Skip to main content

Psoriasis Therapy in the Geriatric Population

  • Chapter
Advances in Geriatric Dermatology

Abstract

The geriatric population of the USA is rapidly growing, and estimates indicate that it will comprise one-fourth of the total population by year 2025. These patients make up a significant percentage of those treated for psoriasis; however there is little literature focused on specific cutaneous concerns within the population. Physiologic changes associated with aging, concurrent comorbidities, and polypharmacy can all complicate a clinician’s treatment approach and lead to inadequate management or undertreatment. This chapter hopes to serve as a clinical aid in safely addressing a geriatric patient’s cutaneous needs.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bureau UC. Projected resident population of the United States as of July 1, 2025, middle series. Washington, DC: Population Division; 2002.

    Google Scholar 

  2. 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 

  3. Wong JW, Koo JY. The safety of systemic treatments that can be used for geriatric psoriasis patients: a review. Dermatol Res Pract. 2012;2012:367475.

    PubMed Central  PubMed  Google Scholar 

  4. Mehta NN, Yu Y, Pinnelas R, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med. 2011;124(8):775.e1–6.

    Article  Google Scholar 

  5. Armstrong EJ, Harskamp CT, Armstrong AW. Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies. J Am Heart Assoc. 2013;2(2), e000062.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hugh J, Van Voorhees AS, Nijhawan RI, et al. From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies. J Am Acad Dermatol. 2014;70(1):168–77.

    Article  PubMed  Google Scholar 

  7. van der Voort EA, Koehler EM, Dowlatshahi EA, 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 Am Acad Dermatol. 2014;70(3):517–24.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. du Vivier A, Stoughton RB. Tachyphylaxis to the action of topically applied corticosteroids. Arch Dermatol. 1975;111(5):581–3.

    Article  PubMed  Google Scholar 

  10. Singh G, Singh PK. Tachyphylaxis to topical steroid measured by histamine-induced wheal suppression. Int J Dermatol. 1986;25(5):324–6.

    Article  CAS  PubMed  Google Scholar 

  11. Grozdev IS, Van Voorhees AS, Gottlieb AB, 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 

  12. 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.

    CAS  PubMed  Google Scholar 

  13. Gould JW, Mercurio MG, Elmets CA. Cutaneous photosensitivity diseases induced by exogenous agents. J Am Acad Dermatol. 1995;33(4):551–73. quiz 574-556.

    Article  CAS  PubMed  Google Scholar 

  14. Bressler R, Bahl JJ. Principles of drug therapy for the elderly patient. Mayo Clin Proc. 2003;78(12):1564–77.

    Article  CAS  PubMed  Google Scholar 

  15. Turnheim K. Drug dosage in the elderly. Is it rational? Drugs Aging. 1998;13(5):357–79.

    Article  CAS  PubMed  Google Scholar 

  16. Flammiger A, Maibach H. Drug dosage in the elderly: dermatological drugs. Drugs Aging. 2006;23(3):203–15.

    Article  CAS  PubMed  Google Scholar 

  17. Boffa MJ. Methotrexate for psoriasis: current European practice. A postal survey. J Eur Acad Dermatol Venereol. 2005;19(2):196–202.

    Article  CAS  PubMed  Google Scholar 

  18. Evans WE, Christensen ML. Drug interactions with methotrexate. J Rheumatol Suppl. 1985;12 Suppl 12:15–20.

    CAS  PubMed  Google Scholar 

  19. Bhutani T, Koo J. A review of the chemopreventative effects of oral retinoids for internal neoplasms. J Drugs Dermatol. 2011;10(11):1292–8.

    CAS  PubMed  Google Scholar 

  20. Falck P, Asberg A, Byberg KT, et al. Reduced elimination of cyclosporine A in elderly (>65 years) kidney transplant recipients. Transplantation. 2008;86(10):1379–83.

    Article  CAS  PubMed  Google Scholar 

  21. Heydendael VM, Spuls PI, Ten Berge IJ, Opmeer BC, Bos JD, de Rie MA. Cyclosporin trough levels: is monitoring necessary during short-term treatment in psoriasis? A systematic review and clinical data on trough levels. Br J Dermatol. 2002;147(1):122–9.

    Article  CAS  PubMed  Google Scholar 

  22. Infliximab. (package Insert). Toronto, Canada 2010.

    Google Scholar 

  23. Ustekinumab. (package insert). Horsham, PA 2011.

    Google Scholar 

  24. Etanercept. (package insert). Thousand Oaks, CA 1998–2011.

    Google Scholar 

  25. Reich K, Langley RG, Lebwohl M, et al. Cardiovascular safety of ustekinumab in patients with moderate to severe psoriasis: results of integrated analyses of data from phase II and III clinical studies. Br J Dermatol. 2011;164(4):862–72.

    Article  CAS  PubMed  Google Scholar 

  26. Adalimumab. (package insert). North Chicago, Ill 2002.

    Google Scholar 

  27. Gottlieb AB, Boehncke WH, Darif M. Safety and efficacy of alefacept in elderly patients and other special populations. J Drugs Dermatol. 2005;4(6):718–24.

    PubMed  Google Scholar 

  28. Militello G, Xia A, Stevens SR, Van Voorhees AS. Etanercept for the treatment of psoriasis in the elderly. J Am Acad Dermatol. 2006;55(3):517–9.

    Article  PubMed  Google Scholar 

  29. Menter A, Gordon KB, Leonardi CL, Gu Y, Goldblum OM. Efficacy and safety of adalimumab across subgroups of patients with moderate to severe psoriasis. J Am Acad Dermatol. 2010;63(3):448–56.

    Article  CAS  PubMed  Google Scholar 

  30. Fleischmann R, Baumgartner SW, Weisman MH, Liu T, White B, Peloso P. Long term safety of etanercept in elderly subjects with rheumatic diseases. Ann Rheum Dis. 2006;65(3):379–84.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Galloway JB, Hyrich KL, Mercer LK, et al. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford). 2011;50(1):124–31.

    Article  CAS  Google Scholar 

  32. Piaserico S, Conti A, Lo Console F, 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 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel C. Butler M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Butler, D.C., Koo, J.Y.M. (2015). Psoriasis Therapy in the Geriatric Population. In: Chang, A. (eds) Advances in Geriatric Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-18380-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18380-0_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18379-4

  • Online ISBN: 978-3-319-18380-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics