Trong điều trị theo trình tự, "thỏ" và "rùa" được ghép nối trong trình tự cụ thể để tối đa hóa hiệu quả và an toàn. Tuần tự điều trị bao trùm các giá trị cung cấp nhanh chóng làm giảm triệu chứng đau khổ bệnh nhân đồng thời cũng nhấn mạnh tầm quan trọng của việc cung cấp một chiến lược | 164 Koo and Colaco Table 1 Sequential Therapy Phase 1 Clearing phase .-Phase 2 Transition phase -Phase 3 Maintenance phase but safer for long-term use. In sequential therapy rabbits and turtles are paired in specific sequences to maximize both efficacy and safety. Sequential therapy embraces the value of providing rapid symptomatic relief to suffering patients while also emphasizing the importance of providing a strategy for safe long-term control of their disease. This is typically accomplished in three phases the clearing phase Phase 1 which employs a rapid-acting or quick fix agent for fast relief the transition phase Phase 2 the most challenging phase in which one attempts carefully patiently and creatively to have the turtle successfully take over from the rabbit without inciting worsening of psoriasis and the maintenance phase Phase 3 the goal of which is long-term control with minimal side effects Table 1 . As the clearing phase agent is usually a superpotent topical steroid there is a risk of rebound of psoriatic lesions while transitioning to the safer less potent maintenance phase agent. The skillful combinational use of therapeutic agents and optimal timing of regimen changes during the transition phase can significantly reduce this risk and is essential to a successful therapeutic course. With all of the therapeutic modalities currently available for psoriasis the possibilities for sequential therapy schemes are endless and include systemic sequential therapy involving the newer biological agents as well as various phototherapy options. This chapter will only focus on the concept of sequential therapy using topical agents. The most common topical sequential therapy scheme in practice today will be described and used to illustrate the principles that guide clinicians in choosing among existing schemes as well as creating new schemes. The concept of sequential therapy using systemic or phototherapy modalities are addressed in other publications. TOPICAL .
