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Updated: Jul 5, 2025

The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Psoriasis: Recognition and Management Strategies
Kathryn K Garner1, Kattie D S Hoy1, Adriana M Carpenter1
1Mike O'Callaghan Military Medical Center Family Medicine Residency Program, Nellis Air Force Base, Nevada; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Insights
Psoriasis is a chronic inflammatory skin and systemic disorder affecting 3.2% of the U.S. population. Management involves lifestyle changes and treatments tailored to disease severity, from topical therapies to systemic agents and phototherapy.
Area of Science:
- Dermatology
- Immunology
- Systemic Inflammatory Diseases
Background:
- Psoriasis is an immune-mediated skin and systemic disorder affecting 3.2% of the U.S. population.
- It is linked to various comorbidities, including cardiovascular disease, obesity, and diabetes.
- Psoriasis manifests in several forms, with plaque psoriasis being the most common.
Purpose of the Study:
- To provide a comprehensive overview of psoriasis, encompassing its epidemiology, pathophysiology, clinical presentation, and management.
- To highlight the importance of a multidisciplinary approach in managing psoriasis and its associated conditions.
Main Methods:
- Clinical diagnosis based on characteristic skin plaques and patient history.
- Assessment of disease severity using tools like the Psoriasis Area and Severity Index (PASI).
- Treatment strategies categorized by disease severity (mild-to-moderate vs. moderate-to-severe) and form.
Main Results:
- Psoriasis affects 3.2% of the U.S. population, with plaque psoriasis being the most prevalent form.
- Treatment options range from topical corticosteroids and vitamin D analogues for mild cases to systemic agents and phototherapy for severe cases.
- Lifestyle modifications such as weight management, smoking cessation, and stress reduction are crucial for disease management.
Conclusions:
- Psoriasis requires a comprehensive management strategy, including medical treatment and lifestyle adjustments.
- Special populations, including children and pregnant or breastfeeding individuals, require tailored treatment considerations.
- Effective management improves patient outcomes and quality of life, emphasizing the need for ongoing monitoring and personalized care.
Abstract:
Psoriasis is an inflammatory skin and systemic disorder that affects 3.2% of the U.S. population, including 1% of children. It is an immune-mediated process triggered by an interplay of genetic, environmental, physical (e.g., skin trauma), and infectious factors. Associated comorbidities include cardiovascular disease, obesity, metabolic syndrome, diabetes mellitus, and inflammatory bowel disease. Psoriasis presents in various forms, including plaque, guttate, erythrodermic, pustular, inverse, nail, and psoriatic arthritis. The most common form is plaque psoriasis, which affects 90% of adults with psoriasis. Psoriasis is diagnosed clinically based on the presence of characteristic erythematous, scaly skin plaques in typical locations, with associated history and systemic symptoms. Treatment strategies are similar for most forms of psoriasis and based on body surface area involved. Topical corticosteroids, vitamin D analogues, and tazarotene are used to treat mild to moderate disease. Systemic treatment with nonbiologic and biologic agents and ultraviolet B phototherapy are used for moderate to severe disease, with the exception of apremilast, a systemic agent approved for mild psoriasis. Disease management is improved with maintaining ideal body weight, avoiding tobacco products, limiting alcohol, and practicing stress reduction techniques. The Psoriasis Area and Severity Index is a tool to assess severity and monitor treatment effectiveness over time. Special consideration is needed for treatment of children and patients who are pregnant, breastfeeding, or trying to conceive.
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