Donate For Public and Patients Store Search

Welcome!
Advertisement

Psoriasis clinical guideline


Psoriasis is a chronic, inflammatory multisystem disease, which affects up to 3.2% of the US population. The guideline is based on current evidence, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients about benefits as well as risks that may be associated.

Psoriasis guideline

Access the full psoriasis guideline from JAAD (free access):

Guideline highlights

Guidelines of care for the management and treatment of psoriasis with phototherapy: What guideline addresses

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 for each of the following phototherapy treatments:

  • Narrowband UVB

  • Broadband UVB

  • Targeted UVB

    • Excimer laser

    • Excimer light

    • Targeted narrowband UVB light

  • UVA with psoralens (PUVA)

    • Topical

    • Oral

    • Bath

  • Photodynamic therapy

  • Grenz ray

  • Climatotherapy

  • Visible light

  • Goeckerman therapy (not a form of phototherapy)

  • Pulsed dye laser (PDL)

A prior guideline was last published in 2009. This 2019 update provides significant additional scope including:

  • Evidence-based use of phototherapy in different types of psoriasis

  • Evidence-based use of phototherapy in combination with other treatment modalities

  • New modalities and specific applications identified within the past decade

  • Safety data including:

    • Adverse events

    • Contraindications

    • Pregnancy and lactation

    • Risk of malignancy

  • Role of the dermatologist: Identifying those patients in whom phototherapy may be a viable or preferred treatment option, either as monotherapy or an adjunct, and working with the patient to outline risks and benefits and to make a joint decision on the best modality and dosing schedule.

  • Role of patient preferences addresses the need of openly discussing safety and efficacy factors that may have an impact on patient decision to start certain treatments.

  • Patient education referring to the importance of educating psoriasis patients regarding etiology, comorbidities and treatment options associated with psoriasis were discussed .

Guidelines of care for the management and treatment of psoriasis with phototherapy: What's been updated from 2009 guideline

A prior guideline was last published in 2009. This 2019 update provides significant additional scope including:

  • Evidence-based use of phototherapy in different types of psoriasis

  • Evidence-based use of phototherapy in combination with other treatment modalities

  • New modalities and specific applications identified within the past decade

  • Safety data including:

    • Adverse events

    • Contraindications

    • Pregnancy and lactation

    • Risk of malignancy

  • Role of the dermatologist: Identifying those patients in whom phototherapy may be a viable or preferred treatment option, either as monotherapy or an adjunct, and working with the patient to outline risks and benefits and to make a joint decision on the best modality and dosing schedule.

  • Role of patient preferences addresses the need of openly discussing safety and efficacy factors that may have an impact on patient decision to start certain treatments.

  • Patient education referring to the importance of educating psoriasis patients regarding etiology, comorbidities and treatment options associated with psoriasis were discussed .

Guidelines of care for the management and treatment of psoriasis with biologics
  • Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the US population.

  • Based on current evidence, this guideline addresses important clinical questions regarding biologic agents used as monotherapy or in combination with other psoriasis therapies to treat moderate to severe psoriasis in adults, emphasizing treatment recommendations.

  • The guideline assesses the efficacy, effectiveness, effect of switching and adverse effects of all biologic agents that have been approved by the Food and Drug Administration (FDA) for the treatment of psoriasis or are currently undergoing the FDA approval process:

    • TNF inhibition

      • etanercept (FDA approval 04/30/2004)

      • infliximab (FDA approval 09/27/2006)

      • adalimumab (FDA approval 01/22/2008)

      • certolizumab (FDA approval 05/27/2018)

    • IL-12/IL-23 inhibition

      • ustekinumab (FDA approval 09/25/2009)

    • IL-17 inhibition

      • secukinumab (FDA approval 01/21/2015)

      • ixekizumab (FDA approval 03/22/2016)

      • brodalumab (FDA approval 02/15/2017)

    • IL-23 inhibition

      • guselkumab (FDA approval 07/13/2017)

      • tildrakizumab (FDA approval 03/21/2018)

      • risankizumab (FDA approval pending)

  • This guideline also highlights the need to educate patients regarding the etiology, comorbidities, and treatment options associated with psoriasis, as well as the dermatologist’s role in monitoring patients and educating them regarding the risks and benefits associated with biologic agents.

  • The guideline emphasizes the need for dermatologists to be up-to-date regarding biologic safety information, as well as the importance of multidisciplinary care to improve outcomes for patients.

Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities
  • Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the US population.

  • Psoriasis is associated with several comorbidities, many of which first manifest as skin disease.

  • This guideline addresses the assessment and management of major comorbid conditions associated with psoriasis, including arthritis, heart disease, metabolic syndrome, smoking, excessive alcohol intake, inflammatory bowel disease, and psychiatric disorders.

  • Identification of comorbidities may require the attention of the patient’s primary care provider and may impact management decisions for cutaneous disease.

  • The guideline also highlights the dermatologist’s role in identifying comorbidities by screening for them and/or alerting psoriasis patients’ primary care physicians about these associations.


Psoriasis Resource Center for patients

Are you looking for information on how to treat and manage your psoriasis? The Academy offers a wealth of treatment help for the public in the Psoriasis Resource Center.


Timeline for other psoriasis guidelines:

  • Joint AAD-NPF guidelines of care for the management of psoriasis in pediatric patients: Expected in the fourth quarter of 2019

  • Joint AAD-NPF guidelines of care for the management of psoriasis with non-biologics: Expected in the first quarter of 2020

  • Joint AAD-NPF guidelines of care for the management of psoriasis with topicals: Expected in the second quarter of 2020


View the AAD guidelines disclaimer.              

Advertisement