Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation - 13/08/11
National Psoriasis Foundation
Reprint requests: Neil J. Korman, MD, PhD, Department of Dermatology, Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106.Abstract |
Background |
The continuous increase in the US population older than 65 years and the chronic course of psoriasis make management of psoriasis in the elderly an important health care problem.
Objective |
We sought to develop a treatment algorithm for patients with psoriasis who are older than 65 years.
Methods |
A systematic literature search for studies on elderly patients with psoriasis was performed using MEDLINE.
Results |
We summarize the available published data on therapeutic modalities used in the elderly. We suggest a treatment algorithm including topical medications as first-line treatment for limited disease, with phototherapy, systemic retinoids, methotrexate, and biologics as the first-line systemic treatments for patients with more extensive disease. Cyclosporine should only rarely be used as a second-line systemic treatment for extensive disease in elderly patients with psoriasis.
Limitations |
Limited data are available regarding treatment modalities specifically for elderly patients with psoriasis.
Conclusion |
Appropriate treatment for elderly patients with limited psoriasis includes topical corticosteroids, topical vitamin D analogues, and topical tazarotene. For appropriately monitored elderly patients who have psoriasis with extensive disease, phototherapy, acitretin, methotrexate, alefacept, etanercept, adalimumab, infliximab, and ustekinumab are first-line therapies that can generally be safely used. There remains a need for further research on the management of psoriasis in elderly patients with psoriasis.
Le texte complet de cet article est disponible en PDF.Key words : algorithm, elderly, evidence, geriatric, management, psoriasis, therapy
Abbreviations used : NPF, PASI, PASI 75, PsA, PUVA, RA, UV
Plan
| Funding sources: Ivan S. Grozdev, MD, PhD, was supported by the Murdough Family Center for Psoriasis Research Fellowship. |
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| Disclosure: Dr Van Voorhees has been a consultant, investigator, or speaker for Abbott, Amgen, Astellas, Centocor, Genentech, Incyte, Connetics, Warner Chilcott, Photomedix, Roche, and Synta. She has a significant conflict of interest with Merck. Almost all of Dr Gottlieb's consulting and speaking fees are paid to Tufts Medical Center. She has current consulting/advisory board agreements with Amgen, Centocor, Wyeth Pharmaceuticals, Celgene, Bristol Myers Squibb, Beiersdorf, Abbott, TEVA, Actelion, UCB, Novo Nordisk, Almirall, Immune Control, Dermipsor, Can-Fite, Incyte, Magen Biosciences, Alnylam, Ono, Cytokine Pharmaciences, and Puretech. Tufts Medical Center has received research/educational grants from Centocor, Amgen, Wyeth Pharmaceuticals, Immune Control, Celgene, Pfizer, Incyte, and Abbott. Dr Hsu has been a consultant for Abbott, Amgen, Biogen Idec, Centocor, and Genentech. She has been a clinical investigator for Amgen and Centocor. Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, UCB Pharma, Stiefel, Triax, Pharmaderm, Medicis, Novartis, and Warner Chilcott. He has been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Bebo is employed by the National Psoriasis Foundation. The foundation receives unrestricted financial support from Abbott, Centocor, Amgen, Wyeth, Genentech, Astellas, Stiefel, Galderma, Warner Chilcott, and Photomedix. Dr Korman has been a consultant, investigator, or speaker for Abbott, Amgen, Astellas, Celgene, Centocor, Genentech, Novartis, Pfizer, and Warner Chilcott. He has also received fellowship support from Centocor. Dr Grozdev has no conflicts of interest to declare. |
Vol 65 - N° 3
P. 537-545 - septembre 2011 Retour au numéro
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