How to treat psoriasis at age 65 and beyond

• Take (or apply) a lower dose of medication

• Change medications

• Use a different type of treatment

Here are the treatments that board-certified dermatologists recommend for their patients who are 65 or older.

Psoriasis medication you apply to your skin

With proper medical evaluation and guidance, the following topical (applied to the skin) medications may be a treatment option for someone who is 65 or older:

• Corticosteroid

• Vitamin D analogues

• Tazarotene

If you are 65 or older and applying a corticosteroid to your skin, watch for:

• Thinning skin (skin looks more transparent)

• Skin bruises or tears more easily

• Purple spots on your skin

• Infection (sore with pus)

• Blood vessels showing up on your skin

Should you see any of these where you apply your psoriasis medication, contact your dermatologist.

Is treatment that you apply to the skin right for you?

For this type of treatment to be effective, you must apply the medication as directed. To find out whether you can do this, ask yourself the following questions:

• Can I comfortably reach and apply the medication to every area of my body that I need to?

• Do I know how often (and where) I will need to apply each medication?

• Do I feel confident that I will apply the right amount every time?

• Will I spend the time required to apply the medication as prescribed?

Psoriasis treatment that uses light

If you have moderate or severe psoriasis, light therapy (also called phototherapy) may be a safe and effective option.

Two types of light therapy are recommended for people who are 65 or older:

• Narrowband UVB

• PUVA (take a medication called psoralen before getting UVA light treatment)

If this is a treatment option for you, you would:

• Go to a medical treatment center two to three times per week, usually for a few months

• Stand (in some cases) in a light box for a specified amount of time

Some people need to take a medication called psoralen (sore-ah-lin), which makes their skin more sensitive to light. You would take psoralen before each light-therapy session.

Is light therapy right for you?

Before you commit to getting this type of treatment, ask yourself these questions:

• Can I stand in the light box without getting tired or falling for the amount of time required to treat my psoriasis?

• Will I be able to get to the treatment center two to three times per week for as long as required?

• Am I taking any medication that makes my skin more sensitive to light, such as some meds used to treat high blood pressure or congestive heart failure? (If you’re unsure, ask your dermatologist.)

• Will I remember side effects that may appear on my skin after I leave the treatment center?

Psoriasis medication that works throughout the body

If you are 65 or older and need to take medication that works throughout your body to treat psoriasis, it is important to get guidance from a doctor who is experienced in treating psoriasis, such as a board-certified dermatologist. With age, our kidneys tend to remove less waste from our bodies. Medication can build up.

Under appropriate guidance, board-certified dermatologists believe that the following medications can be safe in someone who is 65 years of age or older:

• Acitretin

• Apremilast

• Methotrexate

• Some biologics, including etanercept, adalimumab, infliximab, and ustekinumab

Cyclosporine, which is approved to treat psoriasis, should be used with great caution in people 65 years of age and older. Dermatologists warn that it should be considered only when other psoriasis treatment fails to work.

If cyclosporine is prescribed, it is recommended that a kidney doctor (nephrologist) or primary care doctor who has experience monitoring kidneys be part of your medical team.

Is medication that works throughout the body right for you?

If you need strong medication to manage your psoriasis, ask yourself these questions:

• Will I remember to take the medication as prescribed?

• Can I afford the medication?

• Can I return to my dermatologist’s office for follow-up appointments, as needed?

Is it time to evaluate your psoriasis treatment?

If you are treating psoriasis and have celebrated your 65th birthday, dermatologists recommend that you get evaluated. A careful evaluation will make sure that you are using an appropriate treatment at a dose that’s right for you.

Having an evaluation also helps prevent possible side effects and interactions with other medications that you take.

If you need to find a board-certified dermatologist, you can search for one in your area at: Find a dermatologist

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References
Grozdev IS, Van Voorhees AS, et al. “Psoriasis in the elderly: From the Medical Board of the National Psoriasis Foundation.” J Am Acad Dermatol 2011;65:537-45. 

Hodak E, Gottlieb AB, et al. “Climatotherapy at the Dead Sea is a remittive therapy for psoriasis: Combined effects on epidermal and immunologic activation.” J Am Acad Dermatol 2003;49:451-7.

Kushelevsky AP, Harari M, et al. “Climatotherapy of psoriasis and hypertension in elderly patients at the Dead-Sea.” Pharmacol Res. 1996;34(1-2):87-91.

Papp K, Reich K, et al. “Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: Results of a phase III, randomized, controlled trial (Efficacy and Safety Trial Evaluating the Effects of Apremilast in Psoriasis [ESTEEM] 1).” J Am Acad Dermatol. 2015;73:37-49.

Rich, P, Gooderham M, et al. “Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with difficult-to-treat nail and scalp psoriasis: Results of 2 phase III randomized, controlled trials (ESTEEM 1 and ESTEEM 2).” J Am Acad Dermatol2016;74:134-42.