more challenging. For these patients, initial treatment with a systemic therapy or phototherapy is a reasonable alternative to topical therapy, with the most appropriate choice based on the clinical presentation. (See 'Special sites (eg, scalp, genital, palm, sole, or face involvement)' above.)
●Patient education and counseling – Patient education and counseling are important components of management. The clinician should aim to understand patient concerns; adequately answer questions; and optimize the patient's understanding of the disease and treatment options, expectations, and risks. Patients experiencing negative psychosocial effects may benefit from additional support resources. (See 'Patient education and counseling' above.)
●Response assessment – In the clinical setting, assessment of the BSA involved, plaque characteristics, symptom status, and quality of life impact are typically used to assess the response to therapy. The timing for response assessment depends on the selected therapy. An inadequate response to treatment should prompt an evaluation for reasons for treatment failure. (See 'Response assessment and follow-up' above.)
●Combination therapy – Use of more than one mode of therapy to achieve optimal results may be necessary. Often, patients treated with systemic therapy or phototherapy use topical therapy as adjunctive therapy. (See "Chronic plaque psoriasis in adults: Treatment of disease requiring phototherapy or systemic therapy".)
