Psoriasis
ICD-10 L40 · ICD-11 EA90

Treatment of Localized Plaque Psoriasis in Adults with Less Than 10% Body Surface Area Involvement

This protocol covers the management of localized plaque psoriasis in adults aged 18 years and older where disease involvement is limited to less than 10% of body surface area — a presentation for which specific targeted treatment approaches are recommended.

Clinical Scenario

Adults aged 18 years or older with localized plaque psoriasis involving less than 10% of body surface area. The limited extent of involvement directs the treatment strategy used in this protocol.

Treatment Approach

Evidence supports the use of targeted phototherapy as the primary approach in this setting, with different phototherapy modalities available that vary in their efficacy profile. Treatment is delivered at a defined frequency to maximise response. An alternative photochemotherapy option exists for select presentations.

Partial overview only — the complete regimen, dosing protocol, modality selection algorithm, and treatment frequency are available via the link below.
Treatment Goal

The primary clinical target for this protocol is:

PASI 75 — 75% improvement in Psoriasis Area and Severity Index score
Instant Access to Structured Evidence-Based Regimens

References

  1. Targeted UVB phototherapy, including excimer laser (308 nm), excimer light (308 nm), and targeted NB-UVB light (311-313 nm), is recommended for use in adults with localized plaque psoriasis (<10% BSA), for individual lesions, or in patients with more extensive disease.
  2. To achieve maximal efficacy, treatment with targeted UVB phototherapy for adults with localized plaque psoriasis should be carried out 2-3 times/wk rather than once every 1-2 wk.
  3. An excimer laser (308 nm) is more efficacious than an excimer light (308 nm), which is more efficacious than localized NB-UVB light (311-312 nm) for the treatment of localized plaque psoriasis in adults.
  4. Topical PUVA phototherapy is superior to localized NB-UVB light (311 to 313 nm) in the treatment of localized plaque psoriasis, particularly for palmoplantar psoriasis and palmoplantar pustular psoriasis, in adults.
  5. In a study of 120 patients with psoriasis treated with a 308-nm excimer laser, approximately 85% achieved at least a 90% improvement after 7 to 13 treatments.

DOI: 10.1016/j.jaad.2019.04.042

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