Department of Dermatology and Murdough Family Center for Psoriasis, University Hospitals Case Medical Center, Cleveland, Ohio.
Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Acad Dermatol. 2011 Sep;65(3):537-545. doi: 10.1016/j.jaad.2010.05.014. Epub 2011 Apr 15.
The continuous increase in the US population older than 65 years and the chronic course of psoriasis make management of psoriasis in the elderly an important health care problem.
We sought to develop a treatment algorithm for patients with psoriasis who are older than 65 years.
A systematic literature search for studies on elderly patients with psoriasis was performed using MEDLINE.
We summarize the available published data on therapeutic modalities used in the elderly. We suggest a treatment algorithm including topical medications as first-line treatment for limited disease, with phototherapy, systemic retinoids, methotrexate, and biologics as the first-line systemic treatments for patients with more extensive disease. Cyclosporine should only rarely be used as a second-line systemic treatment for extensive disease in elderly patients with psoriasis.
Limited data are available regarding treatment modalities specifically for elderly patients with psoriasis.
Appropriate treatment for elderly patients with limited psoriasis includes topical corticosteroids, topical vitamin D analogues, and topical tazarotene. For appropriately monitored elderly patients who have psoriasis with extensive disease, phototherapy, acitretin, methotrexate, alefacept, etanercept, adalimumab, infliximab, and ustekinumab are first-line therapies that can generally be safely used. There remains a need for further research on the management of psoriasis in elderly patients with psoriasis.
美国 65 岁以上人口不断增加，且银屑病病程慢性，这使得老年人银屑病的管理成为一个重要的医疗保健问题。
我们旨在为 65 岁以上的银屑病患者制定治疗方案。
使用 MEDLINE 对老年银屑病患者的研究进行了系统的文献检索。
我们总结了现有关于老年人中使用的治疗方法的已发表数据。我们建议了一种治疗方案，包括局部药物治疗作为局限性疾病的一线治疗，光疗、全身类视黄醇、甲氨蝶呤和生物制剂作为广泛疾病患者的一线全身治疗。环孢素仅应很少作为老年广泛型银屑病患者的二线全身治疗。
关于专门针对老年银屑病患者的治疗方法的数据有限。
对于局限性银屑病老年患者，适当的治疗包括局部皮质类固醇、局部维生素 D 类似物和局部他扎罗汀。对于经过适当监测的患有广泛疾病的老年银屑病患者，光疗、阿维 A、甲氨蝶呤、阿昔单抗、依那西普、阿达木单抗、英夫利昔单抗和乌司奴单抗是一线治疗方法，通常可以安全使用。对于老年银屑病患者的银屑病管理，仍需要进一步的研究。
