The dermatological community has come to realize that many antipsoriatic treatments used to be cumulatively toxic. Having used every therapeutic card available until it was no longer paying off, patients were confronted with the fact that their kidney, skin, liver and bone marrow had been durably weakened and that, for this reason, dermatologists had no longer any other solution to offer. Moreover, a great many of patients end up relapsing while under treatment, even though that treatment is well tolerated.

With this realization came the idea of creating short-treatment courses, in two different contexts:

*a) short-treatment courses leading to clearance, then resumption on each relapse
*b) when relapses occur too quickly, to alternate treatments using each treatment for short periods to try to avoid cumulative toxicity on the one hand and development of resistance on the other.

Possible suggestions for systematic treatment alternation are then cyclosporine/methotrexate every six months or cyclosporine/methotrexate/retinoids every four months. This idea is appealing, but difficult to assess. Practice shows that the idea of alternating is excellent, but alternating will vary greatly from one patient to the next, and that the desire to standardize therapeutic alternations is illusory because different people respond to different treatments. So even if no standardized alternation strategy can be suggested, in all chronic illnesses the idea of alternating treatments must certainly remain in the therapist’s mind.

SPIN Presentation


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