Topical Add-On Therapy for Moderate to Severe Psoriasis on Systemic or Biologic Treatment
Patients with moderate to severe psoriasis who are already established on a systemic or biologic agent may still require further optimisation. Evidence-based protocols exist for augmenting the existing backbone with a well-chosen topical agent to improve clinical response.
Clinical Scenario
Moderate to severe psoriasis in a patient currently receiving systemic or biologic therapy — where additional plaque clearance is the treatment goal.
Treatment Approach
Current evidence supports adding a targeted topical agent to the patient's existing systemic or biologic backbone. The appropriate topical option depends on which systemic or biologic agent is already in use.
Full selection criteria, agent-specific pairings, and sequencing are in the complete protocol.
References
DOI: 10.1016/j.jaad.2020.07.087
- The addition of an ultrahigh potency (class 1) topical corticosteroid to standard dose etanercept for 12 weeks is recommended for the treatment of moderate to severe psoriasis.
- The addition of calcipotriene/betamethasone to standard dose adalimumab for 16 weeks is recommended for the treatment of moderate to severe psoriasis to accelerate clearance of psoriatic plaques.
- The addition of topical calcipotriene to standard dose methotrexate therapy is recommended for the treatment of moderate to severe psoriasis.
- The addition of calcipotriene/betamethasone dipropionate ointment to low dose (2 mg/kg/d) cyclosporine can be used for the treatment of moderate to severe psoriasis.
- The addition of calcipotriene to standard dose acitretin is recommended for the treatment of moderate to severe psoriasis.
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