A JAAD review, the first of a two-part series, sets out how to select systemic therapy for psoriasis according to a patient's inflammatory comorbidities and any history of cancer.
The range of options now allows treatment to be matched to the whole patient rather than the skin alone. Some choices are well established: interleukin-17 inhibitors carry label warnings about new or worsening inflammatory bowel disease, and agents with evidence in psoriatic arthritis are preferred when joints are involved.
The practical step is to take a structured comorbidity history before the first systemic prescription, and to revisit it whenever a drug is changed. Today's UK cohort adds liver and lung disease to that list of questions.
- Ask about bowel symptoms and any inflammatory bowel disease before choosing an IL-17 inhibitor
- Screen for joint pain and morning stiffness to detect psoriatic arthritis
- Record any past cancer and discuss choice with oncology where relevant
- Check liver health and alcohol intake before methotrexate
- Revisit the comorbidity history whenever a systemic is switched
Why it matters
A drug that clears the skin can worsen a coexisting disease if the history is not taken first.
Don't overread it
This is a narrative review; individual drug choices still depend on local availability and guidelines.
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