New psoriasis treatment guidelines announced

| Steve Bieler
In 2016, the American Academy of Dermatology and the National Psoriasis Foundation embarked on an ambitious project: the first updating of psoriasis treatment guidelines in a decade.
That project is reaching a successful conclusion. The first two guidelines – for biologics and comorbidities – are now available to health care providers, payers, patients and caregivers via the Journal of the American Academy of Dermatology.
These guidelines will not simply reinforce dermatologists’ knowledge of psoriasis and how to treat it. The guidelines will also give other health care providers a reference they may have been lacking when caring for people with psoriasis. They will give health insurance companies the up-to-date treatment information they need to design more appropriate coverage policies for their members living with psoriasis. And the guidelines will provide patients with information that can help them improve their knowledge of psoriasis and how to work with their provider to achieve the best health outcome possible.
The evidence-based guidelines were developed by a joint AAD/NPF team composed of dermatologists, a cardiologist, a rheumatologist and patient representatives.
Alan Menter, M.D., is one of the two co-chairs of the guidelines team. Menter, chair of the Division of Dermatology and director of the Dermatology Residency Program at Baylor University Medical Center in Dallas, received an NPF Lifetime Achievement Award in 2013. 
According to the guidelines, the majority of people with mild-to-moderate psoriasis are capable of controlling their disease with topical medications or phototherapy. However, this approach may be insufficient for anyone with moderate-to-severe psoriasis. Biologics may be more successful and have a high benefit-to-risk ratio.
“We in dermatology were late to the biologic revolution,” Menter says. Biologics developed primarily for psoriasis weren’t available to dermatologists until approximately 2004. Today, he notes, dermatologists have a slew of new biologics to choose from. 
“We are very fortunate to have these biologic agents, with others still to come,” he says. “Instead of clearing 60 to 70 percent of our patients like we did 10 to 15 years ago, most of our new biologics are now clearing up 80 to 90 percent of our patients.”
While he welcomes these new treatments, Menter looks ahead to the day when we also have a way of knowing which biologic works best for which patient. “That’s the million-dollar question,” he says. “If you came in to me with severe psoriasis, which biologic would I choose? We do not yet have what I call biomarkers to say that you are better suited for this biologic drug as opposed to that one.”
The new psoriasis guidelines arrive on the heels of the new PsA treatment guidelines, a collaboration between NPF and the American College of Rheumatology. Together, these guidelines mark a new era in the treatment of psoriatic disease.
There are various conditions associated with psoriasis. The most common are psoriatic arthritis (PsA), cardiovascular disease (diseases of the heart and arteries), metabolic syndrome (including type 2 diabetes) and mental health (depression and anxiety). These conditions are the most pressing to screen for.
PsA leads the comorbidity list because of the impact to your health and quality of life. “More doctors and more patients should be aware of the need to look for psoriatic joint disease at each visit,” he says. “Left untreated, 50 percent of such patients will go on to permanent joint destruction, which we cannot allow. Once those joints are destroyed, they’re destroyed.”
Although the concept of comorbidities can be frightening, Menter believes that you can help your own cause to some extent with simple lifestyle changes. “Our psoriasis population is heavier than the population without psoriasis,” he says. “That’s not just driven by people eating too much or not exercising enough. If you are 20 pounds overweight, and you’ve been thinking it’s due to your lack of discipline, it might also be due to having psoriasis. Psoriasis affects your metabolism. 
“This is why it’s very important that you make sure you have your blood pressure and heart checked regularly and treated if need be. It’s also important that you keep your weight down to the best of your ability, that you exercise and cut back on fatty foods.”
Dermatologists are not specialized in treating heart disease, diabetes or hypertension. They can partner with colleagues in these areas, but also with primary care physicians. Menter encourages dermatologists to work with primary care physicians. “Most PCPs are not aware of all the comorbidities associated with psoriasis,” he says.
Menter points out that the guidelines do not dictate how doctors should treat their patients. They do not define the standard of care and they definitely do not take the place of the conversations you should be having with your doctor about your treatment plan. 
Instead, the guidelines provide an education. “Thanks to these guidelines, your health care provider now has the clinical evidence of the past 10 years, including biologic treatments and the latest findings on comorbidities, at his or her fingertips. You can learn this, too. You should work in partnership with your doctor to find the treatment that works for you and that you want to do.”
Guidelines to come
As of March 2020, the AAD/NPF team has published the following guidelines: 
If you'd like to learn more about the new psoriasis guidelines, or if you need help finding a doctor with whom you can discuss your psoriasis and its treatment, contact our Patient Navigation Center for free, personalized assistance. 

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For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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