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

Menter, Alan; Korman, Neil J.; Elmets, Craig A.; Feldman, Steven R.; Gelfand, Joel M.; Gordon, Kenneth B.; Gottlieb, Alice B.; Koo, John Y.M.; Lebwohl, Mark; Lim, Henry W.; Van Voorhees, Abby S.; Beutner, Karl R.; Bhushan, Reva

doi:10.1016/j.jaad.2009.03.027

« Previous Next »Journal of the American Academy of Dermatology
Volume 61, Issue 3 , Pages 451-485, September 2009

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

Alan Menter, MD (Chair)
- Baylor University Medical Center, Dallas, Texas
Neil J. Korman, MD, PhD
- Murdough Family Center For Psoriasis, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio
Craig A. Elmets, MD
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
Steven R. Feldman, MD, PhD
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Joel M. Gelfand, MD, MSCE
- Department of Dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Kenneth B. Gordon, MD
- Division of Dermatology, Evanston Northwestern Healthcare and Department of Dermatology, Northwestern University, Fienberg School of Medicine, Chicago, Illinois
Alice B. Gottlieb, MD, PhD
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
John Y.M. Koo, MD
- Department of Dermatology, University of California–San Francisco, San Francisco, California
Mark Lebwohl, MD
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York
Henry W. Lim, MD
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
Abby S. Van Voorhees, MD
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
Karl R. Beutner, MD, PhD
- Anacor Pharmaceuticals Inc, Palo Alto, CA, Department of Dermatology, University of California, San Francisco, California
Reva Bhushan, PhD
- American Academy of Dermatology, Schaumburg, Illinois
- Reprint requests: Reva Bhushan, PhD, 930 E Woodfield Rd, Schaumburg, IL 60173.

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