Psoriasis Treatment in Elderly – NPF Guidelines

By: Vivacare - Dr. Mark Becker

An algorithm for the treatment of psoriasis in the elderly was developed in 2001 by the Medical Board of the National Psoriasis Foundation. The study “Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation” was published in the September issue of the Journal of the American Academy of Dermatology.

The study outlines several therapeutic options for elderly patients with psoriasis.

Appropriate treatment for elderly patients with limited psoriasis include the following:

Treatment options for elderly patients who have psoriasis with extensive disease includes:

  • phototherapy (PUVA, UVB)
  • acitretin (Sotret)
  • methotrexate (MTX)
  • biologics, including  etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and ustekinumab (Stelara) are first-line therapies that can generally be safely used.

Importantly, the National Psoriasis Foundation Medical Board recommends prescribing the topical agent calcipotriol/betamethasone diproprionate as first-line therapy for treating limited plaque psoriasis in the elderly, based on level IA evidence of efficacy and tolerability.

The study authors consisted of several psoriasis experts, including Ivan S. Grozdev, MD, PhD, Abby S. Van Voorhees, MD, Alice B. Gottlieb, MD, PhD, Sylvia Hsu, MD, Mark G. Lebwohl, MD, Neil J. Korman, MD, PhD, and Bruce F. Bebo Jr., PhD of the National Psoriasis Foundation.

The study suggested that clinicians consider a treatment algorithm including topical medications as first-line treatment for limited disease, with phototherapy, systemic retinoids, methotrexate, and biologics as the first-line systemic treatments for patients with more extensive disease. Cyclosporine should only rarely be used as a second-line systemic treatment for extensive disease in elderly patients with psoriasis.