Diagnostic and therapeutic guidelines for plaque psoriasis - Brazilian Society of Dermatology

Abstract

Psoriasis is a chronic inflammatory disease that affects 1.3% of the Brazilian population. The most common clinical manifestations are erythematous, scaling lesions that affect both genders and can occur on any anatomical site, preferentially involving the knees, elbows, scalp and genitals. Besides the impact on the quality of life, the systemic nature of the disease makes psoriasis an independent risk factor for cardiovascular disease, especially in young patients with severe disease. By an initiative of the Brazilian Society of Dermatology, dermatologists with renowned clinical experience in the management of psoriasis were invited to form a work group that, in a partnership with the Brazilian Medical Association, dedicated themselves to create the Plaque Psoriasis Diagnostic and Treatment Guidelines. The relevant issues for the diagnosis (evaluation of severity and comorbidities) and treatment of plaque psoriasis were defined. The issues generated a search strategy in the Medline-PubMed database up to July 2018. Subsequently, the answers to the questions of the recommendations were devised, and each reference selected presented the respective level of recommendation and strength of scientific evidence. The final recommendations for making up the final text were worded by the coordinators.

Validation of the Skindex-17 quality of life assessment instrument for a Brazilian population

“…29 This behavior should alert to the influence of gender when describing the impact of HRQoL on dermatological diseases, especially when HRQoL scores subside therapeutic decisions, as occurs in some psoriasis treatment flowcharts. 30 …”

Gamma Delta T Cells and Their Pathogenic Role in Psoriasis

“…Psoriasis is a chronic inflammatory skin disease with an autoimmune component and a strong genetic basis. Plaque psoriasis is characterized by well-defined, raised, chronic erythematous plaques with silver patches observed commonly in the elbows, knees, scalp, umbilicus, and lumbar area (11)(12)(13). The worldwide reported prevalence of psoriasis ranges from 0.09% to 11.43% and results in a severe economic burden to patients and a significant challenge to public health (14,15).…”

Cost-effectiveness of moderate-to-severe psoriasis biologic treatments in Brazilian private healthcare system: cost-per-responder results derived from a network metanalysis

“…Regardless of PASI 75 historically substantial presence as a primary endpoint in PsO randomized controlled trials (RCT), updates to clinical guidelines have reinforced that PASI 90 response may represent a better efficacy outcome for moderate-to-severe disease. Its achievement is related to higher clinically significant improvements in quality of life, providing patients with greater satisfaction with treatment (Arnone et al, 2019;Puig, 2015). For example, in a posthoc analysis of a phase 2 PsO trial, only 33% of patients achieving a PASI 75 response reached a DLQI score of 0 or 1 (meaning the lower impact on QoL).…”