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Psoriasis Academy

Psoriasis Guidelines

Read time: 15 mins
Last updated:30th Mar 2022

Explore our guidelines section to read about and access:

  • Current S3-guidelines from EADV in Europe, including comorbidity guidelines
  • Joint AAD-NPF guidelines addressing adult and childhood psoriasis and psoriatic arthritis
  • Our expert videos with Professor Peter van de Kerkhof on current and future guidelines

Societies, associations, and institutes develop clinical guidelines for the treatment and management of psoriasis at local, national, and international levels. In this section, you can read the current guidelines for the management of psoriasis developed by the European Academy of Dermatology and Venereology (EADV) and the American Academy of Dermatology (AAD).

European Academy of Dermatology and Venereology (EADV) - Guidelines

Developed by the European Academy of Dermatology and Venereology (EADV), the European S3-Guidelines for the treatment of psoriasis provide an overview of practical aspects relevant to selecting drugs, monitoring patients on therapy, and assessing and managing comorbid people with psoriasis1–5.

Based on the evaluation of efficacy and safety data, and on the practical experience obtained with different treatment modalities, the EADV guidelines stipulate a range of recommendations reached in a structured consensus process.

Part 1: Psoriasis treatment and monitoring

This evidence- and consensus-based guideline on the treatment of psoriasis vulgaris was developed following the Euro-GuiDerm Guideline and Consensus Statement Development Manual4.

Part 1 presents general treatment recommendations for psoriasis, including management and monitoring recommendations on individual drugs. Treatment options discussed are: acitretin, ciclosporin, fumarates, methotrexate, adalimumab, apremilast, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab.

View the EADV 2021 guideline on psoriasis treatment and monitoring

Part 2: Specific clinical and comorbid situations

This guideline, developed following the Euro-GuiDerm Guideline and Consensus Statement Development Manual, provides guidance for specific clinical and comorbid situations, such as psoriasis vulgaris with concomitant psoriatic arthritis, inflammatory bowel disease, a history of malignancies, or a history of depression or suicidal ideation5.

Part 2 advises on comorbid diabetes, viral hepatitis, disease affecting the heart or the kidneys and neurological disease.

Recommendations on screening for tuberculosis, and managing people with a positive tuberculosis test result, are given. It covers treatment for pregnant women or patients with a wish for a child in the near future. Information on vaccination, immunogenicity, and systemic treatment during the COVID-19 pandemic is stated.

View the EADV 2021 guideline, Part 2, on specific clinical and comorbid situations in psoriasis

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American Academy of Dermatology (AAD) - Guidelines

The American Academy of Dermatology (AAD) guidelines are based on current evidence, emphasising treatment recommendations, and the role of the dermatologist in monitoring and educating people with psoriasis about benefits and associated risks6–10.

Joint AAD-NPF topical treatment guidelines

Topical medications are the most common agents used to treat mild-to-moderate psoriasis patients6. Alternative Medicine (AM), while not considered part of conventional care, may also benefit a subset of patients6.

Guidelines for the management of psoriasis with topical therapies were developed by American Academy of Dermatology (AAD) in collaboration with the National Psoriasis Foundation (NPF) in 20206.

These guidelines review topical agents and alternative medicine with an emphasis on treatment recommendations as well as the role of dermatologists in monitoring and educating patients on the benefits and risks of these treatments6. The guideline also addresses severity assessment methods of psoriasis6.

View the topical treatment guideline

Joint AAD-NPF guidelines on biologic and non-biologic treatment

Various circumstances drive the decision of a particular medication, including rapidity of onset, individual patient circumstances, and comorbidities.

The joint AAD-NPF guideline observes that anti-TNF biosimilars approved by the FDA should be considered as interchangeable with the reference brand, and that biologics may lose efficacy in patients who initially respond well to treatment7.

While biologic therapies have changed the treatment landscape, many non-biologic therapies are still used either as monotherapy or in combination with biologic medications8. The joint AAD-NPF guideline of care for the management of psoriasis with non-biologics discusses the efficacy and safety of the most commonly used medications, newer therapies, and therapies that are no longer widely used8.

View the biologics guideline

View the non-biologics guideline

Joint AAD-NPF guidelines on management and treatment of psoriasis with awareness and attention to comorbidities

AAD-NPF guidelines were published in 2019 covering the management and treatment of comorbidities that occur in patients with psoriasis.

This guideline provide an overview of the most common comorbidities and recommendations for screening and referral of these conditions9. The importance of patient and physician education surrounding these comorbidities was highlighted by Randy Beranek, president and CEO of the NPF9:

it is critical for both patients and doctors to understand the complexity of psoriasis. It is not just a skin disease; it is a serious condition that can affect all aspects of a patient’s health.
Randy Beranek

View the comorbidities guideline

Joint AAD-NPF guidelines of care for the management of psoriasis in paediatric patients

Published in 2019, the joint AAD-NPF guidelines cover care for the management of psoriasis in paediatric patients10.

This guideline highlights the unique physiology, pharmacokinetics, and patient-parent-provider interactions of paediatric patients, and addresses essential clinical questions in the management of psoriasis in paediatric patients. Common comorbidities in paediatric patients are discussed as they are essential to consider when selecting an appropriate management strategy10.

Providing evidence-based recommendations, the topics included mirror the adult guideline sections where relevant10.

View the paediatric guideline

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The International Psoriasis Council

Do current guidelines provide distinct definitions for mild, moderate, and severe psoriasis?

Will guideline updates offer guidance on oral agents and biologics in people with moderate psoriasis?

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Psoriasis is such an active field of research, and the pace at which new treatments are becoming approved makes it difficult for the guidelines to keep up. In addition, with the vastly improved treatment armamentarium, it has been recognised that improving the classification of psoriasis severity would be of benefit for treatment decision-making.

The International Psoriasis Council (IPC)11, founded in 2004, is a dermatology-led, global, non-profit organisation with a network of more than 100 psoriasis experts, thought leaders, and professionals, dedicated to improving patient care around the globe.

The International Psoriasis Council aims to deepen the understanding of the disease and its management and believe that ultimately a world without psoriasis is possible

The IPC recognises that the current clinical definitions of psoriasis severity are narrowly defined and overlook the unique challenges faced by each patient, which may include localised lesions in specific areas and/or comorbidities. A consensus is needed to define each category of disease severity in order to improve the care of all people with psoriasis.

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References

  1. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatology Venereol. 2009;23(SUPPL. 2):1–70.
  2. Nast A, Gisondi P, Ormerod AD, Saiag P, Smith C, Spuls PI, et al. European S3-Guidelines on the systemic treatment of psoriasis vulgaris - Update 2015 - Short version - EDF in cooperation with EADV and IPC. J Eur Acad Dermatology Venereol. 2015;29(12):2277–2294.
  3. Nast A, Spuls PI, van der Kraaij G, Gisondi P, Paul C, Ormerod AD, et al. European S3-Guideline on the systemic treatment of psoriasis vulgaris – Update Apremilast and Secukinumab – EDF in cooperation with EADV and IPC. J Eur Acad Dermatology Venereol. 2017;31(12):1951–1963.
  4. Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, et al. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatology Venereol. 2020;34(11):2461–2498.
  5. Nast A, Smith C, Spuls PI, Avila Valle G, Bata-Csörgö Z, Boonen H, et al. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations. J Eur Acad Dermatology Venereol. 2021;35(2):281–317.
  6. Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, et al. Joint AAD–NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021;84(2):432–470.
  7. Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029–1072.
  8. Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020;82(6):1445–1486.
  9. Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019;80(4):1073–1113.
  10. Menter A, Cordoro KM, Davis DMR, Kroshinsky D, Paller AS, Armstrong AW, et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020;82(1):161–201.
  11. The International Psoriasis Council. 2021. https://www.psoriasiscouncil.org/. Accessed 1 December 2021.
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