Medical Health Encyclopedia

Administering therapies in a specific sequence is a strategy for providing both quick relief of symptoms and long-term maintenance. It involves three main steps:

• The quick fix, to clear the psoriatic lesions during an acute outbreak (e.g., a high-potency topical steroid in mild to moderate psoriasis or an oral immunosuppressant in more severe cases).
• The transitional phase, intended to gradually introduce the maintenance drug.
• Ongoing maintenance therapy.

Choices for transitional or maintenance regimens depend on the severity of the condition. Some examples are described in the following sections.

Rotational Therapy

In severe chronic cases, a doctor may recommend rotational therapy. This approach alternates treatments. The goal is to prevent severe side or tolerance effects from prolonged use of a single agent. An example of a rotational schedule may be the following:

• Phototherapy is administered for about two years and stopped.
• One or two powerful body-wide drugs are then administered for one or two years and withdrawn.
• Phototherapy is started again, and the cycle is repeated.

Oral and Injected Therapy

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Some doctors use the Koo-Menter Psoriasis Instrument (KMPI) to decide which patients should receive a pill (oral) or an injection. The KMPI’s questions include

• Does psoriasis cover at least 5% of the patient’s body?
• Is the patient disabled by psoriasis?
• Does psoriasis affect the patient’s quality of life?

If the answer to these questions is “yes,” an additional three questions are considered:

• Is light therapy inappropriate for the patient?
• Is the patient’s psoriasis resistant to light therapy?
• Does the patient have psoriatic arthritis?

If the answer to these questions is “yes,” a doctor may decide to prescribe a pill or injected drugs.

Combination Therapies

Combinations of pills, creams and ointments, and phototherapy are increasingly used rather than single agents. Combinations of oral agents are particularly useful since the doses of each one can be reduced, thereby lowering the risk for severe side effects. Thousands of combinations are possible, and the patient and doctor should discuss the most beneficial for individual needs.