Guidance diagram for phototherapy or systemic treatments
When are patients candidates for phototherapy or systemic treatments (including biologics)?
National Psoriasis Foundation Medical Board guidance for managed care systems
Psoriasis has a tremendous impact on the health-related quality of life of patients who suffer with the disease. Phototherapy and systemic treatments are used for patients with more severe forms of the disease. These treatments have the potential for both severe adverse effects and direct impact on patients' lives. The decision to undertake systemic treatment of psoriasis is a complex one that requires both experience and judgment on the part of the physician.
The approach presented here provides guidance that may be used by physicians, insurers and managed health care systems to help document and assure the appropriateness of candidates for these treatments.
What are systemic and biologic medications?
Systemic medications are system-wide (affect the entire body) treatments for moderate to severe psoriasis. These medications include methotrexate, cyclosporine, oral retinoids, biologics and other systemic medications.
Several of the new systemic treatments available to treat psoriasis and psoriatic arthritis, called "biologics," are made from living sources, such as viruses, animals and people. Biologics are a subset of systemic medications. Biologics are distinguished as a class of drugs unlike other systemic drugs because they are injected or infused into the body and not taken orally.
These new drugs target specific parts of the immune response. In general, biologics are designed to block or eliminate various immune system cells involved in psoriasis. Other systemic medications for psoriasis can also impact the immune system, but usually in a broader, less specific way.
Guidance for phototherapy or systemic treatment
Is a psoriasis patient a candidate for phototherapy or systemic treatment? If the answer to any of questions 1-4 is "yes," the disease is sufficiently severe to warrant consideration of systemic treatment or phototherapy.
If the answer to any of questions 5-7 is also "yes," phototherapy is not an option.* If the answers to questions 4-7 are all "no," the patient is a candidate for either phototherapy or systemic treatment.
Work schedules or other obligations may preclude compliance with a phototherapy regimen. Other factors such as ethanol use, past cumulative doses of methotrexate or cyclosporine, a history of hypertension, or family planning issues may influence decisions about the ideal treatment for any particular patient.
*Phototherapy can be used for the treatment of psoriasis skin lesions in patients with psoriatic arthritis, but these patients also require systemic treatment for the joint involvement.
| 
