Treatment of Severe Recalcitrant Psoriasis or Acute Flare During Systemic Therapy
Certain psoriasis presentations demand urgent, structured intervention: disease that has not yielded to prior treatments, or a sudden flare erupting in a patient who is already on systemic therapy. Both scenarios call for a short-course, targeted approach designed for rapid disease control.
Clinical Scenario
This protocol targets two high-acuity situations: severe, recalcitrant psoriasis that has not responded adequately, and an acute psoriasis flare occurring while the patient is already receiving a pre-existing systemic therapy.
Treatment Approach (partial — full protocol below)
Management centres on a rapid-acting systemic agent administered as a time-limited course — providing swift disease suppression and serving as a bridge to a safer long-term treatment. The complete dosing structure, monitoring requirements, and transition plan are detailed in the full protocol.
Treatment Goal
Swift skin improvement with achievement of PASI 75 over the 12 to 16 week course.
References
DOI: 10.1016/j.jaad.2020.02.044
- Cyclosporine is recommended for patients with severe, recalcitrant psoriasis.
- Cyclosporine can be recommended as short-term interventional therapy in patients who flare up while on a pre-existing systemic therapy.
- Nevertheless, it does have an important role as a rapid-acting medication for severe, recalcitrant disease, acute flares, and erythroderma.
- It can also be used as a bridge therapy in the transition to a safer long-term treatment.
- At a dose of 3 mg/kg/d, 50% to 70% of patients with psoriasis achieved PASI 75 and 30% to 50% achieved PASI 90.
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