psoriasis - Maintenance Therapy Statement

Maintenance Therapy Statement

The following article is reprinted from the March 1998 Issue of NpF pharmacy News.
First posted: April 18, 1998
Maintenance therapy statement available to help members get reimbursement

In early 1997, the NpF organized a meeting of dermatologists experienced in psoriasis treatment and managed care. The meeting's goal was to determine the best way to improve psoriasis treatment in the managed health care environment. The physicians drafted and approved a statement affirming the importance of maintenance therapy for psoriasis. This statement accompanies the NpF's insurance brochure "An overview of psoriasis treatments" when appropriate.

NpF concerned

While there are many potential benefits of a managed health care system, the NpF is concerned that the current state of treatment for psoriasis is not as consistent or as high in quality as it should be. Historically, NpF has reacted to the needs of people with psoriasis or their physicians, helping them get reimbursement or treatment access, and responding to managed care provider or insurance companies request for information. We decided a proactive approach in helping to shape the way managed care treats psoriasis patients was necessary.

psoriasis is not a particularly high priority for any health organization, as these organizations are currently trying to address more common and expensive illnesses such as cancer, heart disease and diabetes. Yet NpF is convinced that both health care organizations and people with psoriasis will benefit tremendously from improvements in the way the disorder is treated.

physicians participate

Six physicians, along with NpF staff, participated in the meeting: Gerald Krueger, MD; Alan Menter, MD; Mark Lebwohl, MD; Richard Baughman, MD; Jacob Dijkstra, MD; and committee chair John Koo, MD. NpF would like to thank these physicians for their participation and contributions. We would also like to thank Allergan Skin Care, which helped sponsor both the meeting and the production of the statement.

NpF members are welcome to request the Maintenance Therapy statement and/or the Insurance statement in printed form when needed in working with health insurance companies or health maintenance providers, or simply refer them to this URL.

Maintenance therapy statement

The Importance of Maintenance Therapy for psoriasis

psoriasis is a chronic, immunologically-based inflammatory disease of the skin and joints that affects more than 6 million Americans. The thick, red, scaly patches on any or all parts of the body and painful joints can limit daily activities and interfere with physical, occupational and psychological functions. The occupational impact of this disease poses a significant economic burden for the nation and a financial hardship for the person with psoriasis.

Genetic and incurable

psoriasis is a genetic, currently incurable disease subject to unpredictable flares and remissions. Vigorous initial therapy is required to bring the disease under control. Like diabetes, arthritis, and heart disease, psoriasis requires lifelong treatment. For the majority of patients, who cannot sustain a treatment-free remission, continuing maintenance therapy is required.

Effective flare suppression

patient access to maintenance therapy should not be withheld. Just as diabetic patients require ongoing medication, dietary adjustments and regular physician evaluations, psoriasis patients require maintenance treatment. No one would claim that insulin is "useless" for diabetes just because it is necessary on an ongoing basis. Likewise, psoriasis patients are likely to have flares if they are denied access to effective maintenance therapy, whether it is topical or systemic medication, phototherapy, or a combination thereof.

Maintenance therapy minimizes risk

Lack of access to appropriate and effective maintenance therapy can lead not only to an increased likelihood of a flare of psoriasis, but it may be more costly to manage psoriasis patients in such a "crisis-oriented" manner. Most importantly to the patient, not utilizing strategies to minimize the risk of psoriasis flares will lead to needless pain and suffering and decreased quality of life.

The aim of maintenance therapy is to minimize the risk of recurrence. However, because psoriasis is subject to unpredictable flares, maintenance therapy does not guarantee that a flare will not happen.

Maintenance agents for psoriasis

The following treatments are considered to be appropriate maintenance agents (in alphabetical order):

Topical Therapies

  • Anthralin
  • Calcipotriene
  • Coal Tar
  • Tazarotene
  • Topical corticosteroids


  • pUVA phototherapy (topical and systemic)
  • UVB phototherapy

Systemic Agents

  • Cyclosporine
  • Etretinate/Acitretin
  • Methotrexate

Other agents used for maintenance therapy include:
Azathioprine, calcitriol, hydroxyurea, mycophenolate mofetil, sulfasalazine, 6-thioguanine

Combination Therapies

These therapies are often used in combination to maximize benefit and minimize side effects.

Rotational Therapies

Even if a particular treatment is working well for maintenance, the treatment may be changed periodically to avoid accumulating side effects to the same organ system on a chronic basis.

psoriasis of the hands impairs a person's ability to perform daily and work-related tasks.

Facial psoriasis can be emotionally and psychologically devastating if not vigorously treated and controlled.

Uncontrolled psoriasis in children can interfere with learning and play, and cause severe depression, anxiety and embarrassment.

Maintenance therapy helps prevent disabling, life-threatening flares of generalized erythrodermic psoriasis.

psoriatic arthritis, if not adequately maintained, can cause significant joint destruction and pain

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