The first day of practice

In 1985 the state of the art for psoriasis treatment revolved around the "Rotational Therapy" concept designed by Dr. Gerald Weinstein at UC-Davis.

By changing treatments every so often, one could decrease the cumulative toxicity of each therapy. For example, after one year of methotrexate, switch to PUVA. Super-potent topical therapy did not exist in 1985, so a lot of Lidex (fluocinonide) ointment was used for localized psoriasis.

Broad band UVB was a useful therapeutic tool, however I quickly learned that patients requiring three treatments per week required accessible appointments, so we provided phototherapy appointments from 6 AM - 7 PM and Saturdays at the Psoriasis Treatment Center of Central NJ, so people did not have to miss work.

PUVA was also helpful for patients with more extensive disease.

The Psoriasis Treatment Center of Central New Jersey also offered psoriasis day care treatment, whereby patients with the most severe forms could receive Goeckerman therapy as an outpatient. We provided tar baths, tar applications, scalp debridements, anthralin application, and increasing doses of UVB, under the caring, watchful eyes of our trusted phototherapists Kim Raynor and Crystal Snyder who I am proud to say continue to provide outstanding psoriasis care at our Center.

So for severe psoriasis in 1985, we had phototherapy (UVB and PUVA) and methotrexate or topical therapy -- that was it.