Skip to main content

Advertisement

Log in

Managing Mild-to-Moderate Psoriasis in Elderly Patients: Role of Topical Treatments

  • Therapy in Practice
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The approach to managing mild-to-moderate psoriasis in the elderly (ages >65 years) should be no different to that in the younger population. Topical agents are frequently prescribed for elderly patients as first-line therapy because of their localized impact and minimal systemic effects. Although topical therapy remains the mainstay treatment of mild-to-moderate psoriasis, the elderly population may be at a higher risk of steroid-induced adverse events, including atrophy, purpura, telangiectasia, secondary skin infections, rebound phenomenon, and tachyphylaxis. In addition, offering photo- and systemic therapy to elderly patients with mild-to-moderate psoriasis may pose challenges due to the presence of comorbidities, patient adherence, and reduced physical functioning. Nonetheless, topical therapy remains first-line therapy for elderly and younger patients with mild-to-moderate psoriasis as standalone therapy or in combination with oral and biologic agents. Effective use of topical treatments should be prioritized to ensure elderly patients can be effectively managed prior to advancing to photo- or systemic treatment modalities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Finlay AY, Coles EC. The effect of severe psoriasis on the quality of life of 369 patients. Br J Dermatol. 1995;132(2):236–44.

    Article  CAS  PubMed  Google Scholar 

  2. Fortune DG, Main CJ, O’Sullivan TM, Griffiths CE. Quality of life in patients with psoriasis: the contribution of clinical variables and psoriasis-specific stress. Br J Dermatol. 1997;137(5):755–60.

    Article  CAS  PubMed  Google Scholar 

  3. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr., Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Acad Dermatol. 1999;41(3 Pt 1):401–7.

    Article  CAS  Google Scholar 

  4. Sampogna F, Tabolli S, Mastroeni S, Pietro C, Fortes C, Abeni D. Multipurpose Psoriasis Research on Vital Experiences (IMPROVE) study group. Quality of life impairment and psychological distress in elderly patients with psoriasis. Dermatology. 2007;215:341–7.

    Article  CAS  PubMed  Google Scholar 

  5. Bell LM, Sedlack R, Beard CM, Perry HO, Michet CJ, Kurland LT. Incidence of psoriasis in Rochester, Minn, 1980–1983. Arch Dermatol. 1991;127(8):1184–7.

    Article  CAS  PubMed  Google Scholar 

  6. Liao YH, Chen KH, Tsenq MP, Sun CC. Pattern of skin diseases in a geriatric patient group in Taiwan: a 7-year survey from the outpatient clinic of a university medical center. Dermatology. 2001;203:308–13.

    Article  CAS  PubMed  Google Scholar 

  7. Kassi K, Djeha D, Gbery IP, Kouame K, Sangare A. Psoriasis in elderly patients in the Cote d’Ivoire: socio-demographic, clinical, and therapeutic aspects, and follow-up. Int J Dermatol. 2016;55(2):e83–6.

    Article  PubMed  Google Scholar 

  8. Smith ES, Fleischer AB Jr, Feldman SR. Demographics of aging and skin disease. Clin Geriatr Med. 2001;17(4):631–41, v.

  9. Projected resident population of the United States as of July 1 2025, middle series. In: Division P, editor. Washington, D.C.: Population Projections Program; 2002. Retrieved from: https://www.census.gov/prod/1/pop/p25-1130.pdf. Accessed 30 June 2017.

  10. Eurostat. Regional population ageing of the EU at different speeds up to 2025, Statistics in focus. Statistics in focus In: Eurostat. 1999:1–8. Retrieved from: http://ec.europa.eu/eurostat/documents/3433488/5278217/CA-DN-99-004-EN.PDF/0f91fe65-e0ce-4948-8c2f-7d8ad48c9f64. Accessed 30 June 2017.

  11. Kwon HH, Kwon IH, Youn JI. Clinical study of psoriasis occurring over the age of 60 years: is elderly-onset psoriasis a distinct subtype? Int J Dermatol. 2012;51:53–8.

    Article  PubMed  Google Scholar 

  12. Gottlieb AB, Dann F. Comorbidities in patients with psoriasis. Am J Med. 2009;122(12):1150 e1–9.

  13. Menter A, Gottlieb A, Korman NJ, Gordon KB, Feldman SR, Lebwohl M, Koo JY, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58(5):851–64.

    Article  PubMed  Google Scholar 

  14. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl 2):ii14–7.

  15. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, et al. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005;53(4):573.

    Article  PubMed  Google Scholar 

  16. Kimball AB, Gladman D, Gelfand JM, Gordon K, Horn EJ, Korman NJ, et al. National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol. 2008;58(6):1031–42.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY, et al. Psoriasis and the metabolic syndrome. Acta Derm Venereol. 2007;87(6):506–9.

    Article  PubMed  Google Scholar 

  18. Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol. 2007;157(1):68–73.

    Article  CAS  PubMed  Google Scholar 

  19. Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factor in patients with psoriasis. J Acad Dermatol. 2006;55(5):829–35.

    Article  Google Scholar 

  20. Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296(14):1735–41.

    Article  CAS  PubMed  Google Scholar 

  21. Phan C, Sigal ML, Estève E, Reguiai Z, Barthélémy H, Beneton N, et al. Psoriasis in the elderly: epidemiological and clinical aspects and evaluation of patients with very late onset psoriasis. J Eur Acad Dermatol Venereol. 2016;30(1):78–82. doi:10.1111/jdv.12850.

    Article  CAS  PubMed  Google Scholar 

  22. Herédi E, Csordás A, Clemens M, Adám B, Gáspár K, Törőcsik D, et al. The prevalence of obesity is increased in patients with late compared with early onset psoriasis. Ann Epidemiol. 2013;23:688–92.

    Article  PubMed  Google Scholar 

  23. van der Voort EA, Koehler EM, Dowlatshahi EA, Hofman A, Stricker BH, Janssen HL, et al. Psoriasis is independently associated with nonalcoholic fatty liver disease in patients 55 years old or older: results from a population-based study. J Acad Dermatol. 2014;70:517–24.

    Article  Google Scholar 

  24. Bonifati C, Carducci M, Mussi A, D’Auria L, Ameglio F. Recognition and treatment of psoriasis. Special considerations in elderly patients. Drugs Aging. 1998;12(3):177–90.

    Article  CAS  PubMed  Google Scholar 

  25. Grozdev IS, Van Voorhees AS, Gottlieb AB, Hsu S, Lebwohl MG, Bebo BF Jr, et al. Psoriasis in the elderly: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2011;65(3):537–45.

    Article  PubMed  Google Scholar 

  26. Parslew R, Traulsen J. Efficacy and local safety of a calcipotriol/betamethasone dipropionate ointment in elderly patients with psoriasis vulgaris. Eur J Dermatol. 2005;15(1):37–9.

  27. Coskey RJ. Adverse effects of corticosteroids: I. Topical and intralesional. Clin Dermatol. 1986;4(1):155–60.

  28. Lambert J, Hol CW, Vink J. Real-life effectiveness of once-daily calcipotriol and betamethasone dipropionate gel vs. ointment formulations in psoriasis vulgaris: 4- and 12-week interim results from the PRO-long study. J Eur Acad Dermatol Venereol. 2014;28(12):1723–31.

    Article  CAS  PubMed  Google Scholar 

  29. Koo J, Tyring S, Werschler WP, Bruce S, Olesen M, Villumsen J, et al. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris—a randomized phase II study. J Dermatolog Treat. 2016;27(2):120–7.

    Article  CAS  PubMed  Google Scholar 

  30. Balato N, Patruno C, Napolitano M, Patri A, Ayala F, Scarpa R. Managing moderate-to-severe psoriasis in the elderly. Drugs Aging. 2014;31(4):233–8.

    Article  PubMed  Google Scholar 

  31. Momose M, Asahina A, Hayashi M, Yanaba K, Umezawa Y, Nakagawa H. Biologic treatments for elderly patients with psoriasis. J Dermatol. 2017. doi:10.1111/1346-8138.13853.

    Google Scholar 

  32. Piaserico S, Conti A, Lo Console F, De Simone C, Prestinari F, Mazzotta A, et al. Efficacy and safety of systemic treatments for psoriasis in elderly patients. Acta Derm Venereol. 2014;94(3):293–7.

    Article  PubMed  Google Scholar 

  33. Kragballe K. Topical corticosteroids: mechanisms of action. Acta Derm Venereol Suppl (Stockh). 1989;151:7–10 (discussion 47–52).

  34. Nagpal S, Lu J, Boehm MF. Vitamin D analogs: mechanism of action and therapeutic applications. Curr Med Chem. 2001;8(13):1661–79.

    Article  CAS  PubMed  Google Scholar 

  35. Hamawy MM. Molecular actions of calcineurin inhibitors. Drug News Perspect. 2003;16(5):277–82.

    Article  CAS  PubMed  Google Scholar 

  36. Guenther LC. Topical tazarotene therapy for psoriasis, acne vulgaris, and photoaging. Skin Ther Lett. 2002;7(3):1–4.

    CAS  Google Scholar 

  37. Smith CH, Jackson K, Chinn S, Angus K, Barker JN. A double blind, randomized, controlled clinical trial to assess the efficacy of a new coal tar preparation (Exorex) in the treatment of chronic, plaque type psoriasis. Clin Exp Dermatol. 2000;25(8):580–3.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul S. Yamauchi.

Ethics declarations

Funding

No funding was used in the preparation of this review article.

Conflict of interest

Joseph Kamel and Paul Yamauchi declare they have no conflicts of interest relevant to the contents of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamel, J.G., Yamauchi, P.S. Managing Mild-to-Moderate Psoriasis in Elderly Patients: Role of Topical Treatments. Drugs Aging 34, 583–588 (2017). https://doi.org/10.1007/s40266-017-0480-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-017-0480-8

Navigation