Perioperative management of medications for psoriasis and psoriatic arthritis: a review for the dermasurgeon.
BACKGROUND
Psoriasis affects an estimated 3% of the world's population. Many are on chronic immunosuppressive therapy for the cutaneous and joint manifestations of this disorder. The management of these medications in the perioperative period is controversial. Psoriasis and psoriatic arthritis medications can affect wound healing, hemostasis, and infection risk during cutaneous surgery.


OBJECTIVE
The objective of this article is to provide a critical review of various medications used for care of the psoriatic patient and their potential effect on cutaneous surgical procedures.


CONCLUSIONS
This review summarizes current understanding of wound healing, hemostatic effects, and infectious risks regarding many psoriasis medications including nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, corticosteroids, various immunosuppressants, and biologic response modifiers. Recommendations vary depending on the agent in question, type of procedure, and comorbid conditions in the patient. Caution is advised when using many of the medications reviewed due to lack of human data of their effects in the perioperative period.
Hernandez
Claudia
C
Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois 60612-7300, USA.
Emer
Jason
J
Robinson
June K
JK
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D019990:Perioperative Care; D011565:Psoriasis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D012871:Skin Diseases / Q000503:physiopathology / Q000601:surgery*; D014945:Wound Healing / Q000187:drug effects
D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors