How should we do in the selection and follow-up of systemic conventional treatments in psoriasis?

There is an increasing need for appropriate effective treatment and long-term disease control in patientswith psoriasis because of the decreased quality of life, increased physicosocial deficits and associated comorbidities.Systemic conventional treatments that are the first step in the management of moderate-tosevereplaque psoriasis include methotrexate (MTX), acitretin, cyclosporine and fumarates. MTX isconsidered the gold standard in the treatment of moderate-to-severe chronic plaque type psoriasis. It isalso used to treat pustular psoriasis, erythrodermic psoriasis and psoriatic arthritis. Acitretin monotherapyis less effective than other conventional systemic treatments for plaque psoriasis, while superior togeneralized, palmoplantar pustular, and hyperkeratotic variants. Cyclosporine is preferred in the presenceof unstable acute clinical conditions (erythrodermic or generalized pustular psoriasis) and also in inductionphase of rotational and sequential therapy for severe resistant psoriasis, due to its rapid effect. Dimethylfumarate, which has similar efficacy to MTX, is an appropriate option in the induction and long-termsystemic treatment for adult patients with moderate to severe plaque psoriasis without psoriatic arthritis.Although they are often overshadowed by biologics at the stage of preference by most physicians andpatients today, they are classical and inexpensive agents with known long-term results. When theappropriate patient profile and psoriasis type are selected at the right time and necessary laboratory andclinical follow-ups are made, each of them is an effective treatment with reliable and satisfactory results. Inthis article, important points (recommendations according to patient characteristics, psoriasis type andcomorbidities) to be considered in clinical practice when using the conventional anti-psoriatic agents in thetreatment of psoriasis are overviewed.