Understanding the new Psoriasis Treatment Guidelines
NPF and the American Academy of Dermatology have released four sections of the new clinical guidelines outlining best practices for managing psoriasis. The guidelines, which were published online in the Journal of the American Academy of Dermatology, were developed by an expert group composed of dermatologists, a cardiologist, a rheumatologist and patient representatives.
The two guideline sections published in 2019 relate to biologic therapies, comorbidities, phototherapy and pediatric patients. There will be two more sections released in 2020. Together, they represent the first updating of psoriasis treatment guidelines in a decade. They provide health care professionals, patients, insurers and caregivers with the most accurate, up-to-date, evidence-based approaches for the treatment and monitoring of people with psoriasis.
The current published recommendations:
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, which have a high benefit-to-risk ratio, may be more successful in treating patients with more severe disease.
Psoriasis is a chronic inflammatory disease that affects multiple systems of the body, not just the skin. Comorbidities associated with psoriasis include psoriatic arthritis (PsA), cardiovascular disease (diseases of the heart and arteries), metabolic syndrome (including type 2 diabetes) and mental health illnesses (depression and anxiety). Patients should be screened for these comorbidities, as they can impact a patient's treatment plan. Doctors and patients should be aware of the need to look for psoriatic joint disease and potential problems with comorbid conditions at each visit. Patients should know that making simple lifestyle changes, such as not smoking and limiting alcohol, may be beneficial.
There are many different phototherapy treatment options, and some types of phototherapy are better for certain types of psoriasis. Phototherapy can also be used in combination with other types of psoriasis treatments. A dermatologist should also consider patient preference, including dosing frequency, cost, and proximity to a phototherapy unit, before beginning phototherapy treatment.
Psoriasis affects approximately 1 percent of children, with disease starting most often in adolescence. Monitoring and treating the emotional health of children and teens with psoriasis is important, due to potential teasing and bullying by their peers. Fortunately, treatment options for this population have improved, and evidence-based recommendations are presented. The new guideline is divided into sections focused on the overall management of psoriasis in the pediatric population.
Systemic non-biological therapies
Provides a detailed discussion of the efficacy and safety of the most commonly used 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.
In 2020, the AAD/NPF team will publish the last section of the guidelines: topicals.
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