Mild Psoriasis — Topical-First Management
Placeholder: mild BSA cases begin with topical corticosteroids and vitamin D analogs.
- <3%: Typical BSA range (Placeholder mild threshold)
- Topical steroid: First-line agent (Placeholder text)
- BSA rise: Escalation trigger (Placeholder text)
- 8–12 wk: Review interval (Placeholder text)
Topical step overview
Placeholder: topical agents are tried first for limited, mild plaque psoriasis.
Placeholder callout: most mild cases never require systemic therapy.
Methotrexate as the Conventional Systemic Step
Placeholder: moderate-to-severe disease moves to conventional oral systemic therapy.
- 7.5–25 mg/wk: Typical dose (Placeholder dosing)
- 12–16 wk: Response window (Placeholder timeframe)
- ~40%: PASI75 rate (Placeholder benchmark)
- CBC/LFTs: Monitoring (Placeholder labs)
Conventional systemic overview
Placeholder: methotrexate remains the standard first systemic agent tried.
Placeholder callout: response is assessed before considering escalation.
Inadequate Response Triggers Step-Up Review
Placeholder: insufficient improvement after an adequate trial prompts reassessment.
- <PASI50: Failure definition (Placeholder criterion)
- ≥12 wk: Trial duration (Placeholder minimum)
- ~35%: Step-up rate (Placeholder estimate)
- MDT review: Decision point (Placeholder process)
Step-up decision overview
Placeholder: inadequate response is the formal gate to biologic eligibility.
Placeholder callout: documented failure is required before escalation.
Biologic Therapy Escalation
Placeholder: biologic agents are introduced after conventional therapy failure.
- TNFi/IL-17/IL-23: Common classes (Placeholder classes)
- ~70%: PASI90 rate (Placeholder benchmark)
- 4–12 wk: Onset of effect (Placeholder timeframe)
- High: Cost tier (Placeholder note)
Biologic step overview
Placeholder: biologics target specific inflammatory pathways with higher efficacy.
Placeholder callout: biologics are reserved for step-up failures.
Treat-to-Target — Ongoing Reassessment
Placeholder: therapy is continuously matched to measured disease activity.
- PASI90/BSA<1%: Target (Placeholder target)
- Every 3–6 mo: Review cadence (Placeholder interval)
- Possible: De-escalation (Placeholder note)
- Continuous: Loop type (Placeholder note)
Ongoing reassessment overview
Placeholder: the treat-to-target loop repeats indefinitely to sustain control.
Placeholder callout: treatment adjusts up or down as targets are met.