Topical Treatments:

• Emollients
• Corticosteroids
• Vitamin D analogs
• Calcineurin Inhibitors
• Other Topical Agents

Systemic Treatments:

• Methotrexate
• Oral Retinoids
• Cyclosporine A

Biological Treatments:

• Enbrel (Etanercept)
• Humira (Adalimumab)
• Remicade (Infliximab)
• Stelara (Ustekinumab)

Phototherapy

• PUVA
• UVB
• Excimer Laser & Light

Oral Retinoids

Acitretin a retinoid is FDA approved for the adult psoriasis only. It is an off label but effective treatment option for cutaneous disease in erythrodermic, plaque and pustular psoriasis in adolescents.  

Combining it with topical agents and NB-UVB phototherapy can improve their efficacy.

Its side-effects include cheilitis, pruritus, hair-loss, elevated serum lipids, elevation of liver enzymes and skeletal toxicity. Hence, baseline and follow-up monitoring are essential. Long term use can be of concern about growth potential of children due to associated premature epiphyseal closure apart from other bone changes. Hence periodic radiological bone evaluations are required.

It should be used with caution in girls of childbearing age due to associated teratogenic risk.