The National Psoriasis Foundation (NPF) and the American Academy of Dermatology (AAD) have released five sections of 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 published guideline sections relate to biologic therapies, comorbidities, phototherapy, pediatric patients and systemic non-biologic therapies. The sixth section, topicals, is expected in Summer 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 treatment and care recommendations:
Biologics only target specific parts of the immune system, differentiating them from traditional systemic drugs that impact the entire immune system.
Biologics are prescribed for individuals with plaque psoriasis and psoriatic arthritis. They are a viable option for those who have not responded to or have experienced harmful side effects from other treatments.
Biologics can have multiple indications. Often, they are indicated for moderate-to-severe plaque psoriasis, but may include other types of psoriasis and psoriatic arthritis.
Your health care provider can help determine if biologics are the appropriate treatment for you.
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 illnesses (depression and anxiety). Patients should be screened for these comorbidities, as they can impact a patient's treatment plan. Health care providers and patients should be aware of the need to look for psoriatic joint disease and potential problems with comorbid (related) 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 available. However, some 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, skin tone (doses may very based on this factor), cost and proximity to a phototherapy unit, before beginning phototherapy treatment.
Psoriasis affects approximately 1 percent of children, with the 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.
Provide recommendations for the use of topical treatment and emphasize dermatologists’ role in monitoring and educating patients about benefits and risks associated with this treatment option. The guidelines also covers recommendations on how to assess the severity of psoriasis using different tools such as BSA, PASI, PGA, and others that can be used in clinical practice.
Also included is an alternative medicine section, which summarizes the treatment of psoriasis with traditional Chinese medicine, herbal therapies, diet regimen, and wellness activities. Due to the lack of or conflicting evidence, however, the guidelines do not provide recommendations about the use of these alternative options.