GUIDELINES IN DERMATOLOGY

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PSORIASIS

Burhan Engin1
Sezer Özdil2

1İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Dermatology, İstanbul, Türkiye
2İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Dermatology, İstanbul, Türkiye

Engin B, Özdil S. Psoriasis. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.179-189.

ABSTRACT

Psoriasis is a chronic inflammatory condition characterized by scaly, erythematous plaques and associated comorbidities. Disease severity is evaluated using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI). Moderate-to-severe psoriasis is defined by PASI >10, BSA >10%, or DLQI >10, while mild disease corresponds to scores ≤ 10 in these metrics. Treatment criteria for systemic therapies include BSA > 10%, PASI >10, or DLQI >10, involvement of sensitive areas, or lack of response to topical therapies. Treatment goals include PASI 75 or better, with more ambitious goals like PASI 90 or PASI 100 being increasingly achievable with newer treatments. Topical therapies are commonly used for mild to moderate psoriasis and include emollients, corticosteroids, vitamin D analogs, calcineurin inhibitors, and tazarotene. Corticosteroids remain a cornerstone therapy, with potency adjusted based on the area and severity of plaques. Phototherapy, such as narrowband UVB and PUVA, is recommended for patients unresponsive to topical treatments. These modalities are effective but require careful monitoring for contraindications and side effects. Traditional systemic therapies, including methotrexate, cyclosporine, and acitretin, are used for moderate-to-severe cases. Methotrexate is a first-line option, while cyclosporine is effective for rapid control but limited by long-term nephrotoxicity. Acitretin is suitable for severe forms like pustular or erythrodermic psoriasis but is contraindicated in women of childbearing age due to teratogenicity. Oral small molecules, such as apremilast, offer an alternative for plaque psoriasis and psoriatic arthritis. Biologic therapies, including TNF-alpha inhibitors (adalimumab, infliximab, etanercept), IL-17 inhibitors (secukinumab, ixekizumab), and IL-23 inhibitors (ustekinumab, guselkumab), provide targeted treatment for severe psoriasis. These agents are highly effective but require pre-treatment screening and ongoing monitoring for infections and other risks. Emerging therapies like deucravacitinib, a tyrosine kinase 2 inhibitor, represent promising options for moderate-to-severe plaque psoriasis. Treatment selection is individualized based on disease severity, comorbidities, and patient preference, with regular monitoring to ensure safety and efficacy.

Keywords: Psoriasis; Disease severity; Topical treatment; Systemic traditional treatment; Systemic biologic treatment

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