Optimizing psoriasis treatment for elderly patients: a spotlight on biologics and small molecules

Psoriasis is an immune-mediated, chronic, complex skin disease that can affect people of all ages, but has an increasing prevalence in the elderly as the world population ages. It is the responsibility of the dermatology clinician to diagnose, treat, and manage patients with psoriasis, which includes understanding how to manage treatment for elderly psoriasis patients. Treatment for any moderate to severe psoriasis patient can be complex, with over 15 options to choose from when selecting treatment. In addition, treatment can be complicated by many factors, including those that come with age. The aging population is leading to an increased demand for individualized psoriasis treatment tailored to patient goals and expectations in this group. Key factors for consideration in the elderly include concomitant comorbidities, area of involvement, impact on quality of life, barriers to care, and drug-to-drug interactions. Further, the clinician must consider the safety and efficacy of the drugs available on the market. The newer systemic agents, including biologics and oral small molecules, have demonstrated superior safety and efficacy as compared with traditional systemic treatments for psoriasis. Despite the data that supports the use of biologics and oral small molecules for the elderly, they are still prescribed at a much lower rate to the elderly than their younger counterparts. These newer treatments should be considered for moderate to severe elderly psoriasis patients to improve quality of life and symptom control as well as avoid undertreatment of these patients.