• combination therapy;
  • psoriasis


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

In addition to topical monotherapy for mild and systemic monotherapy for moderate to severe psoriasis, combination therapy plays an important role in daily practice. Although clinical trials almost exclusively evaluate monotherapy regimens, in real life psoriasis patients are usually treated with combination therapies. All combinations are used, topical/topical, topical/UV-light, topical/systemic or UV-light/systemic. Often not only two but more drugs/therapies are combined. Not every combination provides additive or synergistic effects. Some combinations are not possible and may be regarded as contraindications. Data on a benefit-risk-assessment are much more sparse in medical literature as compared to monotherapies. We summarize current knowledge about the use of combination therapies in psoriasis on the basis of published literature in the form of a table to show which combinations are possible, useful or which can not be recommended. This provides a quick overview of available options.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

In recent years, the treatment of psoriasis vulgaris has undergone significant changes. The current standard of care for psoriasis patients is based on the S3 guideline published in 2006 by the German Society of Dermatology (DDG) and the Federal Association of German Dermatologists (BVDD) which is currently being revised [1, 2]. The European S3 guideline, which builds on the German guideline, has also been available since October 2009 [3]. The creation of guidelines was necessary for several reasons:

  • • 
    Increasing need for treatments based on evidence-based medicine,
  • • 
    Availability of various new drugs,
  • • 
    Inadequate care of psoriasis patients.

An important aspect is the formulation of treatment goals which were discussed for the first time in the guidelines and then in subsequent publications [4].

Significant improvements in psoriasis care have been made thanks to the guidelines as well as the advent of various biological therapies (currently three approved TNFa inhibitors, as well as ustekinumab which is the first p40 antagonist) and improved topical galenicals and the potential for use in topical combination therapies (e.g., Elosalic®, Daivobetc®/Psorcutanc® beta). Improvements in care are also reflected in preliminary survey results (e.g., the “National Care Study on Psoriasis – PsoHealth” 2007) [5]. Despite all efforts and advancements, however, in moderate-to-severe disease in particular, which affects as many as 50% of psoriasis patients, treatment is not always adequate or long-lasting which further reduces the satisfaction of patients with available therapy options [6, 7].

Combining medications and therapies is one possible alternative for improving treatment effectiveness and for reducing potential side effects which may limit treatment. At present, due to lacking data, the choice of a combination therapy is often based only on its anticipated effect and personal experience rather than on evidence-based criteria. It is thus vital that recommendations be made for combination therapies with the most commonly-used treatment options in order to enhance long-term disease management while minimizing the risks associated with necessary long-term therapy. Furthermore, psoriasis is no longer seen as merely a disease of the skin, but rather is viewed as an inflammatory systemic disease with associated co-morbidities [8–10]. Long-term, sustained control of the systemic inflammatory reaction is considered increasingly important particularly for reducing associated cardiovascular disease. This underscores the need to develop safe and effective long-term strategies, including combination therapies.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

The aim of the present paper was to provide an overview of the current information on possible therapy combinations in the treatment of psoriasis. The intention is not to conduct a meta-analysis in the sense of a Cochrane review but rather to produce a useful table for practical usage of combination therapies for psoriasis. We have intentionally omitted any discussion or analysis of the data. For more detail, the reader is referred to the cited references.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

A thorough search of the literature was made using Medline/PubMed with the keywords psoriasis, (combination-) therapy, and also by individual drug name/ therapy name. The results are summarized in Table 1. For the majority of possible combination therapies, there were either no or only very limited data and virtually no evidence-based studies. Some therapy combinations, such as topical vitamin D3/corticosteroid (Daivobet®/Psorcutan® beta) and corti-costeroid/salicylic acid (Elosalic®), which are now commercially-available combination therapies, have been thoroughly tested and may be recommended on the basis of current study results.

Table 1.  Assessment of possible therapy combinations for the treatment of psoriasis with literature references. +/−= Combination is useful/not useful, ?= no publications, (+)/(−) = case reports with positive/negative results.
 Calcineurin inhibitorsDithranolCorticosteroidsTarVitamin D3TazaroteneSalicylic acidUreaCyclosporineFumaric acid esterMethotrexateRetinoidsAdalimumabEtanerceptInfliximabUVBPUVA
Calcineurin ???(+)1?+2??????????
Dithranol? +3−/(+)4+5+6++7(+)8??????+9(+)10
Corticosteroids?+3 (+)11+12+13+14????+15?(+)16?17+/−18
Tar?−/(+)4(+)11 (+)19??????????+20−/(+)21
Vitamin D3(+)1+5+12(+)19 +22??+/(+)23+24+25+26?+27?+28+29
Tazarotene?+6+13?+22 ?????????+30+31
Salicylic acid+2++14??? ????????3233
Urea?+7????? ?????????
Cyclosporine?(+)8??+/(+)23??? (+)34+35+/(+)36?+/(+)37(−)38(+)39(+)40
Fumaric acid ester????+24???(+)34 (+)41(+)42?????
Methotrexate????+25???+35(+)41 +/(+)43?+/(+)44+/(+)45+46+47
Retinoids??+15?+26???+/(+)36(+)42+/(+)43 (+)48+/(+)49(+)50+51+52
Adalimumab???????????(+)48 ????
Etanercept??(+)16?+27???+/(+)37?+/(+)44+/(+)49? ?+53?
Infliximab????????(−)38?+/(+)45(+)50?? ??
UVB?+917+20+28+3032?(+)39?+46+51?+53? +54
1[19]12[11, 15, 21–26]23[38, 46–51]34[53]45[74, 78–84]
2[40]13[15, 24, 28–38]24[52]35[38, 55–58]46[38, 58, 103]
3[11–13]14[15, 21, 41–43]25[49, 54]36[38, 62, 63]47[38, 58, 125–127]
4[14–16]15[38]26[38, 49, 59–61]37[67–71]48[64]
5[20]16[65]27[66]38[77]49[64, 65, 71, 75, 76]
6[27]17[38, 91, 92]28[38, 49, 85, 86, 88, 95–99]39[38]50[81]
7[44]18[38, 91,114–116]29[38, 49, 96, 98, 118–120]40[38, 123, 124]51[38, 58, 62, 104–110]
8[45]19[17]30[33, 36, 38, 85, 100, 101]41[53]52[38, 58, 62, 104, 106, 108, 110, 128, 129]
9[86–90]20[89, 93, 94]31[36, 38, 118, 121]42[53]53[111, 112]
10[38, 113]21[38, 114, 117]32[42, 102]43[39, 58, 62]54[38]
11[17, 18]22[35, 38]33[122]44[69–74]  

It is therefore still not possible to present complete data and recommendations on potential or improper combinations.

The table provided here reflects current knowledge from scientific publications and is thus a preliminary overview of potential future recommendations.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

The results of our literature search are summarized in Table 1. Combination therapies for which there are as yet no published results (e.g., randomized studies, case reports, reviews, etc.) have been marked with a “?”. Randomized studies with a positive or negative assessment of the investigated therapy were marked with “+” or “−”. If only case reports or small case series have been published, the assessment was placed in parentheses.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

The following comments apply to the table:

  • • 
    Salicylic acid inactivates vitamin D3 analogues (calcipotriol, calcitriol, and tacalcitol) and should therefore not be combined with them (latency period after salicylic acid and prior to vitamin D3 analogue use: 3 days).
  • • 
    The combination of salicylic acid with systemic therapies such as cyclosporine, methotrexate, and fumaric acid esters can lead to nephrotoxic side effects. These therapies should only be used if absolutely necessary and should be administered under careful surveillance.
  • • 
    For the combination of UV therapy (PUVA or UVB) and topical cal-cineurin inhibitors, a warning has been published in the product information about increased photocarcinogenicity Concomitant use of these therapies is not advised.
  • • 
    The use of salicylic acid-based topical therapies immediately prior to UV therapy diminishes the effectiveness of phototherapy due to absorption of UV by the chemical. An interval of at least 12 hours between the two therapies is recommended.
  • • 
    The combination of cyclosporine and UV therapy is contraindicated given an increased risk of cancer.
  • • 
    The combination of methotrexate and UV therapy is not advised given a possible increased risk of the development of epithelial skin tumors.
  • • 
    Combination use of topical corticosteroids and calcineurin inhibitors is conceivable and appears useful but there are still no published data for psoriasis.
  • • 
    Dithranol-based topical therapies are often available in a salicylic base as this improves stability.
  • • 
    Although the S3 guideline on psoriasis therapy does not advise the use of tarbased therapies given insufficient evidence of their effectiveness, tar-based therapies are nevertheless used under special circumstances. Results for combination therapies with tar-based products have thus been included in the table.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References

Funding for this paper was provided by a stipend from the German Psoriasis Association e. V, Hamburg.


  1. Top of page
  2. Summary
  3. Introduction
  4. Objectives
  5. Methods
  6. Results
  8. Acknowledgements
  9. Conflict of interest
  10. References
  • 1
    Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke, WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. [S3-Gui-delines for the therapy of psoriasis vulgaris]. J Dtsch Dermatol Ges 2006; 4: S1S126.
  • 2
    Nast A, Kopp I, Augustin M, Banditt KB, Boehncke, WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. [German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)]. Arch Dermatol Res 2007; 299: 11138.
  • 3
    Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, Barker J, Bos JD, Burmester GR, Chimenti S, Dubertret L, Eberlein B, Erdmann R, Ferguson J, Girolomoni G, Gisondi P, Giunta A, Griffiths C, Honigsmann H, Hussain M, Jobling R, Karvonen SL, Kemeny L, Kopp I, Leonardi C, Maccarone M, Menter A, Mrowietz U, Naldi L, Nijsten T, Ortonne J P, Orzechowski HD, Rantanen T, Reich K, Reytan N, Richards H. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009; 23: 170.
  • 4
    Reich K, Mrowietz U. Treatment goals in psoriasis. J Dtsch Dermatol Ges 2007; 5: 56674.
  • 5
    Augustin M, Reich K, Reich C, Purwins S, Jeff Rustenbach S, Schäfer I, Radtke M. Quality of psoriasis care in Germany – results of the national study PsoHealth 2007. J Dtsch Dermatol Ges 2008; 6: 6405.
  • 6
    Horn EJ, Fox KM, Patel V, Chiou CF, Dann F, Lebwohl M. Are patients with psoriasis undertreated? Results of National Psoriasis Foundation survey. J Am Acad Dermatol. 2007; 57: 95762.
  • 7
    Christophers E, Griffiths CE, Gaitanis G, van de Kerkhof P. The unmet treatment need for moderate to severe psoriasis: results of a survey and chart review. J Eur Acad Dermatol Venereol 2006; 20: 9215.
  • 8
    Boehncke WH, Buerger C, Boehncke S. [Comorbidities in psoriasis vulgaris]. Hautarzt 2009; 60: 11621.
  • 9
    Gerdes S, Mrowietz U. Impact of comorbidities on the management of psoriasis. Curr Probl Dermatol 2009; 38: 2136.
  • 10
    Mrowietz U, Elder JT, Barker J. The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients. Arch Dermatol Res 2006; 298: 30919.
  • 11
    van de Kerkhof PC, Vissers WH. The topical treatment of psoriasis. Skin Pharmacol Appl Skin Physiol 2003; 16: 6983.
  • 12
    Monk BE, Hehir ME, Clement MI, Pembroke AC, du Vivier A. Anthralin-corticosteroid combination therapy in the treatment of chronic plaque psoriasis. Arch Dermatol 1988; 124: 54850.
  • 13
    Swinkels OQ, Prins M, Kucharekova M, de Boo T, Gerritsen MJ, Van Der Valk PG, van de Kerkhof PC. Combining lesional short-contact dithranol therapy of psoriasis with a potent topical corticosteroid. Br J Dermatol 2002; 146: 6216.
  • 14
    Schulze HJ, Schauder S, Mahrle G, Steigleder GK. Combined taranthralin versus anthralin treatment lowers irritancy with unchanged antipsoriatic efficacy. Modifications of short-contact therapy and Ingram therapy. J Am Acad Dermatol 1987; 17: 1924.
  • 15
    Endzweig-Gribetz CH, Brady C, Lynde C, Sibbald D, Lebwohl M. Drug interactions in psoriasis: the pros and cons of combining topical psoriasis therapies. J Cutan Med Surg 2002; 6: 126.
  • 16
    Duhra P, Ryatt KS. Lack of additive effect of coal tar combined with dithra-nol for psoriasis. Clin Exp Dermatol 1988; 13: 723.
  • 17
    Van Der Vleuten CJ, van de Kerkhof PC. Management of scalp psoriasis: guidelines for corticosteroid use in combination treatment. Drugs 2001; 61: 15938.
  • 18
    Horwitz SN, Johnson RA, Sefton J, Frost P. Addition of a topically applied corticosteroid to a modified Goecker-man regimen for treatment of psoriasis: effect on duration of remission. J Am Acad Dermatol 1985; 13: 78491.
  • 19
    Brill TJ, Elshorst-Schmidt T, Valesky EM, Kaufmann R, Thaci D. Successful treatment of acrodermatitis continua of Hallopeau with sequential combination of calcipotriol and tacrolimus ointments. Dermatology 2005; 211: 3515.
  • 20
    Monastirli A, Georgiou S, Pasmatzi E, Sakkis T, Badavanis G, Drainas D, Sagriotis A, Tsambaos D. Calcipotriol plus short-contact dithranol: a novel topical combination therapy for chronic plaque psoriasis. Skin Pharmacol Appl Skin Physiol 2002; 15: 24651.
  • 21
    Guenther LC. Fixed-dose combination therapy for psoriasis. Am J Clin Dermatol 2004; 5: 717.
  • 22
    Schmitt J, Meurer M. [Combined topical therapy of psoriasis: position of calcitriol and vitamin D analogs]. Hautarzt 2006; 57: 67984.
  • 23
    Kragballe K, Austad J, Barnes L, Bibby A, de la Brassinne M, Cambazard F, Fleming C, Heikkila H, Jolliffe D, Peyri J, Svensson A, Toole J, Wozel G. A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of psoriasis vulgaris. Dermatology 2006; 213: 31926.
  • 24
    Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol 2005; 53: S508.
  • 25
    Saraceno R, Gramiccia T, Frascione P, Chimenti S. Calcipotriene/betamethasone in the treatment of psoriasis: a review article. Expert Opin Pharmacother 2009; 10: 235765.
  • 26
    Kragballe K, Hoffmann V, Ortonne J P, Tan J, Nordin P, Segaert S. Efficacy and safety of calcipotriol plus betamethasone dipropionate scalp formulation compared with calcipotriol scalp solution in the treatment of scalp psoriasis: a randomized controlled trial. Br J Dermatol 2009; 161: 15966.
  • 27
    Sander P, Happe M, Stucker M, Hermes N, Hoffmann K, Altmeyer P. [Tazarotene increases the antipsoriatic effect of dithranol in chronic psoriasis]. Hautarzt 1999; 50: 7237.
  • 28
    Lebwohl M, Lombardi K, Tan MH. Duration of improvement in psoriasis after treatment with tazarotene 0.1% gel plus clobetasol propionate 0.05% ointment: comparison of maintenance treatments. Int J Dermatol 2001; 40: 646.
  • 29
    Guenther L. Tazarotene combination treatments in psoriasis. J Am Acad Dermatol 2000; 43: S3642.
  • 30
    Tanghetti EA. An observation study evaluating the efficacy of tazarotene plus corticosteroid in treating plaque psoriasis in patients switched from treatment with calcipotriene +/– cortico-steroid. Cutis 2000; 66: 128.
  • 31
    Poulin Y P. Tazarotene 0.1% gel in combination with mometasone furoate cream in plaque psoriasis: a photographic tracking study. Cutis. 1999; 63: 418.
  • 32
    Gollnick H, Menter A. Combination therapy with tazarotene plus a topical corticosteroid for the treatment of plaque psoriasis. Br J Dermatol 1999; 140: 1823.
  • 33
    Gollnick H P, Finzi A F, Marks R, Barker JN, Jansen C, Revuz J, Saurat J. Optimising the use of tazarotene in clinical practice: consensus statement from the European advisory panel for tazarotene (Zorac TM). Dermatology 1999; 199: 406.
  • 34
    Lebwohl MG, Breneman DL, Goffe BS, Grossman JR, Ling MR, Milbauer J, Pincus SH, Sibbald RG, Swinyer LJ, Weinstein GD, Lew-Kaya DA, Lue JC, Gibson JR, Sefton J. Tazarotene 0.1% gel plus corticosteroid cream in the treatment of plaque psoriasis. J Am Acad Dermatol 1998; 39: 5906.
  • 35
    Hecker D, Worsley J, Yueh G, Lebwohl M. In vitro compatibility of tazarotene with other topical treatments of psoriasis. J Am Acad Dermatol 2000; 42: 100811.
  • 36
    Dando TM, Wellington K. Topical tazarotene: a review of its use in the treatment of plaque psoriasis. Am J Clin Dermatol 2005; 6: 25572.
  • 37
    McMichael AJ, Griffiths CE, Talwar HS, Finkel LJ, Rafal ES, Hamilton TA, Voorhees JJ. Concurrent application of tretinoin (retinoic acid) partially protects against corticosteroid-induced epidermal atrophy. Br J Dermatol 1996; 135: 604.
  • 38
    Lebwohl M, Menter A, Koo J, Feldman SR. Combination therapy to treat moderate to severe psoriasis. J Am Acad Dermatol 2004; 50: 41630.
  • 39
    Lowenthal KE, Horn PJ, Kalb RE. Concurrent use of methotrexate and acitretin revisited. J Dermatolog Treat 2008; 19: 226.
  • 40
    Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR. Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis treatment. Arch Dermatol 2005; 141: 436.
  • 41
    Koo J, Cuffie CA, Tanner DJ, Bressinck R, Cornell RC, DeVillez RL, Edwards L, Breneman DL, Piacquadio DJ, Guzzo CA, Monroe EW. Mometasone furoate 0.1%-salicylic acid 5% ointment versus mometasone furoate 0.1% ointment in the treatment of moderate-to-severe psoriasis: a multicenter study. Clin Ther 1998; 20: 28391.
  • 42
    Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol 2009; 60: 64359.
  • 43
    Tiplica GS, Salavastru CM. Mometasone furoate 0.1% and salicylic acid 5% vs. mometasone furoate 0.1% as sequential local therapy in psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009; 23: 90512.
  • 44
    Przybilla B, Kaudewitz P, Bieber K. [Urea in combination with dithranol in treating psoriasis vulgaris]. Hautarzt 1989; 40: 547.
  • 45
    Gottlieb SL, Heftler NS, Gilleaudeau P, Johnson R, Vallat V P, Wolfe J, Gottlieb AB, Krueger JG. Short-contact anthralin treatment augments therapeutic efficacy of cyclosporine in psoriasis: a clinical and pathologic study. J Am Acad Dermatol 1995; 33: 63745.
  • 46
    Feliciani C, Zampetti A, Forleo P, Cerritelli L, Amerio P, Proietto G, Tulli A, Amerio P. Nail psoriasis: combined therapy with systemic cyclosporin and topical calcipotriol. J Cutan Med Surg 2004; 8: 1225.
  • 47
    Ashcroft DM, Li Wan PoA, Williams HC, Griffiths CE. Combination regimens of topical calcipotriene in chronic plaque psoriasis: systematic review of efficacy and tolerability. Arch Dermatol 2000; 136: 153643.
  • 48
    Kokelj F, Torsello P, Plozzer C. Calcipotriol improves the efficacy of cyclosporine in the treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 1998; 10: 1436.
  • 49
    Katz HI. Combined topical calcipotri-ene ointment 0.005% and various systemic therapies in the treatment of plaque-type psoriasis vulgaris: review of the literature and results of a survey sent to 100 dermatologists. J Am Acad Dermatol 1997; 37: S628.
  • 50
    Abe M, Syuto T, Hasegawa M, Sogabe Y, Yokoyama Y, Ishikawa O. Daily versus intermittent application of high-concentration tacalcitol ointment in combination with low-dose cyclosporin for psoriasis vulgaris. J Dermatol 2006; 33: 10811.
  • 51
    Grossman RM, Thivolet J, Claudy A, Souteyrand P, Guilhou JJ, Thomas P, Amblard P, Belaich S, de Belilovsky C, de la Brassinne M. A novel therapeutic approach to psoriasis with combination calcipotriol ointment and very low-dose cyclosporine: results of a multicenter placebo-controlled study. J Am Acad Dermatol 1994; 31: 6874.
  • 52
    Gollnick H, Altmeyer P, Kaufmann R, Ring J, Christophers E, Pavel S, Ziegler J. Topical calcipotriol plus oral fumaric acid is more effective and faster acting than oral fumaric acid monotherapy in the treatment of severe chronic plaque psoriasis vulgaris. Dermatology 2002; 205: 4653.
  • 53
    Balasubramaniam P, Stevenson O, Berth-Jones J. Fumaric acid esters in severe psoriasis, including experience of use in combination with other systemic modalities. Br J Dermatol 2004; 150: 7416.
  • 54
    de Jong EM, Mork NJ, Seijger MM, de La Brassine M, Lauharanta J, Jansen CT, Guilhou JJ, Guillot B, Ostrojic A, Souteyrand P, Vaillant L, Barnes L, Rogers S, Klaber MR, van de Kerkhof PC. The combination of calcipotriol and methotrexate compared with methotrexate and vehicle in psoriasis: results of a multicentre placebo-controlled randomized trial. Br J Dermatol 2003; 148: 31825.
  • 55
    Clark CM, Kirby B, Morris AD, Davison S, Zaki I, Emerson R, Saihan EM, Chalmers RJ, Barker JN, Allen BR, Griffiths CE. Combination treatment with methotrexate and cyclospo-rin for severe recalcitrant psoriasis. Br J Dermatol 1999; 14: 27982.
  • 56
    Aydin F, Canturk T, Senturk N, Turanli AY. Methotrexate and ciclosporin combination for the treatment of severe psoriasis. Clin Exp Dermatol 2006; 31: 5204.
  • 57
    Fraser AD, van Kuijk AW, Westhovens R, Karim Z, Wakefield R, Gerards AH, Landewe R, Steinfeld SD, Emery P, Dijkmans BA, Veale DJ. A randomised, double blind, placebo controlled, mul-ticentre trial of combination therapy with methotrexate plus ciclosporin in patients with active psoriatic arthritis. Ann Rheum Dis 2005; 64: 85964.
  • 58
    Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001; 45: 64961.
  • 59
    van de Kerkhof PC, Cambazard F, Hutchinson PE, Haneke E, Wong E, Souteyrand P, Damstra RJ, Combemale P, Neumann MH, Chalmers RJ, Olsen L, Revuz J. The effect of addition of calcipotriol ointment (50 micrograms/g) to acitretin therapy in psoriasis. Br J Dermatol 1998; 138: 849.
  • 60
    Rim JH, Park JY, Choe YB, Youn JI. The efficacy of calcipotriol + acitretin combination therapy for psoriasis: comparison with acitretin monotherapy. Am J Clin Dermatol 2003; 4: 50710.
  • 61
    Giannetti A, Coppini M, Bertazzoni MG, Califano A, Altieri E, Pazzaglia A, Lega M, Lombardo M, Pelfini C, Veller Fornasa C, Rabbiosi G, Cespa M. Clinical trial of the efficacy and safety of oral etretinate with calcipotriol cream compared with etretinate alone in moderate-severe psoriasis. J Eur Acad Dermatol Venereol 1999; 13: 915.
  • 62
    Roenigk HH, Jr. Acitretin combination therapy. J Am Acad Dermatol 1999; 41: S1821.
  • 63
    Brechtel B, Wellenreuther U, Toppe E, Czarnetzki BM. Combination of etretinate with cyclosporine in the treatment of severe recalcitrant psoriasis. J Am Acad Dermatol1994; 30: 10234.
  • 64
    Conley J, Nanton J, Dhawan S, Pearce DJ, Feldman SR. Novel combination regimens: biologics and acitretin for the treatment of psoriasis – a case series. J Dermatolog Treat 2006; 17: 869.
  • 65
    Kazinski K, Joyce KM, Hodson D. The successful use of etanercept in combination therapy for treatment of acrodermatitis continua of hallopeau. J Drugs Dermatol 2005; 4: 3604.
  • 66
    Campione E, Mazzotta A, Paterno EJ, Diluvio L, Prinz JC, Cimenti S. Effect of calcipotriol on etanercept partial responder psoriasis vulgaris and psoriatic arthritis patients. Acta Derm Venereol 2009; 89: 28891.
  • 67
    Ricotti C, Kerdel FA. Subacute annular generalized pustular psoriasis treated with etanercept and cyclosporine combination. J Drugs Dermatol 2007; 6: 73840.
  • 68
    Yamauchi PS, Lowe NJ. Cessation of cyclosporine therapy by treatment with etanercept in patients with severe psoriasis. J Am Acad Dermatol 2006; 54: S1358.
  • 69
    Kress DW. Etanercept therapy improves symptoms and allows tapering of other medications in children and adolescents with moderate to severe psoriasis. J Am Acad Dermatol 2006; 54: S1268.
  • 70
    Gul U, Gonul M, Kilic A, Erdem R, Cakmak SK, Gunduz H. Treatment of psoriatic arthritis with etanercept, methotrexate, and cyclosporin A. Clin Ther 2006; 28: 2514.
  • 71
    Iyer S, Yamauchi P, Lowe NJ. Etanercept for severe psoriasis and psoriatic arthritis: observations on combination therapy. Br J Dermatol 2002; 146: 11821.
  • 72
    Spadaro A, Ceccarelli F, Scrivo R, Varesini G. Life-table analysis of etanercept with or without methotrexate in patients with psoriatic arthritis. Ann Rheum Dis 2008; 67: 16501.
  • 73
    Zachariae C, Mork NJ, Reunala T, Lorentzen H, Falk E, Karvonen SL, Johannesson A, Clareus B, Skov L, Mork G, Walker S, Qvitzau S. The combination of etanercept and methotrexate increases the effectiveness of treatment in active psoriasis despite inadequate effect of methotrexate therapy. Acta Derm Venereol 2008; 88: 495501.
  • 74
    Driessen RJ, van de Kerkhof PC, de Jong EM. Etanercept combined with methotrexate for high-need psoriasis. Br J Dermatol 2008; 159: 4603.
  • 75
    Gisondi P, Del Giglio M, Cotena C, Girolomoni G. Combining etanercept and acitretin in the therapy of chronic plaque psoriasis: a 24-week, randomized, controlled, investigator-blinded pilot trial. Br J Dermatol 2008; 158: 13459.
  • 76
    Smith EC, Riddle C, Menter MA, Lebwohl M. Combining systemic retinoids with biologic agents for moderate to severe psoriasis. Int J Dermatol 2008; 47: 5148.
  • 77
    Mahe E, Descamps V, Grossin M, Fraitag S, Crickx B. CD30+ T-cell lymphoma in a patient with psoriasis treated with ciclosporin and infliximab. Br J Dermatol 2003; 149: 1703.
  • 78
    Zargari O. Sustained effects of low dose infliximab in combination with methotrexate in the management of chronic recalcitrant psoriasis. Dermatol Online J 2005; 11: 21.
  • 79
    Dalaker M, Bonesronning JH. Long-term maintenance treatment of moderate-to-severe plaque psoriasis with infliximab in combination with methotrexate or azathioprine in a retrospective cohort. J Eur Acad Dermatol Venereol 2009; 23: 27782.
  • 80
    Warren RB, Brown BC, Carmichael AJ, Griffiths CE. Long-term control of recalcitrant psoriasis with combination infliximab and methotrexate. Clin Exp Dermatol 2009; 34: 4156.
  • 81
    Takahashi MD, Castro LG, Romiti R. Infliximab, as sole or combined therapy, induces rapid clearing of erythrodermic psoriasis. Br J Dermatol 2007; 157: 82831.
  • 82
    Kirby B, Marsland AM, Carmichael AJ, Griffiths CE. Successful treatment of severe recalcitrant psoriasis with combination infliximab and methotrexate. Clin Exp Dermatol 2001; 26: 279.
  • 83
    Heikkila H, Ranki A, Cajanus S, Karvonen SL. Infliximab combined with methotrexate as long-term treatment for erythrodermic psoriasis. Arch Dermatol 2005; 141: 160710.
  • 84
    Barland C, Kerdel FA. Addition of low-dose methotrexate to infliximab in the treatment of a patient with severe, recalcitrant pustular psoriasis. Arch Dermatol 2003; 139: 94950.
  • 85
    Schiener R, Behrens-Williams SC, Pillekamp H, Kaskel P, Peter RU, Kerscher M. Calcipotriol vs. tazarotene as combination therapy with narrowband ultraviolet B (311 nm): efficacy in patients with severe psoriasis. Br J Dermatol 2000; 143: 12758.
  • 86
    Dutz J P, Lui H. A comparative study of calcipotriol and anthralin for chronic plaque psoriasis in a day care treatment center. Int J Dermatol 1998; 37: 513.
  • 87
    McBride SR, Walker P, Reynolds NJ. Optimizing the frequency of outpatient short-contact dithranol treatment used in combination with broadband ultraviolet B for psoriasis: a randomized, within-patient controlled trial. Br J Dermatol 2003; 149: 125965.
  • 88
    Hofmann UB, Eggert AA, Brocker EB, Goebeler M. Calcitriol vs. dithranol in combination with narrow-band ultraviolet B (311 nm) in psoriasis. Br J Dermatol 2003; 148: 77983.
  • 89
    Swinehart JM, Lowe NJ. UVABA therapy for psoriasis. Efficacy with shortened treatment times with the combined use of coal tar, anthralin, and metal halide ultraviolet machines. J Am Acad Dermatol 1991; 24: 5947.
  • 90
    Gerritsen MJ, Boezeman JB, Elbers ME, van de Kerkhof PC. Dithranol embedded in crystalline monoglycerides combined with phototherapy (UVB): a new approach in the treatment of psoriasis. Skin Pharmacol Appl Skin Physiol 1998; 11: 1339.
  • 91
    Meola T, Jr., Soter NA, Lim HW. Are topical corticosteroids useful adjunctive therapy for the treatment of psoriasis with ultraviolet radiation? A review of the literature. Arch Dermatol 1991; 127: 170813.
  • 92
    Petrozzi J W. Topical steroids and UV radiation in psoriasis. Arch Dermatol 1983; 119: 20710.
  • 93
    Bagel J. LCD plus NB-UVB reduces time to improvement of psoriasis vs. NB-UVB alone. J Drugs Dermatol 2009; 8: 3517.
  • 94
    Serrao R, Davis MD. Goeckerman treatment for remission of psoriasis refractory to biologic therapy. J Am Acad Dermatol 2009; 60: 3489.
  • 95
    de Rie MA, de Hoop D, Jonsson L, Bakkers EJ, Sorensen M. Pharmacoeconomic evaluation of calcipotriol (Daivonex/Dovonex) and UVB phototherapy in the treatment of psoriasis: a Markov model for The Netherlands. Dermatology 2001; 202: 3843.
  • 96
    Brazzelli V, Barbagallo T, Prestinari F, Rona C, de Silvestri A, Trevisan V, Borroni G. Non-invasive evaluation of tacalcitol plus puva versus tacalcitol plus UVB-NB in the treatment of psoriasis: “right-left intra-individual pre/post comparison design”. Int J Immunopathol Pharmacol 2005; 18: 75560.
  • 97
    Kragballe K. Vitamin D and UVB radiation therapy. Cutis 2002; 70: 912.
  • 98
    Koo J. Calcipotriol/calcipotriene (Dovonex/Daivonex) in combination with phototherapy: a review. J Am Acad Dermatol 1997; 37: S5961.
  • 99
    Woo WK, McKenna KE. Combination TL01 ultraviolet B phototherapy and topical calcipotriol for psoriasis: a prospective randomized placebo-controlled clinical trial. Br J Dermatol 2003; 149: 14650.
  • 100
    Lowe NJ. Optimizing therapy: tazarotene in combination with phototherapy. Br J Dermatol 1999; 140: 811.
  • 101
    Behrens S, Grundmann-Kollmann M, Schiener R, Peter RU, Kerscher M. Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. J Am Acad Dermatol 2000; 42: 4935.
  • 102
    Kristensen B, Kristensen O. Topical salicylic acid interferes with UVB therapy for psoriasis. Acta Derm Venereol 1991; 71: 3740.
  • 103
    Paul BS, Momtaz K, Stern RS, Arndt KA, Parrish JA. Combined methotrexate-ultraviolet B therapy in the treatment of psoriasis. J Am Acad Dermatol. 1982; 7: 75862.
  • 104
    Ozdemir M, Engin B, Baysal I, Mevlitoglu I. A randomized comparison of acitretin-narrow-band TL-01 phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis. Acta Derm Venereol 2008; 88: 58993.
  • 105
    Kampitak T, Asawanonda P. The efficacy of combination treatment with narrowband UVB (TL-01) and acitretin vs narrowband UVB alone in plaque-type psoriasis: a retrospective study. J Med Assoc Thai 2006; 89: S204.
  • 106
    Spuls PI, Rozenblit M, Lebwohl M. Retrospective study of the efficacy of narrowband UVB and acitretin. J Dermatolog Treat 2003; 14: 1720.
  • 107
    Lebwohl M, Drake L, Menter A, Koo J, Gottlieb AB, Zanolli M, Young M, McClelland P. Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol 2001; 45: 54453.
  • 108
    Lebwohl M. Acitretin in combination with UVB or PUVA. J Am Acad Dermatol 1999; 41: S224.
  • 109
    Ruzicka T, Sommerburg C, Braun-Falco O, Koster W, Lengen W, Lensing W, Letzel H, Meigel WN, Paul E, Przybilla B. Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis. Arch Dermatol 1990; 126: 4826.
  • 110
    Green C, Lakshmipathi T, Johnson BE, Ferguson J. A comparison of the efficacy and relapse rates of narrowband UVB (TL-01) monotherapy vs. etretinate (re-TL-01) vs. etretinate-PUVA (re-PUVA) in the treatment of psoriasis patients. Br J Dermatol 1992; 127: 59.
  • 111
    Kircik L, Bagel J, Korman N, Menter A, Elmets CA, Koo J, Yang YC, Chiou C F, Dann F, Stevens SR. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. J Drugs Dermatol 2008; 7: 24553.
  • 112
    Wolf P, Hofer A, Legat FJ, Bretterklieber A, Weger W, Salmhofer W, Kerl H. Treatment with 311-nm ultraviolet B accelerates and improves the clearance of psoriatic lesions in patients treated with etanercept. Br J Dermatol 2009; 160: 1869.
  • 113
    Morison WL. PUVA combination therapy. Photodermatol 1985; 2: 22936.
  • 114
    Morison WL, Parrish JA, Fitzpatrick TB. Controlled study of PUVA and adjunctive topical therapy in the management of psoriasis. Br J Dermatol 1978; 98: 12532.
  • 115
    Hanke CW, Steck WD, Roenigk HH, Jr. Combination therapy for psoriasis. Psoralens plus long-wave ultraviolet radiation with betamethasone valerate. Arch Dermatol 1979; 115: 10747.
  • 116
    Schmoll M, Henseler T, Christophers E. Evaluation of PUVA, topical corticosteroids and the combination of both in the treatment of psoriasis. Br J Dermatol 1978; 99: 693702.
  • 117
    Kar PK, Jha PK, Snehi PS. Evaluation of psoralen with solar ultraviolet light (puvasol) and adjunctive topical tar therapy in psoriasis. J Indian Med Assoc 1994; 92: 1201.
  • 118
    Tzaneva S, Honigsmann H, Tanew A, Seeber A. A comparison of psoralen plus ultraviolet A (PUVA) monotherapy, tacalcitol plus PUVA and ta-zarotene plus PUVA in patients with chronic plaque-type psoriasis. Br J Dermatol 2002; 147: 74853.
  • 119
    Torras H, Aliaga A, Lopez-Estebaranz JL, Hernandez I, Gardeazabal J, Quintanilla E, Mascaro JM. A combination therapy of calcipotriol cream and PUVA reduces the UVA dose and improves the response of psoriasis vulgaris. J Dermatolog Treat 2004; 15: 98103.
  • 120
    Mascaro JM. Vitamin D and psoralen plus UVA radiation. Cutis 2002; 70: 135.
  • 121
    Behrens S, Grundmann-Kollmann M, Peter RU, Kerscher M. Combination treatment of psoriasis with photochemotherapy and tazarotene gel, a receptor-selective topical retinoid. Br J Dermatol 1999; 141: 177.
  • 122
    Birgin B, Fetil E, Ilknur T, Tahsin GA, Ozkan S. Effects of topical petrolatum and salicylic acid upon skin photore-action to UVA. Eur J Dermatol 2005; 15: 1568.
  • 123
    Hunt MJ, Lee SH, Salisbury EL, Wills EJ, Armati R. Generalized pustular psoriasis responsive to PUVA and oral cyclosporin therapy. Australas J Dermatol 1997; 38: 199201.
  • 124
    Petzelbauer P, Honigsmann H, Langer K, Anegg B, Strohal R, Tanew A, Wolff K. Cyclosporin A in combination with photochemotherapy (PUVA) in the treatment of psoriasis. Br J Dermatol 1990; 123: 6417.
  • 125
    Shehzad T, Dar NR, Zakria M. Efficacy of concomitant use of PUVA and methotrexate in disease clearance time in plaque type psoriasis. J Pak Med Assoc 2004; 54: 4535.
  • 126
    Morison WL, Momtaz K, Parrish JA, Fitzpatrick TB. Combined methotrexate-PUVA therapy in the treatment of psoriasis. J Am Acad Dermatol 1982; 6: 4651.
  • 127
    Laxmisha C, Vinod K P, Thappa DM. Modified combined methotrexate PUVA therapy in the treatment of recalcitrant psoriasis: a preliminary report. Indian J Dermatol Venereol Leprol 2006; 72: 1535.
  • 128
    Tanew A, Guggenbichler A, Honigsmann H, Geiger JM, Fritsch P. Photochemotherapy for severe psoriasis without or in combination with acitretin: a randomized, double-blind comparison study. J Am Acad Dermatol 1991; 25: 6824.
  • 129
    Muchenberger S, Schopf E, Simon JC. The combination of oral acitretin and bath PUVA for the treatment of severe psoriasis. Br J Dermatol 1997; 137: 5879.