Psoriasis guideline

Guidelines of care for the management and treatment of psoriasis with phototherapy

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Access the full psoriasis with phototherapy guideline from JAAD

 

Overview

  • Psoriasis is a chronic, inflammatory multisystem disease, which affects up to 3.2% of the U.S population. This guideline addresses important clinical questions regarding psoriasis phototherapy.  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.
  • This guideline addresses multiple phototherapy options, including widely used ultraviolet modalities, combined use of photosensitizing agents, and newer, promising, but less prevalent choices. The recommended dosing regimen, efficacy, and adverse effects of the various phototherapy modalities used as monotherapy or in combination with other psoriasis therapies for psoriasis in adults is described 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; using it as monotherapy or an adjunct treatment; working with patients to outline risks and benefits
    • Role of patient preferences: carefully discussing safety, efficacy and convenience factors that may influence decisions to initiate phototherapy; helping the patient decide whether phototherapy is a sensible and practical treatment option; making a joint decision on the optimal modality and dosing schedule.  
    • Role of psoriasis support groups, such as the National Psoriasis Foundation (www.psoriasis.org) and the International Federation for Psoriasis (www.IPFA-pso.org): providing psoriasis and psoriatic arthritis patients with the help they need to best manage their disease; offering valuable information about phototherapy and alternatives to phototherapy; providing answers to questions about phototherapy; enabling member support groups, webinars and other initiatives.

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

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Access the full psoriasis with biologics guideline from JAAD
   

Guideline highlights:

  • Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2 percent of the U.S 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 U.S. Food and Drug Administration 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


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Access the full psoriasis with awareness and attention to comorbidities guideline from JAAD
   

Guideline highlights:

  • Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2 percent of the U.S 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.


Timeline for other psoriasis guidelines:

  • Joint AAD-NPF guidelines of care for the management of psoriasis with phototherapy: Expected in the second quarter of 2019
  • Joint AAD-NPF guidelines of care for the management of psoriasis in pediatric patients: Expected in the third quarter of 2019
  • Joint AAD-NPF guidelines of care for the management of psoriasis with non-biologics: Expected in the fourth quarter of 2019
  • Joint AAD-NPF guidelines of care for the management of psoriasis with topicals: Expected in the first quarter of 2020

Additional resources