Psoriasis: Update on Therapy for the Various Manifestations

A middle-aged man with"jock itch" that has failed torespond to antifungal creams.An older woman who has diffusehyperkeratosis of predominantlyweight-bearing surfaces.A young man with mildlypruritic, small, salmon pinkpapules and thick white scaleon his trunk and arms.What do these patients havein common-and what treatmentstrategies would you pursue?These patients all have psoriasis,which affects 2.6% ofAmericans.1 Manifestationsrange from localized, pruritic,scaly, erythematous papulesand plaques to widespread erythrodermicor pustular disease to psoriaticarthritis. Many patients respond wellto the various therapies in the broadarmamentarium; however, some havebeen disappointed by ineffective, inadequate,inconvenient, and potentiallytoxic treatments that fail to relievetheir symptoms.Here we present 9 cases thatillustrate various types of psoriasis.After each case, we review the availabletreatment options and offer ourrecommendations.