MedWire News: The latest guideline in a series published by the American Academy of Dermatology (AAD) suggests that patient education and the fostering of a good patient-doctor relationship is essential to optimize psoriasis treatment.
Dermatologists are also in a "unique" position to identify the onset of comorbidities associated with psoriasis, says the guidance, as the condition is "predominantly a disease of younger patients" and therefore, the dermatologist may be the sole physician the patient sees on a regular basis.
"In this regard, all patients with moderate to severe psoriasis should be strongly encouraged to develop an ongoing relationship with a primary care provider so that potential comorbidities can be prevented or diagnosed and treated early to minimize organ damage," advise Reva Bhushan (AAD, Illinois, USA) and colleagues.
The guidelines - the sixth in a series published in the Journal of the American Academy of Dermatology - detail the recommended approach to treating patients with mild to severe psoriasis, including patients with psoriatic arthritis (PsA).
Bhushan et al suggest that mild cases can be "effectively treated with topical agents," while patients who require more than topical therapy are suitable candidates for ultraviolet-based, or systemic (oral and biologic agents) therapy.
Indeed, psoralen plus ultraviolet (UV)A therapy should still be considered a valuable treatment option despite the advent of narrowband UVB treatment, says the work group, because of its "high efficacy, systemic safety, and potential for long-term remissions."
Patients with PsA should be managed with non-steroidal anti-inflammatory drugs (NSAIDs) in mild instances, and then methotrexate, tumor necrosis factor blockade, or a combination of these therapies in PsA that is non-responsive after 2-3 months of NSAIDs, write Bhusan and team.
"There are many factors that dermatologists must consider when treating psoriasis, including the severity of the disease, overall health of the patient, tolerability of therapies and potential side effects, and the patient's level of satisfaction with the treatment regimen," said president of the AAD, Ronald Moy (Beverley Hills, California, USA).
Recent evidence links psoriasis with an increased prevalence of comorbid conditions including multiple sclerosis, lymphoma, heart disease, obesity, the metabolic syndrome, and Type 2 diabetes, note the specialists.
Thus, "regular health screenings and continual monitoring by their dermatologist can help psoriasis patients with the early detection of many of the associated medical conditions," concluded Moy.
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