New guidelines from the Medical Board of the National Psoriasis Foundation (NPF) recommend that elderly individuals with limited psoriasis should use topical treatments while those with more severe forms of the disease should receive phototherapy or biologics with appropriate monitoring.
In addition, the board recommends that the immunosuppressant cyclosporine be used with great caution in the elderly because of the baseline renal impairment in this population.
"Managing psoriasis in the elderly is challenging as there are limited data regarding safe and efficacious treatment options," said Neil Korman, M.D., member of the Psoriasis Foundation Medical Board and his colleagues.
To create their recommendations, the group studied existing literature on the treatment of psoriasis in elderly patients and constructed a treatment algorithm from their findings.
Among their recommendations:
- Regarding the use of systemic medication, the elderly may be more susceptible to adverse drug reactions and interactions.
- Although no studies investigated the effect of cyclosporine specifically, its known renal risks led the medical board to suggest great caution with use in the elderly. They also recommend that patients have their kidney function measured before starting cyclosporine.
- Biologics such as alefacept and etanercept were generally acceptable for use in elderly patients with psoriasis, but caution should be taken due to the higher incidence of infection in this population.
This paper, published online April 18 in the Journal of the American Academy of Dermatology, is one of a series of articles released by the NPF Medical Board on treatment recommendations to dermatologists on niche psoriasis, or psoriasis that occurs in special circumstances. Other treatment guidelines from the medical board include psoriasis and obesity and scalp psoriasis, among others. Once all papers have been published, the board will create a book of recommendations for specialty psoriasis.
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