Guidelines

Guidelines

Societies, associations and institutes develop clinical guidelines for the treatment and management of Psoriasis at local, national, and international levels. The selections of guidelines below will aid healthcare professionals in the diagnosis, treatment, and management of their patients.

View the latest European S3-Guidelines on the Systemic Treatment of Psoriasis Vulgaris.

Topical treatment guidelines

Guidelines for the management of psoriasis with topical therapies were developed by the American Academy of Dermatology (AAD) in 2009 (Menter et al., 2009). These guidelines highlight that the majority of patients with psoriasis have limited disease (<5% body surface area [BSA] involvement) and can be safely and effectively treated with topical agents tailored to meet individual patients’ needs (Menter et al., 2009). Updates to these guidelines are expected to be published by the AAD in collaboration with the National Psoriasis Foundation (NPF) in the second quarter of 2020. All AAD guidelines can be accessed below.

Joint AAD-NPF guidelines on biologic and non-biologic treatment

All AAD guidelines are freely available. Joint AAD-NPF guidelines highlight that anti-TNF biosimilars approved by the FDA should be considered as interchangeable with the reference brand and that biologics may lose efficacy in patients who initially respond well to treatment (Menter et al., 2019).

The most recent joint AAD-NPF guidelines of care for the management of psoriasis with systemic non-biological therapies provides detailed information on some of the most widely prescribed non-biologic drugs including methotrexate, ciclosporin, and acitretin, as well as newer therapies such as tofacitinib and apremilast. Other medications including those not yet approved in the US and others which are no longer widely used for the treatment of psoriasis are also discussed. Based on what is currently known about their safety and efficacy as well as other factors influencing treatment selection, these guidelines offer recommendations intended to inform prescribers on the appropriate use of these drugs (Menter et al., 2020a)

Joint AAD-NPF guidelines on care for the management and treatment of psoriasis in paediatric patients

There are important pathogenic distinctions between paediatric- and adult-onset psoriasis. These guidelines offer recommendations tailored to meet the unique needs of paediatric patients, focusing on treatment options, comorbidities and quality of life. It includes a summary of new evidence regarding the safety and efficacy of both biologic and non-biologic systemic treatments and there is a strong focus on the importance of establishing a positive patient-physician relationship (Menter et al., 2020b).

Joint AAD-NPF guidelines on care for the management and treatment of psoriasis with phototherapy

Several different types of phototherapy are currently available to treat psoriasis and may be prescribed as a monotherapy or in combination with other treatments. These guidelines are intended to aid prescribing physicians by offering evidence-based recommendations regarding the appropriate use of this treatment option for psoriasis in adult patients (Elmets et al., 2019b).

Psoriasis and comorbidity guidelines

To help ensure physicians include prompt diagnosis of concomitant disease and prevent and treat any comorbidity, the EADV and the AAD-NPF have developed  precise, easy-to-use tools for systematising the diagnosis of comorbidity in patients with psoriasis and facilitate decision making regarding referral and treatment of patients diagnosed with an associated disease.

EADV Practical Guidance on Comorbidity - Europe

A downloadable PDF of the EADV Clinical Practice Guideline for an Integrated Approach to Comorbidity in Patients with Psoriasis.

AAD-NPF guidelines were also published in 2019 covering the management and treatment of comorbidities that occur in patients with psoriasis.

VIEW

The guidelines provide an overview of the most common comorbidities and recommendations for screening and referral of these conditions (Elmets et al., 2019a). The importance of patient and physician education surrounding these comorbidities was highlighted by Randy Beranek, president and CEO of the NPF (AAD, 2019):

“it is critical for both patients and doctors to understand the complexity of psoriasis. It is not just a skin disease; it is a serious condition that can affect all aspects of a patient’s health”.

Professor Andrew Blauvelt discussed the comorbidities that are a challenge to psoriasis treatment.

Guidelines references

Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–1072.

Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019a;80(4):1073–1113.

Elmets CA, Lim HW, Stoff B, Connor C, Cordoro KM, Lebwohl M et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019b;81(3):775-804.

Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR et al. Joint AAD-NPF guidelines of care for the management of psoriasis with systemic non-biological therapies. J Am Acad of Dermatol. (2020a). doi: https://doi.org/10.1016/ j.jaad.2020.02.044.

Menter A, Cordoro KM, Davis DMR, Kroshinsky D, Paller AS, Armstrong AW et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020b;82(1):161–201.

Useful links

Associations are able to provide educational support and guidance to healthcare professionals, specific to the country or region for which they serve. The links below will take you to sites outside the Psoriasis Learning Zone where you can further your knowledge of the disease, including the treatment and management options available.

National societies

Societies are able to provide educational support and guidance to healthcare professionals specific to the country or region for which they serve. The links below will take you to sites outside the Psoriasis Learning Zone where you can further your knowledge of the disease, including the treatment and management options available.

Getting to the Heart of Comorbidities

Presented by Dr. Nehal Mehta

Research continues to link individuals with psoriasis to a host of other physical and psychological diseases. From a physiological standpoint, the inflammation involved in psoriasis plays a large role in related conditions such as cardiovascular disease, cancer, Crohn’s and many others. Social stigma and the general public’s lack of knowledge about psoriasis leads to psychological issues such as depression and anxiety among those with the disease.

Getting to the Heart of Comorbidities is an online, pre-recorded webinar that will educate patients and caregivers on the related conditions associated with psoriasis.

This material is published with permission from the US-based National Psoriasis Foundation, whose mission is to drive efforts to cure psoriatic disease and improve the lives of those affected. Learn more at www.psoriasis.org. This link will take you to an external site outside the control of epgonline.org.