Psoriasis: Which therapy for which patient, updated, part II. Focus on special populations and chronic infections

Choosing systemic therapy for psoriasis remains challenging in populations underrepresented in clinical trials, including pregnant and pediatric patients, patients with chronic infections, and those with difficult-to-treat phenotypes. Since the 2019 version of this article, therapeutic options have expanded substantially, including new pediatric approvals, oral targeted agents, and biologics with increasingly phenotype-specific evidence. This second article in the continuing medical education series reviews systemic treatment selection for moderate-to-severe psoriasis in pregnancy, pediatric patients, hepatitis, HIV, latent tuberculosis, nail psoriasis, erythrodermic psoriasis, generalized pustular psoriasis, and palmoplantar psoriasis. Emphasis is placed on balancing efficacy, safety, monitoring burden, infection/reactivation risk, reproductive considerations, and disease phenotype. Traditional agents remain useful in selected scenarios, while IL-17, IL-23, IL-36, TNF-α, TYK2, JAK, and other targeted therapies offer expanding options. Available evidence is summarized with expert-opinion recommendations where comparative data are limited.