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Abstract
Background Psoriasis is a chronic, systemic, inflammatory condition for which a variety of treatment modalities exist. Combinations of therapies are used often in clinical practice to enhance efficacy and reduce drug toxicities.
Purpose The purpose of this review is to assess the literature on the efficacy and safety of combination therapy in the treatment of psoriasis.
Methods MEDLINE was reviewed to identify Englishlanguage publications from 1966 to 2011 examining combination therapy in psoriasis. Fifty-three articles met inclusion criteria and were included in this review. Randomized controlled trials addressing various combinations of treatment modalities for psoriasis were included. Data from these clinical studies were summarized and the outcomes were discussed.
Results Large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis are limited. The strongest data support the use of combinations of vitamin D derivatives and corticosteroids as topical combinations and, to a lesser extent, the combination of other topical agents. Phototherapy and topical vitamin Dderivatives aswell as phototherapy in combinationwith oral retinoids are well supported in the literature. Combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety.
Limitations Our data were limited by the small number of clinical trials examining the multiple available combinations that are used in clinical practice.
Conclusions The use of combination treatments falls within the standard of care for psoriasis, even if these combinations have not been extensively studied in clinical trials.
1 Introduction
Psoriasis is a chronic, inflammatory disease characterized by skin lesions and systemic co-morbidities that affects approximately 6-7.5 million patients in the USA. Plaque psoriasis, or psoriasis vulgaris, is the most common form [1]. Numerous therapeutic options exist for treating plaque psoriatic skin lesions. If disease is considered mild, topical agents will suffice in many cases [1]. Moderate-to-severe psoriasis may require systemic or UV light therapies. Failure of disease to remit with monotherapy is common. Topical, systemic, and phototherapy agents may be used in combination to induce faster and more efficacious results with less toxicity [2, 3].
Use of combination therapy in the treatment of psoriasis is common in clinical practice. Although clinical trials continue to be predominantly limited to the investigation of monotherapies, there are a growing number of randomized controlled trials looking...