Psoriasis Foundation announces new algorithm for the treatment of psoriasis
Treatment strategies targeted at specific patient types and early aggressive treatment with systemic medications
Portland, Ore., Oct. 11, 2002—The National Psoriasis Foundation today released a set of algorithms for the medical management of psoriasis using an innovative approach of therapy based on specific patient types, employing combination therapies and bringing currently under utilized systemic treatments to the forefront of options.
"Psoriasis is a life-long, chronic, recurrent disease that can be tremendously frustrating for physicians and their patients," said Mark Lebwohl, M.D., professor and chairman of the Department of Dermatology at Mount Sinai School of Medicine of NYU, and co-author of the algorithms. "The algorithms will help patients with psoriasis by providing physicians with different ways to take control of the disease early on, using a variety of systemic and topical medications along with phototherapy. The algorithms address not only specific types of psoriasis, but also different patient types, such as those with other conditions."
Gail Zimmerman, president and CEO of the National Psoriasis Foundation, said, "These guidelines are important in helping physicians and patients find new ways to manage psoriasis with treatments they may have used before that are available to them right now. We are hopeful that this tool will help people with psoriasis improve their quality of life."
Physician Pocket Guide
The treatment algorithms are the result of a landmark consensus meeting held in March 2002. They were developed by four highly regarded physician researchers from leading institutions: Dr. Lebwohl; Alan Menter, M.D., Baylor University Medical Center; John Koo, M.D., University of California, San Francisco; and Steven R. Feldman, M.D., Ph.D., Wake Forest University School of Medicine. They all serve on the Psoriasis Foundation Medical Advisory Board and are members of the American Academy of Dermatology.
The algorithms have been organized into a pocket-size handbook called Psoriasis: Treatment Options and Patient Management. They outline specific treatment recommendations based on type of psoriasis—plaque, guttate, erythrodermic, palmoplantar, or pustular, nail and scalp psoriasis—as well as disease severity and comorbidities such as hypertension or melanoma, which can occur in psoriasis patients.
View a sample page of the algorithm booklet in Adobe Acrobat format. 
Treatment strategies
According to a recent Psoriasis Foundation survey, only 35 percent of people with moderate to severe psoriasis have ever tried phototherapy or systemic therapy and 25 percent of patients are very unsatisfied with their physicians' lack of aggressive treatment. These guidelines validate the early and aggressive use of systemic therapies in patients with moderate to severe psoriasis, along with other therapeutic options such as topical therapy and phototherapy. While many physicians have been cautious about prescribing systemic agents, often relegating them to a last line of defense, the new guidelines delineate how and when to employ them earlier in the treatment cycle, thereby giving physicians the confidence to utilize them more aggressively and thus meet the needs of their patients.
According to the algorithm for plaque psoriasis, the most common of all types of psoriasis, the systemic treatment, acitretin (Soriatane®) combined with UVB is recommended immediately following a standard topical treatment. Acitretin with UVB is also recommended as first-line therapy for psoriasis patients with hypertension.
Other systemic therapies, such as cyclosporine (Neoral®) and methotrexate are recommended as first-line therapy for erythrodermic and guttate psoriasis. New treatments currently in development will be added as they are approved.
"Our many years of experience in using these therapies gave us the confidence to move them to first- or second-line therapy in many cases," Dr. Lebwohl said.
The new algorithms also explore appropriate therapies to use in various treatment strategies, such as:
- combination – using two or more treatments;
- rotation – using therapeutic agents for a specified period of time and then switching to others;
- and sequential, using a fast-acting agent initially to clear the psoriasis, followed by a less toxic agent for long-term maintenance therapy to reduce the frequency of flare-ups.
Lowering doses or switching between therapies yields fewer side effects and avoids cumulative toxicity while eliciting maximum efficacy from each individual therapy.
"Psoriasis is a systemic disease with genetically and immunologically modulated components, and therapy must be individualized to each patient," Dr. Lebwohl said. "Because the condition is episodic, chronic and essentially incurable, we need both acutely acting agents and long-term maintenance agents."
Socioeconomic impact of psoriasis
Between 150,000 and 260,000 new cases of psoriasis are diagnosed each year in the United States. Psoriasis affects all ages, genders, races and ethnicities. From an economic standpoint, psoriasis patients in the U.S. lose an estimated 56 million hours of work each year. In addition, patients spend between $1.6 billion and $3.2 billion annually in treating the disease. Approximately 1.5 million U.S. adults have moderate to severe psoriasis.
The financial costs are greater for those with more severe disease and are associated with a lower quality of life. These costs are more than those of other life-long illnesses such as emphysema and epilepsy.
Psoriasis can profoundly affect a person's lifestyle, emotional well-being, social life and ability to work. In fact, data show that the physical and mental functioning of people with psoriasis can be as impaired as that of patients with cancer, arthritis, heart disease, diabetes and depression. The difficulties physicians and patients often face finding an effective treatment strategy are compounded by the number of psoriatic patients with concomitant conditions that must be taken into account when devising treatment. The development of the algorithms has provided a detailed overview of the best treatment options for a wide range of special patient populations.
More information about psoriasis is available from the National Psoriasis Foundation, the leading nonprofit organization providing information, support and services to people with psoriasis and psoriatic arthritis and healthcare professionals at 800-723-9166 or visit the Web site at www.psoriasis.org. Copies of the handbook have been distributed to all U.S. office-based dermatologists, and additional copies may be requested from the Psoriasis Foundation.
The algorithms project was an Approved Education Partnership of the National Psoriasis Foundation and was supported by an educational grant from Roche.
Media inquiries
Marketing and communications department
National Psoriasis Foundation
503.244.7404, ext. 413
pfasano@psoriasis.org
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