TREATMENT OF PATIENTS HOSPITALIZED FOR PSORIASIS

In general, patients with psoriasis present with a mild-to-moderate degree of disease involvement. These patients usually are not hospitalized for their skin condition, and most respond well to the various forms of outpatient therapy. A small percentage of patients, however, can progress to one of the more severe forms of psoriasis—some of which may even be life-threatening—and require hospitalization and a more intensive assortment of treatments. Box 1 lists criteria for hospitalization of patients with psoriasis. 16 Box 1Criteria for Hospitalization of Patients With Psoriasis Data from Bohm ML, Voorhees JJ: White paper on hospitalization for psoriasis care. J Am Acad Dermatol 10:842–851, 1984. Extensive involvement >25% body surface area, uncontrolled by previous outpatient therapy of ≤4 weeks or a less extensive involvement but affecting certain body sites: Hands and feet, genitalia, flexures, and one or more of the following: Limited mobility from joint disease (e.g., arthritis) Concomitant illness requiring hospitalization (e.g., intractable diabetes, congestive heart failure, arthritis) Complications of antipsoriatic therapy Socially, physically, or emotionally disabling disease Severe involvement of >50% skin surface area with or without complications listed above Acute flare of psoriasis: Generalized pustular psoriasis Erythrodermic or exfoliative flare Acute eruptive psoriasis with doubling of body surface in 1 month Severe forms of psoriasis may have devastating consequences on every aspect of patients' lives. Life quality of patients can be greatly improved after appropriate inpatient therapy. 40 In an effort to better understand how to treat these disorders and improve quality of life for these patients, this article explores several aspects of inpatient treatment available for patients with psoriasis. Special attention is given to Goeckerman regimen, combination therapies, and some innovative approaches that may shorten the hospital stay and prolong remission periods of the disease.