Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation

Abstract

Background: The continuous increase in the US population older than 65 years and the chronic course of psoriasis make management of psoriasis in the elderly an important health care problem.

Objective: We sought to develop a treatment algorithm for patients with psoriasis who are older than 65 years.

Methods: A systematic literature search for studies on elderly patients with psoriasis was performed using MEDLINE.

Results: We summarize the available published data on therapeutic modalities used in the elderly. We suggest 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.

Limitations: Limited data are available regarding treatment modalities specifically for elderly patients with psoriasis.

Conclusion: Appropriate treatment for elderly patients with limited psoriasis includes topical corticosteroids, topical vitamin D analogues, and topical tazarotene. For appropriately monitored elderly patients who have psoriasis with extensive disease, phototherapy, acitretin, methotrexate, alefacept, etanercept, adalimumab, infliximab, and ustekinumab are first-line therapies that can generally be safely used. There remains a need for further research on the management of psoriasis in elderly patients with psoriasis.