Increasing use of more potent treatments for psoriasis

Background: Psoriasis therapy has evolved during the past 25 years as newer and more effective medications become available. Furthermore, various combination regimens and approaches have been advocated. Objective: We sought to describe patterns of psoriasis treatment from 1986 to 2005. Methods: Visits to dermatologists for treatment of psoriasis were identified using National Ambulatory Medical Care Survey data, a representative survey of visits to physician offices in the United States. We focused on medications listed at these visits during the 1986-to-2005 interval to determine how treatment for psoriasis has changed. Results: There were an estimated 23.9 million visits for psoriasis during the 20-year study period. As a category, the most common medications used for psoriasis were topical steroids. Dermatologists are prescribing more potent topical steroids compared with nondermatologists. The use of these potent drugs has increased from 1986 to 2005. There has been growing use of systemic treatments, with biologic therapies introduced in the 2001-to-2005 time period. Limitations: National Ambulatory Medical Care Survey data represent national trends in psoriasis treatment and cannot be used to evaluate smaller subpopulations of patients with psoriasis. These data are used to speculate why certain trends in treatment are seen. Conclusion: The primary treatment for psoriasis in the late 1980s and early 1990s was mid-potency corticosteroids. Since then, the primary therapies for psoriasis have evolved to include class I ultrapotent topical corticosteroids, vitamin-D analogs, and systemic medications such as methotrexate and biologic agents. These changes in psoriasis management are consistent with patient desire for better disease control. (J Am Acad Dermatol 2009;60:478-81.)