Etanercept With Tacrolimus for Psoriasis

Inclusion Criteria * Adults 18 years or older with moderate to severe psoriasis, who are candidates for systemic or phototherapy, with a baseline score of 6 or higher on the target lesion score, and a baseline score of 3 or higher on the Physician's Global Assessment, on each side of the body * Patients who are already on a stable dose of etanercept for at least 2 months and have the above criteria * Subjects must have target lesions on each side of the body that are at least 1.5 cm in diameter and roughly symmetrical in appearance and location Exclusion Criteria * Inability to understand consent or comply with study requirements * Pregnancy or unwillingness to use adequate birth control method * Lactation * Psoriasis plus ultraviolet A (PUVA) or systemic therapy within the past 4 weeks (other than a stable dose of Enbrel for at least 2 months) * Ultraviolet B (UVB) or topical therapy (other than over-the-counter moisturizers) within the past 2 weeks * Active tuberculosis or other opportunistic infection * Demyelinating disease * Uncontrolled congestive heart failure * Known allergy to or any contraindications to using topical tacrolimus or etanercept * Lack of insurance coverage or inability/refusal to pay out of pocket for etanercept and standard of care laboratory tests and PPD/CXR