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Treatment selection for moderate to severe plaque psoriasis in special populations

April W Armstrong, MD, MPH
Section Editor
Kristina Callis Duffin, MD
Deputy Editor
Abena O Ofori, MD


Topical therapy is the primary mode of treatment for plaque psoriasis in patients with limited skin involvement. Patients with moderate to severe plaque psoriasis (considered here as psoriasis involving more than 5 to 10 percent of the body surface area) usually require an alternative approach to therapy. (See "Treatment of psoriasis in adults", section on 'Choice of therapy'.)

The major treatment options for patients with moderate to severe psoriasis include phototherapy and a variety of systemic medications. Because the risks associated with treatment may be altered by the presence of additional medical disorders, treatment selection must involve consideration of the patient's underlying diseases.

The approach to the treatment of plaque psoriasis in patients with hepatitis B, hepatitis C, human immunodeficiency virus (HIV) infection, latent tuberculosis, and internal malignancy will be reviewed here. A general review of psoriasis therapy is provided separately. (See "Treatment of psoriasis in adults".)


The major categories of treatments used for moderate to severe plaque psoriasis include:

Ultraviolet light phototherapy (psoralen plus ultraviolet A [PUVA] and narrowband or broadband ultraviolet B [UVB]) (see "Treatment of psoriasis in adults", section on 'Ultraviolet light' and "Psoralen plus ultraviolet A (PUVA) photochemotherapy" and "UVB therapy (broadband and narrowband)")

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Literature review current through: Oct 2017. | This topic last updated: Jul 28, 2017.
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