Treating to Target

A doctor smiles at her patient as she writes on a clipboard.

The desire to give psoriasis patients the best care possible drove the National Psoriasis Foundation’s efforts to establish the first psoriasis treatment targets in the U.S. Published by the Journal of the American Academy of Dermatology in November 2016 as an effort led by the NPF Medical Board, the targets give patients and providers an easy way to work together to achieve clear skin.

The targets were developed through research, discussion, and consensus-building among medical board members, other leaders in the field of dermatology, practicing dermatologists, and psoriasis patients. What resulted is a blueprint for what degree a patient should aim to achieve clear or almost-clear skin and in what time frame to evaluate their treatment plan.

“It’s important to have treatment targets because, while we all think we’re doing the best job we possibly can for our patients, having goals that we can objectively measure ourselves against keeps us from growing complacent,” says Abby Van Voorhees, M.D., chair of dermatology at Eastern Virginia Medical School and chair of the NPF Medical Board.

Here are the specifics:

  • The goal is to reduce a patient’s psoriasis down to 1 percent body surface area (BSA) or less three months after starting a new treatment. Once the patient has reached that 1 percent goal, you and the patient will schedule regular check-ups every six months or so to make sure he or she is still experiencing the same amount of improvement.
  • If your patient doesn’t meet the target after three months of treatment, the treatment targets offer you some options. If the patient is experiencing some improvement, one option is to wait and see. In addition to the treatment target, the recommendations also offer what can be considered an “acceptable response” after three months: psoriasis covers 3 percent BSA or less, or the patient has experienced 75 percent improvement in BSA.
  • If the acceptable response has been met, you and your patient may want to stick with that treatment for another three months. If you don’t see enough improvement after six months — or the acceptable response hasn’t been met after three months — it’s time to discuss other or additional treatment options with your patient.
  • Changing the dose, adding a new treatment, or switching to a different treatment are all possibilities.

The treatment targets — which do not recommend any specific treatments — come at a time when there are a wealth of safe and effective treatment choices for psoriasis. Many different treatment options can be used to meet the targets. At times, you may have to adjust the targets to meet the needs of certain patients, taking into account their comorbidities, their other medications, or adverse events they’ve experienced with particular psoriasis or other medications. The doctor-patient relationship is critical.

Specific patient populations, such as children and pregnant women, may require specific considerations.

For people with psoriasis, achieving clear skin improves more than just their skin. The list of comorbidities associated with psoriasis is extensive, including cardiovascular disease, diabetes, and depression. Treating to reduce inflammation in the skin may reduce systemic inflammation, which can lead to better long-term health outcomes. If you’re wondering how to start a conversation about treatment goals with your patients, these targets can guide that discussion, increase patient satisfaction, and help you both see the best results possible.

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