Which Therapy to Use?
During the consultation with a new patient with psoriasis vulgaris the physician must produce a plan of action for treatment and this plan is based on a detailed analysis of the patient and the disease and an understanding of the likely risks and beneﬁts of each available treatment. Psoriasis represents a continuum from the patient with minimal disability to the patient with incapacitating disability. The decisions about management of the extremes are fairly easy. The patient with a few lesions of psoriasis, so-called mild disease, is best treated with a topical agent or perhaps an excimer laser. The patient with generalized disease bordering on a pustular or erythrodermic phase will require systemic therapy, at least in the short term. The patients in the middle of the continuum will probably beneﬁt from UV therapy. The aims of this discussion are to provide guidance ﬁrst as to whether UV therapy should or should not be used and second whether the choice should be PUVA or UVB phototherapy.