Therapeutic psoriasis cure strategies

Key points:

• Rotational treatments aim to prevent toxic doses accumulating in the patient's body and to overcome the problem of a cure becoming less effective over time.
• A sequential cure involve higher doses of medications being prescribed for a short time and then gradually replaced or combined with other drugs.
• In both strategies, there is a risk that the patient will cling to a drug, despite its toxicity.
• Combined therapies bring together several drugs in order to optimise their effectiveness.

Monotherapy refers to psoriasis treatment with a single agent. Advantages of this approach include convenience and simplicity. The primary disadvantage is the occurrence of unwanted side effects that occurs with prolonged use of many agents.

To overcome the limitations of monotherapy, many dermatologists use combination therapy in which 2 or more agents with different mechanisms of action are used together. This approach has been proven to maximize the clinical benefits and tolerability of each agent while simultaneously limiting their side effects. The most commonly used combination regimen pairs as a superpotent corticosteroid with a vitamin D analogue (Calcipotriol).

Rotational therapy involves utilizing a single agent for a specific period of time and then switching to another agent(s). This involves stopping an effective, but potentially toxic therapy and initiating treatment with less dangerous, but possibly less effective, treatment.

Rotational therapy is more commonly used in the treatment of more severe disease where the use of potentially toxic systemic agents such as methotrexate, cyclosporine or oral retinoids is required.

The objective is to avoid a cumulative dose that would be toxic for the patient (a number of drugs have side effects). It can also be used to overcome the problem of a treatment becoming less effective over time, as is frequently the case for a monotherapy.

For example, for severe cases cyclosporine may be prescribed at first, followed by a retinoid six months later and subsequently another drug. Similarly, when a patient has a flare of psoriasis or has side effects resulting from one drug, the doctor can prescribe a different monotherapy.

Topical medications can also be used in rotation. This therapeutic strategy is used mainly in moderate to severe psoriasis, and can be followed with or without scheduled interruptions in treatment.

The doctor may prescribe a rotational treatment from the beginning or as a result of the patient's clinical response. 

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