Naslov
Clinical practices for improvement of psoriasis in elderly

Autori
Žužul, Kristina ; Bukvić Mokos, Zrinka ; Čeović, Romana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Liječnički vjesnik / - , 2020, 62-63

Skup
Better Future of Healthy Ageing 2020

Mjesto i datum
Online ; Zagreb, Hrvatska, 03.06.2020. - 05.06.2020

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
psoriasis, treatment, elderly

Sažetak
Psoriasis is a systemic inflammatory disease of multifactorial etiology, in which an increased release of proinflammatory cytokines and activation of the immune system cause damage to various tissues and organs. It is a chronic disease affecting 2–3% of the population, characterized by inflammation and scaling of the skin, but not limited to it. Mild psoriasis is generally treated with topical therapy, while phototherapy, oral systemic medications or biologic therapy are treatment options for moderate to severe disease. Taking into account the chronic course of this disease and the continuing rise in life expectancy, the prevalence of psoriasis among the elderly will further increase, which makes management of psoriasis in the elderly an important health care problem. Management of psoriasis in elderly patients may be challenging since they are often excluded from clinical trials, and the data regarding efficacy and safety in this population is lacking. Consequently, some dermatologists recommend only topical therapy and avoid prescribing systemic therapy, which may lead to inadequate treatment response in this population. Individualized treatment to each elderly patient should be provided due to possible drug-induced or aggravated psoriasis, higher prevalence of comorbidities, polypharmacy, adverse effects, self-care capability and quality of life. Topical therapy is probably the safest option for treating elderly patients with psoriasis, although topical corticosteroids should be used with caution due to the physiologic changes in older skin and a higher risk of cutaneous side effects. The physical limitations and dependence on caregivers should also be taken into account, as compliance may be reduced due to difficulty in applying topical agents. Due to a higher prevalence of hypertension and decreased renal and hepatic function in the elderly, special caution should be taken when prescribing conventional systemic therapy – methotrexate, cyclosporine, and acitretin. Biologic therapy is more often initiated in younger than in elderly patients, although it may be a safer option than conventional systemic therapy in the elderly due to its high efficacy, a lower rate of adverse events, and lower frequency of hospital visits. Still, regular follow-up is necessary because of the increased risk of infections and malignancies. Since psoriasis is becoming increasingly widespread in the elderly, it is surprising that studies regarding treatment efficacy and safety in the geriatric population are scarce. Further clinical research on treatment modalities in the elderly are needed, in order to improve management outcomes in this population.

Izvorni jezik
Engleski

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