Moderate to severe psoriasis: from topical to biological treatment

Introduction  The simple use of topical corticosteroids in the treatment of severe psoriasis is often inefficient and harmful. The first line of treatment in these cases is based on systemic therapies such as methotrexate, cyclosporin and phototherapy. Later on, biological treatments can be used.
Observations  We present three cases of severe psoriasis that have been treated by topical corticosteroids for a long time and with large doses without success and many side-effects. For each one of them, we have introduced either a systemic or a biological treatment with a good efficacy and tolerance.
Discussion  Psoriasis has a strong impact on the quality of life and is comparable to patients with major diseases like cancer or depression. Patients who have severe psoriasis are for the most part disappointed and dissatisfied from their treatment. In fact, the misuse of topical corticosteroids for prolonged periods of time may induce local or systemic side-effects without any improvement. Although patients are more pleased with systemic treatments, their use is often limited because physicians are anxious from the systemic side-effects that may occur.
Conclusion  Systemic treatments are often used too late. Patients are not pleased from the way they are treated. Accordingly, using these treatments earlier may improve patients' quality of life.