Psoriasis treatments for patients of all ages often include topicals, phototherapy, oral agents like methotrexate and cyclosporine, new oral inhibitors, and biologic injectables. However, older patients, especially those with moderate-to-severe psoriasis, face higher risks of side effects from systemic treatments, such as methotrexate, due to factors like reduced renal function and common comorbidities. Adjusting doses based on true kidney function, which may be overestimated in older adults with low creatinine levels, is critical.

When choosing treatments, comorbid conditions should guide decisions. For example, cyclosporine may not be suitable for patients with hypertension, while anti-TNF agents may help those with a history of heart attacks. Older patients with extensive psoriasis may require systemic agents or phototherapy, and insurance coverage plays a key role in accessing biologics, especially for those on Medicare. While phototherapy use has decreased, it remains effective. The challenges of treating psoriasis in aging patients highlight the need for continued research to ensure the safety and efficacy of new medications for this population.

Reference: Lebwohl M. Psoriasis in Older Patients: Key Considerations and Best Practices for Effective Management. International Psoriasis Council. Accessed September 12, 2024. https://psoriasiscouncil.org/expert-insights/psoriasis-in-older-patients-effective-management/