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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.

New guideline: Psoriasis in pediatric patients

View the joint AAD-NPF guidelines of care for the management and treatment of psoriasis in pediatric patients.

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Psoriasis guideline

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

Guideline highlights

Joint AAD-NPF guidelines of care for the management and treatment of psoriasis in pediatric patients
  1. Psoriasis is a chronic, multisystem, inflammatory disease that affects approximately one percent of children, with onset most common during adolescence. One-third of psoriasis cases begin in the pediatric years.

  2. Psoriasis may be triggered or exacerbated by infections, physiological, emotional and environmental stressors, as well as cutaneous trauma. Pediatric psoriasis in particular can be associated with emotional stress, increased body mass index, second-hand cigarette smoke, pharyngeal and perianal Group A beta-hemolytic strep infection, Kawasaki disease, withdrawal of systemic corticosteroids.

  3. This guideline addresses the assessment and management of major comorbid conditions associated with psoriasis, including psoriatic arthritis, metabolic syndrome, cardiovascular disease, dyslipidemia, hypertension, insulin resistance, mental health and Inflammatory bowel disease.

  4. Identification of comorbidities requires the attention of the patient’s primary care provider and may have an important impact on management decisions for psoriasis as a cutaneous disease.

  5. Topical corticosteroids with Vitamin D are commonly used as an off label treatment for pediatric psoriasis. However, caution should be used regarding ultra-high and high potency corticosteroids. Topical tazarotene is used in combination with topical corticosteroids for skin or nail psoriasis. Psoriasis treatment of the face and genitalia is effective with off-label topical calcineurin inhibitors either as monotherapy or in combination with topical corticosteroids.

  6. Side effects of Anthralin may limit its use and should not be used for face or genitalia. However, it is effective as a long-term treatment of mild to moderate disease.

  7. Phototherapy is effective for moderate to severe plaque as well as guttate psoriasis and is often used in conjunction with anthralin or coal tar as adjuvants.

  8. Among non-biologic systemic drugs, methotrexate is most commonly used for moderate to severe psoriasis with good efficacy and should be supplemented with folic acid. Cyclosporine is effective for moderate to severe pediatric psoriasis particularly for patients with pustular or erythrodermic psoriasis. While systemic retinoids are effective for guttate psoriasis, pustular and palmar planter psoriasis, it does not cause immunosuppression and can be helpful for transplant patients.

  9. Etanercept and Ustekinumab are FDA approved for four years and older and twelve years and older respectively. Other biologic drugs are used off-label. Biologics can be used in combination with systemic and topical therapies.

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 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.              

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