German S3-guidelines on the treatment of psoriasis vulgaris (short version)

Abstract

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance (Richards et al. in J Am Acad Dermatol 41(4):581-583, 1999). To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis first published in 2006 and now updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. This short version of the guidelines presents the resulting series of therapeutic recommendations, which were based on a systematic literature search and discussed and approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs, as well as detailed information on how best to apply the treatments described (for full version please see Nast et al. in JDDG Suppl 2:S1-S104, 2011 or http://www.psoriasis-leitlinie.de ).

Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO‐ABLE study

“…Although many patients with mild‐to‐moderate psoriasis are treated with topical therapy alone,6, 7, 8 adherence remains a significant issue as the daily treatment regimen can be cumbersome and time consuming 9. Studies have shown that the type of topical vehicle used can impact on adherence;10, 11 patients prefer a vehicle that is simple and fast to apply, quickly absorbed and non‐greasy 12…”

“…Topical formulations containing corticosteroids and/or vitamin D 3 analogues are recommended for treating psoriasis 7, 8, 13, 14, 15. The efficacy and safety of the fixed combination of calcipotriol 50 μg/g (Cal) and betamethasone 0.5 mg/g as dipropionate (BD) has been confirmed in long‐term trials 16, 17, 18, 19.…”

Protocolos de Fototerapia no Tratamento da Psoríase

“…Estes agentes devem ser aplicados nos dias de repouso da fototerapia, ou após a realização do tratamento para não interferirem com a penetração da radiação UV. 20 A aplicação tópica de tazaroteno em combinação com UVB de banda estreita ou PUVA pode aumentar a eficácia terapêu-tica, permitindo uma redução da dose cumulativa necessária à melhoria do quadro. Contudo, o uso deste retinóide tópico aumenta o risco de queimadura local, devendo ser ajustadas as doses de radiação utilizadas.…”

The Dermatologists' Role in Managing Psoriatic Arthritis: Results of a Swiss Delphi Exercise Intended to Improve Collaboration with Rheumatologists

“…Drugs that allow to treat many different clinical manifestations of PsO and/or PsA help to reduce the number of drugs a patient needs to take. This is of direct clinical relevance, as comorbidity and resulting comedication is a common problem in PsO patients and minimizing the likelihood for drug-drug interactions is therefore regarded as important [2,26] . Moreover, simplifying the treatment regimen is likely to increase patient adherence [29] .…”

“…The efficacy of DMARDs on skin and joint symptoms is quite diverse: while methotrexate is considered to be fairly effective on PsO [26] , leflunomide -which is regarded as an effective therapy for PsA -has shown insufficient efficacy on skin symptoms to warrant its use in dermatology [27] . Moreover, DMARDs have shown insufficient efficacy in certain common clinical manifestations of PsA, namely axial involvement, dactylitis and enthesitis [28] .…”