Care of Generalized Psoriasis in Elderly Patients beyond Topical Therapy: A Review and a Proposed Algorithm

Abstract

Treatment of psoriasis in the elderly population can present many challenges to the physician. Herein we propose a treatment algorithm for psoriasis in this age group. When choosing a therapy for generalized psoriasis in elderly patients, ultraviolet treatments should be attempted first because of their efficacy and safety. Of the external treatment approaches, Goeckerman, although one of the safest and most effective therapies, should be a later treatment option, reserved for the most severe, recalcitrant cases. Acitretin is the next best approach because of its nonclinically immunosuppressive nature. If combination therapy of acitretin with phototherapy proves inadequate, etanercept, adalimumab, alefacept, ustekinumab, and infliximab should then be considered, in successive order. The penultimate treatment options to consider should be the oral agents, cyclosporine and methotrexate, because of their greater risk of major organ toxicity. The last option involves combination therapy with systemic immunosuppressant agents.