By Gerald Weinstein, Alice Gottlieb
This instruction manual positive factors up to date chapters discussing the most recent and most typically prescribed remedies for sufferers with moderate-to-severe psoriasis. issues comprise the administration of paediatric sufferers and sufferers with psoriatic arthritis.
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Extra resources for Therapy of Moderate-to-Severe-Psoriasis, Second Edition,
Topical agents can be messy and may look or feel unacceptable to the patient. Using quality-of-life parameters, response to treatment has been used to deﬁne severity; by this deﬁnition severe psoriasis does not have a satisfactory response to treatments that have minimal risks (1). Thus moderate-tosevere psoriasis may, by deﬁnition, be moderate to severe because it does not respond to topical agents. Despite their limitations, topical therapies have a useful role in the treatment of moderate-to-severe psoriasis.
A recent review article by Lebwohl notes unpublished data showing that tazarotene has similar potential to reduce corticosteroid-related atrophy (62). Tazarotene also appears to be stable in vitro when combined with a variety of topical corticosteroids and calcipotriene, and does not appear to aﬀect adversely the stability of the other compounds (38). 05% ointment applied twice daily (63). C. Administration Patients using tazarotene as monotherapy should apply the medication once daily, taking care to avoid surrounding unaﬀected skin.
When used once daily, onset of atrophy is delayed, but does occur, as early as 2–3 months. The scalp is more resistant to atrophy but it does occur; frequently telangiectasia precedes atrophy. Application on one or two consecutive days out of each week, known as pulse therapy, provides adequate maintenance in some patients However, maintenance therapy in combination with calcipotriene or tazarotene is more eﬃcacious (see sections on these agents below). 3. Prescribe the Appropriate Quantity for the Frequency of Application and the Area to be Treated Limiting quantities and reﬁlls, requiring frequent follow up and close observation, educating the patient, and combining corticosteroids with other non-steroid therapy will help maximize eﬀectiveness of therapy and minimize side eﬀects.