Consensus document on the evaluation and treatment of moderate‐to‐severe psoriasis: Psoriasis Group of the Spanish Academy of Dermatology and Venereology

Abstract

Psoriasis is a highly prevalent disease with a major impact on quality of life; therefore, appropriate patient management is mandatory. Given that many issues in psoriasis are controversial and not clearly defined by evidence-based medicine, management of psoriasis is very variable. Expert consensus can generate practical guidelines for optimization of patient care. Much has changed since 2009, when the Consensus Document on the Evaluation and Treatment of Moderate to Severe Psoriasis was published by the Spanish Psoriasis Group (GEP) of the Spanish Academy of Dermatology and Venereology (AEDV). The objective of the present consensus document is to provide the dermatologist with updated recommendations for the evaluation and treatment of patients with moderate-to-severe plaque psoriasis. All active members of the GEP of the AEDV were invited to participate in the survey. The final group comprised 46 members from various areas of Spain and with substantial experience in managing psoriasis. A 3-round Delphi process was used to reach consensus. Consistent agreement and consistent disagreement (consensus) required the achievement of at least two of the following three criteria: Criterion 1, which was based on the position occupied by the mean on a scale of 1-9 and an SD <2; Criterion 2, which was based on the median and interquartile range (IQR) on a scale of 1-9; Criterion 3, which considered the percentage of the voting experts on a scale of 1-9. The items studied were definition of severity, therapeutic objectives, indications for systemic treatment and biologic therapy, induction and maintenance periods, therapeutic failure, loss of response, relapse and rebound, continuous and intermittent therapy, screening of patients before treatment, adherence to therapy, follow-up of treatment outcome, combination of drugs, transitioning and associated comorbidities. Consistent agreement or disagreement (consensus) was achieved for 198 items (agreement, 3 criteria 146 items, 2 criteria 43 items; disagreement, 3 criteria 9 items, 2 criteria 0 items) based on the criteria described above. Completion of the Delphi consensus process enabled a broad and experienced group of Spanish psoriasis experts to provide useful and practical guidelines for the management and treatment of patients with moderate-to-severe psoriasis, particularly in areas where evidence is lacking.

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

“…Consequently, in daily practice, a systemic therapy could be indicated even if PASI or BSA is lower than 10. Consensus statements involving also patients’ association have indicated PASI or BSA higher than 5 as the threshold for prescribing systemic treatments . We reached consensus in identifying the most important factors influencing psoriasis severity that are listed in Table .…”

Fatigue in psoriasis: a controlled study

“…A patient with very few psoriasis plaques or limited psoriasis in special locations such as the scalp, genitals, hands and feet may nevertheless be devastated by the disease. Accepted clinical tools for defining psoriasis severity include the PASI, body surface area and the DLQI, which can be used individually or in combinations . While the PASI is an objective measure of psoriasis severity, the DLQI includes elements related to mood, pain and fatigue.…”

PGRN Suppresses Inflammation and Promotes Autophagy in Keratinocytes Through the Wnt/β-Catenin Signaling Pathway

“…Moreover, psoriasis is also regarded to have a connection with cardiovascular disease, depressive illness, obesity, dyslipidemia, hypertension, and psoriatic arthritis [3,4]. Despite conventional systemic therapy (e.g., methotrexate, cyclosporine, acitretin, and photochemotherapy) and biological agents (e.g., efalizumab, etanercept, infliximab, and adalimumab) being advanced [5], the treatment effect was temporary and there were side effects and a potential cumulative toxicity of these drugs [6]. Therefore, it is urgently needed to fully understand the pathogenesis of psoriasis and develop more effective therapies.…”