Integrating Systemic Agents in Clinic-Based Practice

The document discussed the integration of systemic agents in managing psoriasis, focusing on cyclosporine, methotrexate (MTX), and acitretin. Cyclosporine, effective for various psoriasis types, achieved PASI 75 in 50%-70% of patients but had side effects like hypertension and renal impairment. Methotrexate, effective for psoriasis and PsA, showed PASI 75 in 24%-42% of patients, with side effects including hepatotoxicity and lung fibrosis. Acitretin, with a PASI 75 response rate of 25%, was useful for erythrodermic and pustular psoriasis, especially when combined with phototherapy, but had side effects like dryness, dyslipidemia, and teratogenicity. Each drug had specific dosing strategies and contraindications, particularly concerning pregnancy and chronic infections.