Lancet. 2007;370( 9583):272-84.
Management of psoriasis begins with identification of the extent of cutaneous disease.
However, a holistic, contractual approach to treatment is encouraged, with particular
reference to psychosocial disability and quality-of-life issues. The presence of psoriasis
on palms, soles, body folds, genitals, face, or nails, and concomitant joint disease,
are also important when considering treatment options. An evidence-based approach
is essential in delineating differences between the many available treatments. However,
archaic approaches, especially combinational ones, are routinely used by some clinicians,
with inadequate prospective or comparative evidence. Treatments currently available
are: topical agents used predominantly for mild disease and for recalcitrant lesions
in more severe disease; phototherapy for moderate disease; and systemic agents including
photochemotherapy, oral agents, and newer injectable biological agents, which have
revolutionised the management of severe psoriasis. Other innovative treatments are
undergoing clinical studies, with the aim of maintaining safe, long-term control of