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Updated: Jun 27, 2025
The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Management of Psoriasis Patients with Serious Infectious Diseases
Matteo Megna1, Giuseppe Lauletta1, Nello Tommasino1
1Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy.
Abstract:
The management of patients affected by moderate-to-severe psoriasis may be challenging, in particular in patients with serious infectious diseases [tuberculosis (TB), hepatitis B and C, HIV, COVID-19]. Indeed, these infections should be ruled out before starting and during systemic treatment for psoriasis. Currently, four conventional systemic drugs (methotrexate, dimethyl fumarate, acitretin, cyclosporine), four classes of biologics (anti-tumour necrosis factor alpha, anti-interleukin (IL)12/23, anti-IL-17s, and anti-IL-23], and two oral small molecules (apremilast, deucravacitinib) have been licensed for the treatment of moderate-to-severe psoriasis. Each of these drugs is characterized by a unique safety profile which should be considered before starting therapy. Indeed, some comorbidities or risk factors may limit their use. In this context, the aim of this manuscript was to evaluate the management of patients affected by moderate-to-severe psoriasis with serious infectious diseases.
Insights
Managing moderate-to-severe psoriasis in patients with serious infections like tuberculosis (TB) or HIV requires careful consideration of systemic treatments. Ruling out infections before and during therapy is crucial due to unique drug safety profiles.
Area of Science:
- Dermatology
- Infectious Diseases
- Pharmacology
Background:
- Psoriasis management is complicated by serious infectious diseases, including tuberculosis (TB), hepatitis B and C, HIV, and COVID-19.
- Systemic treatments for moderate-to-severe psoriasis necessitate thorough infection screening before initiation and ongoing monitoring.
- Available treatments include conventional systemic drugs, biologics (anti-TNF-alpha, anti-IL-12/23, anti-IL-17, anti-IL-23), and oral small molecules (apremilast, deucravacitinib).
Purpose of the Study:
- To evaluate the management strategies for patients with moderate-to-severe psoriasis who also have serious infectious diseases.
- To highlight the importance of safety profiles of various psoriasis treatments in the context of comorbidities.
Main Methods:
- Review of current literature and guidelines on psoriasis treatment.
- Analysis of safety profiles of systemic drugs, biologics, and oral small molecules.
- Consideration of comorbidities and risk factors influencing treatment choices.
Main Results:
- Each psoriasis therapeutic agent possesses a distinct safety profile that must be evaluated.
- Certain comorbidities or risk factors may restrict the use of specific psoriasis medications.
- Pre-treatment and ongoing screening for serious infections are essential for patient safety.
Conclusions:
- Effective management of moderate-to-severe psoriasis in patients with serious infections requires a personalized approach.
- Careful consideration of drug safety profiles and infection status is paramount for successful therapeutic outcomes.
- Further research may be needed to optimize treatment algorithms for this complex patient population.
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