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American Academy of Dermatology Issues New Guidelines For the Management of Psoriasis With Systemic Medications
Date:6/4/2009

nked to the genetic transmission of the disease.

Although a prerequisite to starting a systemic therapy traditionally has been whether a patient is affected by psoriasis over a minimum body surface area of about 10 percent, a subset of patients with limited psoriasis have debilitating symptoms on their palms, soles or scalp that can significantly impact their quality of life - making systemic treatments an appropriate option for them.

Methotrexate

As the most commonly prescribed traditional systemic therapy for psoriasis, methotrexate can be very effective with even the most severe cases of psoriasis. Methotrexate works by competitively inhibiting the enzyme dihydrofolate reductase, which decreases the production of folic acid thus blocking DNA synthesis and cell division.

Efficacy & Dosage

In the only placebo-controlled trial of methotrexate for psoriasis, 36 percent of patients treated with a low weekly dosage of 7.5 mg of methotrexate - which was increased as needed up to 25 mg per week - achieved a 75 percent or greater improvement in their Psoriasis Area and Severity Index (PASI) score after 16 weeks. In general, methotrexate is administered as a single weekly oral dose that can be increased gradually until an optimal response is achieved. Although there are no established maximum or minimum dosages of methotrexate, weekly dosages usually range from 7.5 mg to 25 mg.

"Some patients can be gradually tapered off treatment and restarted when the psoriasis recurs, and it is important for physicians to minimize the total cumulative dose of methotrexate while maintaining adequate control of psoriasis and the patient's tolerance of the medication," said Dr. Pariser.

Toxicities & Contraindications

Because of the known organ toxicities of traditional systemic medications, proper patient selection and appropriate monitoring are cruc
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SOURCE American Academy of Dermatology
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