The American Academy of Dermatology (Academy) has released new guidelines of care for the management of psoriasis and psoriatic arthritis based on an extensive analysis of the highest-quality scientific studies on these serious conditions.The experts and members of the National Psoriasis Foundation medical board established defined treatment targets for patients with psoriasis in a paper published in the Journal of the American Academy of Dermatology.
An estimated 6-7 million Americans are affected by psoriasis and the presence of psoriatic arthritis in the general U.S. population has been estimated to affect between 300,000 and 750,000 individuals.
According to Experts –
- Body surface area (BSA) was the preferred instrument in selecting treatment targets for patients with psoriasis.
- Three months was the preferred time for evaluating patient response after starting a new therapy, with BSA 3% or less or BSA improvement of 75% or greater from baseline considered acceptable response at that time. BSA 1% or less was a target response at 3 months.
- Evaluation every 6 months during the maintenance period was most preferred by the experts, with a target response during the evaluation of BSA 1% or less.
Based on a comprehensive examination of the most recent studies on therapies for psoriasis, the Academy’s guidelines outline the benefits and limitations of topical and systemic therapies currently available to treat psoriasis.
According to the guidelines-
- Topical treatments are appropriate for patients who are good candidates for localized therapy, but in many cases they should not be used exclusively to treat psoriasis if patients could benefit from a combination of systemic and/or phototherapy treatments.
- When evaluating a patient, a dermatologist will determine if traditional systemic treatments, [methotrexate, cyclosporine (CyA) and oral retinoids] phototherapy, or the newer biologic agents are safe and effective for each individual.
Recommendations for Biologics
With the recent introduction of biologic therapies to treat psoriasis and psoriatic arthritis, dermatologists have more options available to find an appropriate treatment regimen to manage these conditions.
- Given by injection or infusion, biologics are systemic medications that pinpoint precise immune responses involved with psoriasis and psoriatic arthritis. They work, in part, by acting as a tumor necrosis factor (TNF) inhibitor to slow the inflammatory response.
- Studies confirm that the chronic physical symptoms that plague patients with moderate to severe psoriasis can be successfully alleviated with biologics, and they also are credited with helping improve a patient’s quality of life.
- Research shows that the activation of T-cells, a type of white blood cell, is the key immune system trigger in the development of psoriasis. Once activated, these cells release cytokines – chemicals used by the immune system to communicate messages. In psoriasis patients, these cytokines signal skin cells to reproduce and mature at an accelerated rate, which cause other reactions that lead to the formation of psoriatic lesions. Biologics are designed to target the precise immune responses involved with psoriasis, thereby controlling the condition and reducing the risk of future flare-ups.
- Currently, five biologic agents are approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis and three of these five are approved for psoriatic arthritis.
- Because biologic therapies target the immune system, the guidelines stress that it is important to use all approaches to prevent infection, including vaccinations. However, once biologic therapy has begun, patients should avoid vaccinations with live vaccines under all circumstances, including live-attenuated vaccines – such as intra-nasal influenza and the herpes zoster vaccine and consult their dermatologist before receiving a vaccination of any kind. Patients also need to be periodically re-evaluated by their dermatologist for the development of new symptoms, including infections and potential cancers.
“Regardless of the therapy that is used to treat psoriasis or psoriatic arthritis, patients need to be in constant contact with their dermatologists to report any unusual side effects or fluctuations in their condition that may require an adjustment in their medications or indicate the onset of psoriatic arthritis or another secondary medical condition,” said Dr. Hanke. “These guidelines should help further the understanding of the current psoriasis therapies and help enhance the overall health and quality of life of patients.”
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Dr. Kamal Kant Kohli
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