Adapting the Goeckerman Regimen for Psoriasis Treatment in Kenya: A Case Study of Successful Management in a Resource-Limited Setting

Payton Smith,1 Allison Kranyak,1 Chandler E Johnson,1 Kathryn Haran,1 Isabel Muraguri Snr,2 Toby Maurer,3,4 Tina Bhutani,1 Wilson Liao,1 Samson Kiprono2,3 1Department of Dermatology, University of California at San Francisco, San Francisco, CA, USA; 2Department of Dermatology, Moi Teaching and Referral Hospital, Eldoret, Kenya; 3Department of Medicine Moi University, Eldoret, Kenya; 4Department of Dermatology, Indiana University, Indianapolis, IN, USACorrespondence: Payton Smith, University of California, San Francisco, Mount Zion Cancer Research Building, 2340 Sutter St., Box 0808, Floor 04, Room N426, San Francisco, CA, 94115, USA, Tel +1 415-944-7618, Email payton.smith@ucsf.eduIntroduction: Goeckerman therapy, which combines ultraviolet B (UVB) light with crude coal tar (CCT), remains highly effective for moderate-to-severe psoriasis. While it is rarely still used in the USA as effective biotherapeutics have become more readily available, it offers an alternative therapy in developing countries with limited access to newer medications. Moi Teaching & Referral Hospital (MTRH) in Eldoret, Kenya, in collaboration with UCSF, developed a modified Goeckerman regimen suitable for local healthcare needs, condensing the treatment into an intensive two-week program.Case Report: A 55-year-old female with erythrodermic psoriasis traveled 350 kilometers to MTRH. After the diagnosis was confirmed, she underwent a nine-day inpatient treatment with narrow-band UVB phototherapy and topical medications under occlusion as a modified Goeckerman regimen.Response to Treatment: Significant improvement was observed within three days, with full recovery in ten days. Follow-up one month later showed no active lesions, and her psoriasis remained controlled for four months with topical treatments.Conclusion: The modified Goeckerman regimen at MTRH, in collaboration with UCSF, effectively treated severe psoriasis in a challenging healthcare context. This case highlights the potential for adapting established treatments to improve patient outcomes in developing countries with limited access to systemic therapies.Keywords: Goeckerman therapy, erythrodermic psoriasis, UVB phototherapy, global health