To help health care providers treat the millions of people affected by psoriasis while improving the patient’s quality of life, the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) have released guidelines related to the use of biologics, comorbidities, use of phototherapy, management of pediatric patients, and use of systemic non-biological therapies.
The guidelines were developed by an expert working group composed of dermatologists, a cardiologist, a rheumatologist, and patient representatives. Each section has been published online in the Journal of the American Academy of Dermatology (JAAD).
Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.
An overview of the biologic medications available for the treatment of moderate-to-severe psoriasis. In addition to outlining research on the effectiveness of these drugs and recommendations for their use, the guidelines describe the potential side effects of each biologic.
“Before starting any psoriasis treatment, it’s important for patients to understand its potential effects, both positive and negative,” says board-certified dermatologist Alan Menter, M.D., FAAD, co-chair of the guidelines working group. Dr. Menter is the chair of the Division of Dermatology and director of the Dermatology Residency Program at Baylor University Medical Center in Dallas. He received an NPF Lifetime Achievement Award in 2013.
“This guideline provides physicians with the information they need to discuss biologic medications with their patients and help them choose the treatment plan that’s best for them,” he says.
Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities.
This section of the guideline focuses on the comorbidities that may be associated with psoriatic disease, including psoriatic arthritis, cardiovascular disease, metabolic syndrome, malignancy, renal disease, sleep apnea, chronic obstructive pulmonary disease, uveitis, hepatic disease, and inflammatory bowel disease. The guidelines also address mental health and the increased risk of anxiety and depression in patients with psoriasis. Additionally, the guidelines discuss lifestyle choices such as smoking and alcohol consumption, as those can affect the risk of developing psoriasis or make the condition worse in those who already have it.
“We believe this guideline will be a vital resource in the treatment of psoriasis,” says board-certified dermatologist Craig A. Elmets, M.D., FAAD, who co-chairs the work group with Dr. Menter. “Doctors should be aware of the conditions associated with this disease, educate patients accordingly, and work with those patients and other physicians to ensure that each patient receives the appropriate screening and treatment.”
Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with phototherapy.
This guideline addresses multiple phototherapy treatment options ranging from widely used ultraviolet modalities to the combined use of photosensitizing agents to newer and less prevalent choices, which have demonstrated promise. The recommended dosing regimen, efficacy and adverse effects of the various phototherapy modalities used as monotherapy or in combination with other psoriasis therapies to treat moderate-to-severe psoriasis in adults is assessed.
Joint AAD-NPF guidelines of care for the management and treatment of psoriasis in pediatric patients.
Comprehensive care of children with psoriasis requires attention to the overall physical, mental and emotional health of the patient. The new guideline is divided into six sections focused on overall management, including measuring disease severity, assessing triggers, screening for comorbidities and treating with topical, photo, systemic and biologic therapies.
“A working knowledge of differences in pediatric compared to adult psoriasis and a reference document to guide decisions to optimize clinical care is a welcomed addition to the management toolbox,” says Kelly Cordoro, M.D., of the San Francisco School of Medicine at the University of California and NPF Medical Board member.
Joint AAD-NPF guidelines of care for the management of psoriasis with systemic non-biological therapies.
This section of the guideline provides a detailed discussion of the efficacy and safety of the most commonly used non-biologic systemic medications – including methotrexate, cyclosporine, and acitretin – and recommendations to assist prescribers in initiating and managing patients on these treatments. The guideline discusses newer therapies, including tofacitinib and apremilast, and briefly reviews other medications, including therapies that are no longer widely used for the treatment of psoriasis.
Topical Therapy and Alternative Medicine Modalities
Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.
This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine (AM) will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.