Traditional Systemic Therapy II: Retinoids and Others

Some patients with psoriasis either do not respond to or develop significant toxicities from the well-recognized first-line systemic therapeutic agents. However, there are a number of second-line systemic agents which may be effective. For example, acitretin is particularly effective in erythrodermic psoriasis and palmoplantar pustulosis, as well being the consensus treatment of choice for generalized pustular psoriasis. Since acitretin does not induce immunocompromise, it is useful in the management of severe psoriasis associated with HIV infection. Concomitant UVB or PUVA may be synergistic with acitretin. Although not FDA-approved to treat psoriasis, hydroxyurea has shown some efficacy in treating chronic plaque psoriasis and, in short bursts, may be useful to stop the earliest flare of pustular psoriasis.