How I Treat: Localized to Progressive Psoriasis Case Presentation

An adult female patient presented to my dermatology practice with plaque psoriasis presenting on the hands and feet. Because of the sensitive, localized area, the patient was started on topical clobetasol cream twice daily, and cotton gloves following topical clobetasol application and wet wraps at bedtime were recommended.

At follow-up 1 month later, the patient reported doing better, but she still had not achieved the agreed treatment goals. The patient was then prescribed halobetasol propionate and tazarotene (HP/T) lotion, which was selected for its retinoid properties. For another two months of treatment, the patient experienced some improvement, but the choice was made to step up therapy to apremilast with HP/T lotion application in the morning and clabetsol cream application at night. With this combination approach, the patient cleared up to the point where she was happy with her results.

After 1 year, the patient presented again to the dermatology office with more widespread psoriasis. Instead of localized disease, she had bilateral plaques on the lower extremities as well as lesions on the trunk that were difficult to reach with topical therapy.

Based on the patient’s history, what would you do next? Take the poll below and then watch what Dr Connor had to say about his approach to psoriasis cases!