The management of psoriasis-tazarotene: the bottom line.

In treating patients with psoriasis, my frustration has been in the topical therapy of patients with limited or mild psoriasis. When clinical improvement was obtained with topical therapy, it could not be maintained. Clinical experience has shown that, in the minority of patients with moderate to severe psoriasis, we can generally do a much better job not only improving, but also maintaining improvement over the course of a year by using therapeutic options such as psoralen/ultraviolet A, ultraviolet B, methotrexate, or etretinate. In a survey that we did several years ago, dermatologists registered with the American Academy of Dermatology reported that approximately 80% of their patients with psoriasis had limited disease requiring only topical therapy, while the remaining 20% had more extensive disease requiring photo or systemic therapies. Thus the challenge has been to improve our ability to better treat limited disease.