Treatment algorithms for special cases

Treatment of psoriasis differs in special cases such as in women who wish to become pregnant, during pregnancy and lactation, in pediatric and geriatric populations, in the presence of obesity or chronic viral diseases, and during the COVID-19 pandemic. Due to their well-known teratogenic effect, neither topical nor systemic use of retinoids is recommended in any period of pregnancy and lactation. Literature data on treatment approaches in psoriasis in children is less than in adults, and safety data usually relate to short-term use. There is a multifactorial relationship between psoriasis and obesity; response to treatment is lower in obese patients with a body mass index greater than 30. It should be noted that the elderly have comorbidities and concomitant drug use, which increases the likelihood of side effects and drug interactions of psoriasis medications. In the presence of a viral disease, many agents used in the treatment of psoriasis carry the risk of exacerbating the infection due to their immunosuppressive properties. In such a case, the option that can be considered apart from topical therapies is narrowband phototherapy. It was observed during the COVID-19 pandemic that there had been no increase in the risk of infection-related mortality and morbidity solely due to biological therapy.

Keywords: Psoriasis, treatment, pregnancy, children, COVID-19

Özel durumlarda tedavi algoritmalar?

Psoriasis tedavisi gebe kalmak isteyen kad?nlarda, gebelikte, laktasyonda, pediatrik ve geriatrik popülasyonda, obesite ya da kronik viral hastal?k varl???nda ve COVID-19 pandemisi s?ras?nda özellik arz eder teratojenik etkisi iyi bilinen retinoidlerin gerek topikal gerekse sistemik kullan?m? gebeli?in hiçbir döneminde ve laktasyon döneminde önerilmez. Çocuk psoriasis olgular?nda tedavi yakla??mlar?na yönelik literatür verileri yeti?kinlere nazaran daha azd?r ve güvenlik verileri s?kl?kla k?sa dönem kullan?m?na aittir. Psoriasis ile obezite aras?nda multifaktöriyel bir ili?ki vard?r ve vücut kitle indeksi 30’un üzerinde olan obez hastalarda tedaviye yan?t daha dü?üktür. Ya?l?lar?n ayn? anda birden çok hastal??? ve ilaç kullan?m? oldu?u ve bunun da psoriasis ilaçlar?n?n yan etkilerinin ve ilaç etkile?imlerinin görülme olas?l???n? art?raca?? unutulmamal?d?r. Kronik viral hastal?k varl???nda psoriasis tedavisinde kullan?lan birçok ajan?n immün bask?lay?c? özelli?inden dolay? enfeksiyonu alevlendirme riski bulunur. Bu durumda topikal tedaviler d???nda en çok tercih edilebilecek tedavi dar bant fototerapisidir. COVID-19 pandemisi s?ras?nda psoriasis hastalar?n özellikle biyolojik tedaviden ötürü enfeksiyon ili?kili mortalite ve morbidite riskinde art?? olmad???n? gözlenmi?tir.

Anahtar Kelimeler: Psoriasis, tedavi, gebelik, çocuk, COVID-19