New guidance for treating your psoriasis patients

To help physicians treat the millions of people affected by psoriasis while improving the patient's quality of life, the American Academy of Dermatology and the National Psoriasis Foundation have released sections of guidelines.

The guidelines were developed by an expert work 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 adverse 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 work group. 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

Focuses on the other health conditions that may be associated with psoriatic disease, including psoriatic arthritis, cardiovascular disease, metabolic syndrome and inflammatory bowel disease. The guidelines also address the increased risk of anxiety and depression in psoriasis patients, as well as the effects of smoking and alcohol consumption, which can increase one’s risk of developing the disease 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 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 was 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"

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.

The last psoriasis guideline is slated for publication in JAAD in 2020: topicals​.

Refer to the following CME Psound Bytes podcasts

“Guidelines for Managing and Treating Pediatric Psoriasis” (Dec. 17, 2019)

“Comorbidities Guidelines: Lifestyle Changes” (Jan. 8, 2020)

“One Plaque Matters: The Impact of Cardiovascular and Psoriatic Disease” (Feb. 6, 2020)