Chronic plaque psoriasis

• There is firm RCT evidence of effectiveness of a range of treatments for chronic plaque psoriasis, specifically:

How effective are treatments for acrodermatitis continua of Hallopeau?

calcipotriol ciclosporin systemic retinoids (acitretin and etretinate), especially in combination with phototherapy phototherapy including broadband ultraviolet B (UVB), narrowband UVB and psoralen photochemotherapy (PUVA) combinations of topical vitamin D3 analogues and topical corticosteroids with either UVB or PUVA heliotherapy (natural sunlight) fumaric acid esters

• methotrexate, although effectiveness of this widely accepted drug has been examined specifically in chronic plaque psoriasis in only one RCT.

• There is evidence of lack of efficacy of UVA sunbed (with low UVB emission) and balneotherapy (spa water).

• There is a lack of firm RCT evidence of effectiveness of other therapies for chronic plaque psoriasis, including tacalcitol, azathioprine, hydroxyurea and sulfasalazine (although one small RCT has shown moderate efficacy from sulfasalazine).

• It is clear that there is a paucity of studies addressing long-term management of severe chronic plaque psoriasis. There is, however, good evidence of risk of serious harm from the major treatment modalities used for treating severe psoriasis, including skin cancer from PUVA and heliotherapy, hypertension and renal impairment from ciclosporin, myelosuppression and hepatic fibrosis from methotrexate, and teratogenicity from systemic retinoids.

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