Severe or Recalcitrant Psoriasis When Goeckerman Therapy Has Not Achieved PASI 75
Some patients with severe or recalcitrant psoriasis do not reach the PASI 75 response threshold with first-line regimens. When that threshold is not met, a structured next-line approach is indicated.
Clinical scenario: Severe or recalcitrant psoriasis — a presentation in which disease extent or resistance to treatment places it beyond standard first-line management.
Prior treatment and failure condition: Goeckerman therapy — the combination of topical coal tar application followed by UVB phototherapy, carried out over a period of weeks, or climatotherapy such as a supervised program at the Dead Sea — did not achieve PASI 75. This unmet target is the escalation criterion that brings this protocol into play.
Next-line approach (partial): The protocol involves an alternative form of radiation-based therapy directed at resistant or localised areas of psoriasis, used in patients who have not responded to numerous other treatments or in whom conventional phototherapy is not appropriate. The complete regimen, including session parameters and cumulative limits, is available via the full protocol.
References
DOI: 10.1016/j.jaad.2019.04.042
Goeckerman therapy is a psoriasis treatment that was developed in 1921 and involves the use of coal tar in combination with UVB phototherapy. It is a safe and effective option for patients with severe or recalcitrant psoriasis.
Grenz ray therapy can be an alternative to UV therapy for resistant localized psoriasis, including palmoplantar psoriasis, in cases in which patients have not responded to numerous other treatments, or when UV therapy cannot be used.
The typical treatment regimen involves administration of 200 rad per session at weekly intervals up to a total of 800 to 1000 rad.
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