Psoriasis: Update on Therapy for the Various Manifestations

A middle-aged man with “jock itch” that has failed to respond to antifungal creams. An older woman who has diffuse hyperkeratosis of predominantly weight-bearing surfaces. A young man with mildly pruritic, small, salmon pink papules and thick white scale on his trunk and arms.What do these patients have in common-and what treatment strategies would you pursue? These patients all have psoriasis, which affects 2.6% of Americans.1 Manifestations range from localized, pruritic, scaly, erythematous papules and plaques to widespread erythrodermic or pustular disease to psoriatic arthritis. Many patients respond well to the various therapies in the broad armamentarium; however, some have been disappointed by ineffective, inadequate, inconvenient, and potentially toxic treatments that fail to relieve their symptoms. Here we present 9 cases that illustrate various types of psoriasis. After each case, we review the available treatment options and offer our recommendations.