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The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
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GRAPPA Point-Counterpoint: Should Biologics Be Used for Mild Psoriasis?

Gretchen D Ball1, Hassan Hamade2, Alice B Gottlieb2

  • 1G.D. Ball, BS, H. Hamade, MD, A.B. Gottlieb, MD, PhD, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; gretchen.ball@einsteinmed.edu.

The Journal of Rheumatology
|August 1, 2024
PubMed
Summary

Topical therapies are standard for mild psoriasis (PsO), but biologics may be considered for limited PsO with psoriatic arthritis or special site involvement. Early biologic treatment might reduce psoriatic arthritis risk.

Keywords:
GRAPPAbiological therapypsoriasispsoriatic arthritis

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Area of Science:

  • Dermatology
  • Rheumatology

Background:

  • Psoriasis (PsO) is classified by severity (mild, moderate, severe) using measures like body surface area (BSA).
  • Topical therapies are generally recommended for mild PsO, but the role of biologics in specific mild cases is debated.

Purpose of the Study:

  • To explore the debate on using topical versus biologic therapies for mild or limited psoriasis.
  • To present arguments for and against biologic use in mild PsO cases, considering factors beyond BSA.

Main Methods:

  • Discussion and presentation of arguments at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting.
  • Review of new data and existing therapeutic options for psoriasis management.

Main Results:

  • Arguments for biologics in mild PsO include psoriatic arthritis (PsA) presence and special site involvement (scalp, face, genitals, nails, etc.).
  • New data suggest early treatment of limited PsO may decrease PsA development risk.
  • Arguments against biologics for mild PsO emphasize that limited BSA with PsA and quality of life impact should not be classified as mild, favoring safer, lower-cost topicals.

Conclusions:

  • The definition of mild PsO and appropriate treatment strategies, including biologics, remain areas of discussion.
  • Emerging therapies like roflumilast and tapinarof offer expanded topical choices, particularly for special sites.