Inpatient Management of Psoriasis: A Current Perspective and Update for Clinicians

The purpose of this narrative review article is to describe the current literature on the psoriasis inpatient population, discuss considerations for admission, and provide updated recommendations for inpatient psoriasis workup, management, and post-discharge follow-up. Studies report variable rates of psoriasis hospitalizations in the last decade even with the advent of highly efficacious outpatient therapies. Inequities in access to these therapies have resulted in disparities in the psoriasis inpatient population. Patients with severe variants of psoriasis, including generalized pustular and erythrodermic psoriasis, often have severe systemic complications and require immediate stabilization and supportive care. Traditional, rapid acting systemic therapies, including cyclosporine and infliximab, are efficacious, though the interleukin-17 inhibitors, secukinumab, ixekizumab, and brodalumab, may represent reasonable options. The interleukin-36 inhibitor, spesolimab, is a new and promising therapy under investigation for generalized pustular psoriasis. Psoriasis patients presenting with severe variants of disease, including pustular and erythrodermic psoriasis, in combination with systemic findings such as infection or compromised hemodynamic status, require hospitalization. Supportive measures to address systemic signs and complications are needed. Topical treatments with rapid acting systemic therapies should be employed to improve skin symptoms. Racial, ethnic, and insurance disparities exist in the hospitalized psoriasis patient population, highlighting the need for providers to obtain thorough sociodemographic histories and establish strong therapeutic alliances with these patients, identifying stable treatment options to prevent future exacerbations and hospitalizations.