What are the treatment guidelines for psoriasis?

Updated: Mar 17, 2021
  • Author: Jacquiline Habashy, DO, MSc; Chief Editor: William D James, MD  more...
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Answer

Expert dermatologists from across the globe released a consensus report on treatment optimization and transitioning for moderate-to-severe plaque psoriasis. Recommendations of the 2013 consensus report include the following:

  • Methotrexate may be used for as long as it remains effective and well-tolerated.

  • Cyclosporine is generally used intermittently for inducing a clinical response with one or several courses over a 3–6 month period.

  • Transition from conventional systemic therapy to a biological agent may be done directly or with an overlap if transitioning is needed because of lack of efficacy, or with a treatment-free interval if transitioning is needed for safety reasons.

  • Combination therapy may be helpful.

  • Continuous therapy for patients receiving biologicals is recommended.

  • Switching biologicals because of lack of efficacy should be performed without a washout period while switching biologicals for safety reasons may require a treatment-free interval.

The American Academy of Dermatology (AAD) is developing a series of recommendations under the umbrella title, Guidelines of Care for the Management of Psoriasis and Psoriatic Arthritis. The most recent addition was Section 6 (published online in November 2010; in print 2011.) All 6 sections are available online at the AAD website. [6, 39, 40, 41, 42] Section 6 of the AAD guideline recommends that psoriasis treatment be personalized for each patient’s clinical situation and discusses examples of this approach to treatment. [42]


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