How I Treat: Psoriasis Case Presentation

An adult female patient presented to my dermatology practice with plaque psoriasis presenting on the hands and feet. Due to the sensitive, localized area, the patient started with topical clobetasol cream twice daily. Cotton gloves following topical clobetasol application and wet wraps at bedtime were recommended.

At the follow-up 1 month later, the patient reported doing better, but she still had not achieved the agreed treatment goals. They were then prescribed halobetasol propionate and tazarotene (HP/T) lotion due to its retinoid properties. For another two months of treatment, the patient experienced some improvement, but the choice was made to switch to combination therapy using apremilast with HP/T lotion application in the morning and clabetsol cream application at night. With this, the patient cleared up to the point where she was happy with her results.

About 1 year later, the patient presented again to the dermatology office with more widespread psoriasis. Instead of localized disease, she had bilateral plaques on the lower extremities as well as lesions on the trunk that were difficult to reach with topical therapy.

Based on the patient’s history, what would you do next? Take the poll above and then read about what Dr Connor had to say on his approach to psoriasis cases!