Systemic Therapy |
Dapsone | SPD | Anti-inflammatory; molecular mechanism and mode of action unknown. | 50-200 mg QD | Methemoglobinemia, hemolytic anemia, agranulocytosis, hypersensitivity syndrome, renal toxicity, hepatic toxicity, peripheral motor neuropathy | Pretreatment: check for glucose-6-phosphate dehydrogenase deficiency; CBC, methemoglobine, renal and liver function (initially weekly, then monthly) | IV1-3 |
Glucocorticoids | SPD, not for long-term treatment | Anti-inflammatory, immunosuppressive; modulation of gene expression through binding to intracellular glucocorticoid receptors. | As required, typically 0.5-1.0 mg/kg/d | HPA suppression, infections, arterial hypertension, hyperglycemia, gastrointestinal toxicity, osteoporosis | None | IV4 |
Acitretin | SPD, not in women of childbearing potential | Anti-inflammatory; modulation of gene expression through binding to intracellular retinoid receptors | 0.5 mg/kg/d | Teratogenic, cheilitis, conjunctivitis, skin dryness, hyperlipidemia, pancreatitis | Renal, liver, lipid levels, and pregnancy test (pretreatment, then monthly) | IV5,6 |
Doxycycline | SPD, not in pregnancy and in children <9 years | Anti-inflammatory; molecular mechanisms and mode of action unknown | 100 mg QD | Rare, GI upset, headache, esophagitis, photosensitivity | None | IV7 |
Infliximab | SPD | Anti-inflammatory, immunosuppressive; chimeric monoclonal antibody, binding and inactivation of tumor necrosis factor-α (TNF-α) | 5 mg/kg wk 0/2/6, thereafter q8wk | Rare, infusion reaction, infections, cutaneous reactions, demyelinating disease, heart failure | Pretreatment: Check for latent tuberculosis, viral hepatitis-B/-C, and HIV (no further laboratory monitoring) | IV8,9 |
Etanercept | SPD | Anti-inflammatory, immunosuppressive; TNF-α receptor/IgG1-constant region fusion protein, binding and inactivation of TNF-α | 50 mg once to twice weekly | Very rare, injection site reactions, infections, cutaneous reactions, demyelinating disease, heart failure | Pretreatment: Check for latent tuberculosis, viral hepatitis-B/-C, and HIV (no further laboratory monitoring) | IV10-12 |
Adalimumab | SPD | Anti-inflammatory, immunosuppressive; human monoclonal antibody, binding and inactivation of TNF-α | Initially 80 mg, thereafter 40 mg q2wk | Rare, injection site reactions, infections, cutaneous reactions, demyelinating disease, heart failure | Pretreatment: Check for latent tuberculosis, viral hepatitis-B/-C, and HIV (no further laboratory monitoring) | IV13 |
Guselkumab | SPD | Anti-inflammatory, immunosuppressive; human monoclonal antibody, binding and inactivation of interleukin (IL)-23 | Initially 100 mg q4wk; thereafter q8wk | Rare, injection site reactions, infections, cutaneous reactions | Pretreatment: check for latent tuberculosis, viral hepatitis-B/-C, and HIV (no further laboratory monitoring) | IV14 |
Phototherapy |
Psoralen plus ultraviolet A (PUVA) | SPD | Anti-inflammatory; photoactivation and DNA-strand intercalation of methoxsalen, mode of action unknown | Individual approach usually 2–3 times a week with intake of methoxsalen 0.4-0.6 mg/kg 2 h before UVA exposure | Nausea, phototoxicity, skin cancer | ...