| | Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents published online 04 June 2009. Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fourth of 6 sections of the guidelines of care for psoriasis, we discuss the use of traditional systemic medications for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety, and offer recommendations for the use of the 3 most commonly used, and approved, traditional systemic agents: methotrexate, cyclosporine, and acitretin. We will also briefly discuss the available data for the use of azathioprine, fumaric acid esters, hydroxyurea, leflunomide, mycophenolate mofetil, sulfasalazine, tacrolimus, and 6-thioguanine in psoriasis. Abbreviations used: AAD, American Academy of Dermatology, AST, aspartate aminotransferase, BUN, serum urea nitrogen, CBC, complete blood cell, CSA, cyclosporine, FDA, Food and Drug Administration, MMF, mycophenolate mofetil, PASI, Psoriasis Area and Severity Index, PPD, purified protein derivative, PUVA, psoralen plus ultraviolet A, SCC, squamous cell carcinoma, TB, tuberculosis, UV, ultraviolet a Baylor University Medical Center, Dallas, Texas b Murdough Family Center For Psoriasis, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio c Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama d Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina e Department of Dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania f Division of Dermatology, Evanston Northwestern Healthcare and Department of Dermatology, Northwestern University, Fienberg School of Medicine, Chicago, Illinois g Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts h Department of Dermatology, University of California–San Francisco, San Francisco, California i Department of Dermatology, Mount Sinai School of Medicine, New York, New York j Department of Dermatology, Henry Ford Hospital, Detroit, Michigan k Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania l Anacor Pharmaceuticals Inc, Palo Alto, CA, Department of Dermatology, University of California, San Francisco, California m American Academy of Dermatology, Schaumburg, Illinois  Reprint requests: Reva Bhushan, PhD, 930 E Woodfield Rd, Schaumburg, IL 60173.
The authors' conflict of interest/disclosure statements appear at the end of the article. PII: S0190-9622(09)00390-9 doi:10.1016/j.jaad.2009.03.027 © 2009 American Academy of Dermatology, Inc. Published by Elsevier Inc All rights reserved. | |
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