ABSTRACT
Optimal management of psoriasis, a chronically recurring disease, must include a strategy for initial rapid symptomatic relief as well as long-term maintenance therapy. Sequential therapy is a therapeutic approach that employs a deliberate sequence of specific therapies to maximize the rate of initial improvement and smooth transition to long-term maintenance therapy. The traditional therapeutic approach to psoriasis has been the initiation of a single treatment modality. If the chosen medication does not work effectively, it is discontinued and replaced by a new therapy and so on. A natural consequence of this simplistic monotherapy approach is the tendency to evaluate treatments predominantly based on the rate at which they result in initial symptomatic relief. In reality, there are other factors that should also guide treatment choice including long-term safety, duration of response, and propensity toward tachyphylaxis. The idea of sequential therapy is to optimize these factors by recognizing the advantages and disadvantages of each therapeutic option and then creating the most ideal pairs. Most psoriasis therapies can be categorized into ‘‘rabbits,’’ which are fast acting and very effective but have questionable long-term safety profiles, or ‘‘turtles,’’ which have a slower onset of action and are less effective
but safer for long-term use. In sequential therapy, ‘‘rabbits’’ and ‘‘turtles’’ are paired in specific sequences to maximize both efficacy and safety.
