{ "schemaVersion": 2, "eyebrow": "Dermatology", "title": "Psoriasis", "summary": "Manage psoriasis by confirming the clinical phenotype, quantifying extent and life impact, identifying psoriatic arthritis and cardiometabolic comorbidity, then selecting site-directed topical therapy, phototherapy, systemic therapy, or biologic treatment according to severity, trajectory, and treatment risk.", "seoDescription": "Point-of-care psoriasis management: severity assessment, diagnostic escalation, topical and systemic treatment selection, biologic safety, and comorbidity screening.", "clinicalQuestion": "How should physicians assess psoriasis severity, select treatment intensity, and screen for consequential comorbid disease?", "specialty": "Dermatology", "audience": "U.S. physicians and medical trainees", "tags": [ "plaque psoriasis", "psoriasis severity", "PASI", "body surface area", "DLQI", "topical psoriasis therapy", "systemic psoriasis therapy", "biologic psoriasis therapy", "psoriatic arthritis" ], "keyTakeaways": [ "Diagnosis is usually clinical; biopsy is most useful for atypical morphology, diagnostic uncertainty, pustular disease, or erythroderma. [2][15][16]", "Record BSA, PASI or PGA, and quality-of-life impact at baseline; BSA greater than 10%, PASI greater than 10, or DLQI greater than 10 identifies a commonly used moderate-to-severe threshold for systemic-treatment consideration. [5][14][15][17]", "Use topical corticosteroids and/or vitamin D analogues for mild or limited disease, while extensive, refractory, or high-impact disease warrants phototherapy or systemic treatment selection. [1][2][7][9]", "Ask specifically about inflammatory musculoskeletal symptoms and examine for nail disease, dactylitis, enthesitis, and swollen joints; suspected psoriatic arthritis requires rheumatology-directed assessment because persistent inflammatory disease can be disabling. [1][24]", "Before biologic treatment, perform a focused infection history and screen for latent tuberculosis; treatment should be withheld during major infection. [11][12]" ], "sections": [ { "id": "triage-and-diagnostic-confirmation", "eyebrow": "Initial assessment", "heading": "Confirm psoriasis clinically and identify presentations requiring urgent escalation", "intro": "Most plaque psoriasis does not require laboratory confirmation.", "paragraphs": [ "Make the diagnosis clinically when sharply demarcated scaly plaques have a typical symmetric distribution involving scalp, extensor elbows or knees, lumbosacral skin, or flexures. Document morphology and distribution before treatment because plaque psoriasis accounts for approximately 80% to 90% of cases and may coexist with nail or fold disease that changes topical formulation and potency selection. [16][17]", "Obtain a skin biopsy when the morphology or distribution is atypical, when an alternative papulosquamous disorder remains plausible, or when erythrodermic or pustular disease creates diagnostic uncertainty. Histopathology can complement the clinical diagnosis but is not routine for characteristic plaque psoriasis. [15][16]", "Treat generalized erythroderma as an urgent dermatologic presentation. It may arise from progressive confluent plaque disease or unstable psoriasis precipitated by infection, medications, or corticosteroid withdrawal, and can cause hypothermia, hypoalbuminemia, anemia, and nutrient loss. [15] Evaluate for precipitating infection or medication exposure and arrange urgent specialty management rather than escalating outpatient topical therapy alone. [15]" ], "bullets": [ "At each flare, review potential exacerbating factors: infection, alcohol, medications, stress, and intercurrent illness. [2]", "Document a trauma-associated distribution when present; new lesions at sites of injury support a Koebner phenomenon. [16]", "Refer promptly for atypical, pustular, erythrodermic, or extensive disease and for failure of systemic or biologic therapy. [14]" ], "subsections": [], "table": { "caption": "Clinical findings that change diagnostic or disposition decisions. [14][15][16]", "columns": [ "Finding", "Interpretation", "Next action" ], "rows": [ [ "Typical, symmetric, well-circumscribed scaly plaques", "Clinical diagnosis is usually sufficient. [2][16]", "Quantify severity and initiate site-appropriate treatment. [1][2]" ], [ "Atypical morphology or persistent diagnostic uncertainty", "Psoriasis may require histopathologic confirmation or exclusion of another dermatosis. [15][16]", "Perform skin biopsy or refer to dermatology. [14][15]" ], [ "Generalized exfoliative erythema", "Possible erythrodermic psoriasis with thermoregulatory and metabolic complications. [15]", "Urgent dermatology assessment; evaluate triggers and systemic complications. [15]" ], [ "Pustular phenotype", "Requires specialist assessment because it is not managed as routine stable plaque disease. [14]", "Expedite dermatology evaluation. [14]" ] ] } }, { "id": "severity-and-treatment-thresholds", "eyebrow": "Treatment intensity", "heading": "Measure extent, site burden, and quality-of-life impact before choosing therapy", "intro": "Extent alone can underestimate high-impact localized disease.", "paragraphs": [ "Record BSA and a reproducible activity measure such as PASI or PGA at baseline and before changing treatment. PASI incorporates plaque erythema, induration, scaling, and involved surface area across the head and neck, trunk, and upper and lower limbs; PGA, BSA, DLQI, and nail scores can complement PASI when the disease phenotype or practice workflow makes PASI less practical. [15]", "Use severity measures to guide, not replace, clinical judgment. A PASI of at least 10 or BSA of at least 10% with DLQI greater than 10 is a commonly used severe-disease threshold, while dermatology referral criteria also identify BSA greater than 10%, PASI greater than 10, or DLQI greater than 10 as moderate-to-severe disease. [5][14] Lesions on the scalp, face, flexures, hands, feet, genitals, or nails can justify escalation despite limited BSA when symptoms, function, or treatment feasibility are disproportionate. Site and symptom burden are explicit components of severity assessment. [15][17]", "Use topical treatment for mild or limited psoriasis, particularly when disease can be treated reliably by the patient. Topical corticosteroids and vitamin D analogues are the core first-line options for limited disease. [1][2][7] If disease is extensive, cannot be practically treated with topical therapy, remains uncontrolled despite an adherent topical regimen, or produces substantial functional or quality-of-life burden, assess candidacy for phototherapy or systemic treatment. [7][9][14]" ], "bullets": [ "Measure DLQI when visible, genital, hand-foot, scalp, or nail disease appears discordant with BSA; impact on daily life is part of severity determination. [15][17]", "Record nail involvement because it contributes to disease burden and should heighten surveillance for musculoskeletal disease. [15][24]", "Use serial BSA, PASI/PGA, and patient-reported impact to determine whether a treatment is controlling disease rather than relying on a single baseline category. [15][17]" ], "subsections": [], "table": { "caption": "Practical escalation framework for cutaneous psoriasis. [1][2][5][7][9][14][15]", "columns": [ "Clinical pattern", "Assessment target", "Management direction" ], "rows": [ [ "Limited plaque disease", "Document BSA, symptomatic sites, and response to prior topical therapy. [1][15]", "Use topical corticosteroid and/or vitamin D analogue therapy. [1][2]" ], [ "High-impact localized disease", "Assess affected site and DLQI even when BSA is low. [15][17]", "Consider dermatology escalation when topical treatment is inadequate or impractical. [14]" ], [ "Extensive or high-burden disease", "BSA greater than 10%, PASI greater than 10, or DLQI greater than 10 supports moderate-to-severe classification. [5][14]", "Consider phototherapy or systemic nonbiologic or biologic therapy through individualized selection. [7][9][13]" ], [ "Refractory disease on systemic or biologic treatment", "Reassess phenotype, adherence, safety, and comorbid inflammatory disease. [14][24]", "Refer or re-engage dermatology; switching to another biologic is an accepted strategy after biologic failure. [8][9]" ] ] } }, { "id": "site-directed-topical-and-phototherapy-care", "eyebrow": "Skin-directed therapy", "heading": "Match topical vehicle and escalation to body site and treatment feasibility", "intro": "Topical therapy remains foundational for mild-to-moderate plaque disease.", "paragraphs": [ "For limited psoriasis, select a topical corticosteroid, a vitamin D analogue, or their combination according to lesion thickness, anatomic site, cosmetic acceptability, and ability to apply treatment consistently. AAD-NPF guidance addresses topical agents and severity measurement, and BMJ Best Practice identifies topical corticosteroids and/or vitamin D analogues as treatment for mild or limited disease. [1][7]", "For scalp psoriasis, use topical therapy in a formulation the patient can apply through hair-bearing skin. When a potent corticosteroid or vitamin D analogue used for up to 8 weeks does not achieve clearance, near-clearance, or satisfactory control, an adult can receive a very potent corticosteroid up to twice daily for 2 weeks; coal tar once or twice daily and specialist support with application technique are alternatives. [19] Vitamin D analogue monotherapy is most appropriate when corticosteroids cannot be used at that site or for mild-to-moderate scalp disease. [19]", "Move beyond topical monotherapy when distribution makes application burdensome or when objective activity and patient-reported burden remain unacceptable despite a coherent regimen. Phototherapy is addressed in AAD-NPF psoriasis guidance and is an appropriate treatment-domain consideration before or alongside systemic options based on disease extent, access, and patient preference. [2][7][14]" ], "bullets": [ "Choose vehicle and regimen around the involved site; lesion location is a core determinant of treatment selection. [17]", "For scalp disease uncontrolled after the defined topical course, reassess adherence and formulation before declaring pharmacologic failure. [19]", "Use dermatology referral for phototherapy candidacy or when topical application support and alternative options are required. [14][19]" ], "subsections": [], "table": { "caption": "Site- and response-based topical decisions. [1][7][19]", "columns": [ "Scenario", "Action", "Escalation trigger" ], "rows": [ [ "Mild or limited plaque psoriasis", "Topical corticosteroid and/or vitamin D analogue. [1][2]", "Persistent activity or impractical topical treatment. [7][14]" ], [ "Mild-to-moderate scalp psoriasis when corticosteroids cannot be used", "Topical vitamin D analogue alone may be used. [19]", "Inadequate control after up to 8 weeks of topical therapy. [19]" ], [ "Adult scalp psoriasis uncontrolled after up to 8 weeks", "Very potent corticosteroid up to twice daily for 2 weeks, or coal tar once or twice daily. [19]", "Refer for application support or alternative therapy. [19]" ] ] } }, { "id": "systemic-and-biologic-selection", "eyebrow": "Advanced treatment", "heading": "Choose systemic or biologic therapy by disease burden, comorbidity, and safety constraints", "intro": "Moderate-to-severe disease requires individualized risk-benefit selection.", "paragraphs": [ "For adults with moderate-to-severe psoriasis, AAD-NPF guidance supports methotrexate and apremilast as systemic nonbiologic options; methotrexate is less effective for cutaneous psoriasis than adalimumab and infliximab. [9] Cyclosporine and acitretin are also addressed within systemic nonbiologic treatment guidance. [13] Select among these approaches according to urgency of control, reproductive considerations, hepatic and renal risk, comorbid inflammatory disease, treatment burden, and monitoring capacity; the available guideline summary does not establish a universal sequence among systemic agents. [13][20]", "Biologic therapy is a treatment option for adults with moderate-to-severe psoriasis, including TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibition, and IL-23 inhibitors. [9][11] After inadequate response to a first biologic, switching to a second biologic is a guideline-supported strategy; biologic plus methotrexate is another possible approach, although psoriasis-specific evidence for combination treatment is limited. [8]", "Before initiating a biologic, obtain a focused infection history and physical examination and screen for latent tuberculosis infection. [11] Screen for viral infections, including HIV and hepatitis, before biologic therapy as described in psoriasis management recommendations; withhold biologic treatment during a major infection. [12] Incorporate inflammatory bowel disease, congestive heart failure, multiple sclerosis, hepatitis B, prior nonmelanoma skin cancer, lymphoma, and latent tuberculosis into biologic selection because these conditions materially alter class-specific risk assessment. [11]" ], "bullets": [ "Use noninvasive hepatic-fibrosis assessment when monitoring methotrexate-associated hepatotoxicity, consistent with revised AAD-NPF monitoring guidance. [9]", "Do not continue biologic treatment through a major infection. [12]", "When biologic efficacy is inadequate, verify diagnosis, phenotype, adherence, safety, and joint disease before switching mechanism or agent. Switching to a second biologic is an accepted next step. [8][24]" ], "subsections": [ { "heading": "Interpreting infection risk during biologic treatment", "paragraphs": [ "Discuss infection risk in class- and patient-specific terms rather than treating all biologics as equivalent. In PSOLAR, serious-infection incidence was 0.83 per 100 patient-years with ustekinumab, 1.47 with etanercept, 1.97 with adalimumab, and 2.49 with infliximab; pneumonia and cellulitis were the most frequently reported serious infections. [11] These observational rates inform counseling but do not substitute for baseline infection screening or individualized selection." ], "bullets": [] } ], "table": { "caption": "Systemic-treatment safety decisions supported by psoriasis guidance and observational safety data. [8][9][11][12][13]", "columns": [ "Decision point", "Action", "What changes management" ], "rows": [ [ "Moderate-to-severe cutaneous disease", "Consider methotrexate, apremilast, cyclosporine, acitretin, phototherapy, or biologic therapy according to patient factors. [7][9][13]", "Comorbidities, reproductive risk, organ toxicity risk, access, and monitoring capacity determine selection. [11][13][20]" ], [ "Before biologic initiation", "Take infection history and perform examination; screen for latent tuberculosis and viral infections including HIV and hepatitis. [11][12]", "Treat or otherwise address identified infection risk before immunomodulatory therapy. [11][12]" ], [ "Major infection during biologic therapy", "Withhold treatment. [12]", "Resume only after the infection has been clinically addressed. [12]" ], [ "Inadequate response to first biologic", "Switch to a second biologic; combination with methotrexate is possible but supported by limited psoriasis-specific evidence. [8]", "Reassess phenotype and comorbid conditions before choosing the next mechanism. [11][24]" ] ] } }, { "id": "comorbidity-and-psoriatic-arthritis-surveillance", "eyebrow": "Longitudinal care", "heading": "Screen actively for psoriatic arthritis and cardiometabolic disease", "intro": "Cutaneous control does not exclude clinically consequential systemic disease.", "paragraphs": [ "Screen for psoriatic arthritis at psoriasis visits by asking about inflammatory joint pain, prolonged stiffness, swollen digits, heel or other entheseal pain, back symptoms, and functional limitation; examine for swollen joints, dactylitis, enthesitis, and nail disease. Approximately 30% of patients with cutaneous psoriasis in dermatology clinics have rheumatologist-diagnosed psoriatic arthritis. [1] Refer suspected inflammatory musculoskeletal disease to rheumatology because psoriatic arthritis is potentially debilitating and requires targeted treatment with ongoing monitoring. [24]", "Treat psoriasis as a multisystem disease and address cardiovascular risk factors rather than focusing only on plaque clearance. Psoriasis and psoriatic arthritis are epidemiologically linked to cardiovascular risk factors and increased cardiovascular disease risk, while psoriatic arthritis is associated with hypertension, metabolic syndrome, obesity, hyperlipidemia, diabetes mellitus, and cardiovascular disease. [9][23][24] Measure and manage blood pressure, weight, glycemic status, and lipids according to standard primary-care and cardiovascular-prevention pathways.", "Ask about inflammatory bowel symptoms and ocular symptoms when musculoskeletal disease is present. Inflammatory bowel disease, particularly Crohn disease, is associated with increased risk of psoriatic arthritis, and uveitis requires ophthalmologic evaluation and treatment. [24] These findings should influence biologic-class selection and coordination with gastroenterology, rheumatology, or ophthalmology. [11][24]" ], "bullets": [ "Trigger rheumatology referral for swollen joints, dactylitis, enthesitis, inflammatory axial symptoms, or persistent functional limitation suggestive of psoriatic arthritis. [24]", "In patients with psoriatic arthritis, screen for obesity, hypertension, dyslipidemia, diabetes, and cardiovascular disease. [24]", "Refer uveitis for ophthalmologic evaluation rather than managing ocular inflammation solely through dermatologic therapy. [24]" ], "subsections": [], "table": { "caption": "Comorbidity findings that require a defined next step. [1][11][23][24]", "columns": [ "Finding", "Clinical implication", "Next step" ], "rows": [ [ "Inflammatory joint symptoms, dactylitis, enthesitis, or swollen joints", "Possible psoriatic arthritis with risk of persistent disabling inflammatory disease. [24]", "Refer to rheumatology for diagnostic assessment and targeted management. [24]" ], [ "Hypertension, obesity, dyslipidemia, diabetes, or metabolic syndrome", "Higher cardiometabolic burden accompanies psoriasis and psoriatic arthritis. [23][24]", "Measure and treat modifiable risk factors through standard cardiovascular prevention pathways. [23][24]" ], [ "Inflammatory bowel disease or neurologic/cardiac comorbidity", "May alter biologic risk-benefit selection. [11][24]", "Coordinate treatment selection with the relevant specialty. [11]" ], [ "Uveitis symptoms or diagnosis", "Requires specialist ocular evaluation and treatment. [24]", "Refer to ophthalmology. [24]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Psoriasis - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/74?locale=ar", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 2, "title": "Psoriasis - Symptoms, diagnosis and treatment | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/74", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 3, "title": "Guidelines for the Diagnosis and Treatment of Psoriasis in China", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijdv/fulltext/2020/03000/guidelines_for_the_diagnosis_and_treatment_of.3.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 4, "title": "22nd PANLAR Congress: Miami, FL, August 12-15 2020 : JCR - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/jclinrheum/fulltext/2020/04001/22nd_panlar_congress__miami,_fl,_august_12_15_2020.1.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 5, "title": "Biologics and Biosimilars in Psoriasis : Indian Journal of Dermatology", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijd/fulltext/2023/68030/biologics_and_biosimilars_in_psoriasis.9.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 6, "title": "Systemic Management of Psoriasis Patients in Indian Scenario - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/idoj/fulltext/2021/12050/systemic_management_of_psoriasis_patients_in.2.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 7, "title": "Psoriasis clinical guideline", "detail": "staging.aad.org", "url": "https://staging.aad.org/member/clinical-quality/guidelines/psoriasis", "authors": "staging.aad.org", "host": "staging.aad.org" }, { "number": 8, "title": "Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3964298", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 9, "title": "Psoriasis clinical guideline - American Academy of Dermatology", "detail": "www.aad.org", "url": "https://www.aad.org/member/clinical-quality/guidelines/psoriasis", "authors": "www.aad.org", "host": "www.aad.org" }, { "number": 10, "title": "Risk of psoriasis in people with hidradenitis suppurativa: A systematic review and meta-analysis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9752046", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 11, "title": "Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8051287", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 12, "title": "Recommendations for Management of Childhood Psoriasis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8664175", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 13, "title": "Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/32119894", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 14, "title": "Plaque Psoriasis - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK430879", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 15, "title": "[PDF] 29 October 2024 WHO Expert Committee on the Selection and Use ...", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/addition-of-new-medicines/a.31_ustekinumab.pdf", "authors": "cdn.who.int", "host": "cdn.who.int" }, { "number": 16, "title": "1. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Psoriasis - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/74?locale=ar", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "# Psoriasis. Last reviewed: 1 Nov 2025. Mild or limited psoriasis is treated with topical corticosteroids and/or vitamin D analogs. Psoriasis is a chronic inflammatory skin disease characterized by erythematous, circumscribed scaly papules and plaques. Although approximately 30% of people with cutan", "score": 0.7680558 }, { "number": 2, "title": "Psoriasis - Symptoms, diagnosis and treatment | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/74", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology – National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019 Sep;81(3):775-804.Full text30637-1/fulltext)Abstract\n\nMenter A, Gelfand JM, Connor C, ", "score": 0.5957048 }, { "number": 3, "title": "Guidelines for the Diagnosis and Treatment of Psoriasis in China", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijdv/fulltext/2020/03000/guidelines_for_the_diagnosis_and_treatment_of.3.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "treatment is not required. The DLQI score ranges from 2 to 5 points, and the PASI score is ≤3. Moderate: The skin rash involves 3%–10% of the BSA and affects", "score": 0.52071625 }, { "number": 4, "title": "22nd PANLAR Congress: Miami, FL, August 12-15 2020 : JCR - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/jclinrheum/fulltext/2020/04001/22nd_panlar_congress__miami,_fl,_august_12_15_2020.1.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Methods: Patients with active PsA fulfilling Classification for Psoriatic Arthritis criteria, ≥3/66 tender and ≥3/68 swollen joints, ≥3% psoriasis body surface area (BSA) involvement, no prior treatment with biologic DMARDs, and prior inadequate response to ≥1 conventional synthetic DMARD, were rand", "score": 0.45842203 }, { "number": 5, "title": "Biologics and Biosimilars in Psoriasis : Indian Journal of Dermatology", "detail": "journals.lww.com", "url": "https://journals.lww.com/ijd/fulltext/2023/68030/biologics_and_biosimilars_in_psoriasis.9.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Must have criteria: severe psoriasis defined as a PASI score of 10 or more (or a BSA of 10% or more where PASI is not applicable) and a DLQI >10.", "score": 0.45420644 }, { "number": 6, "title": "Systemic Management of Psoriasis Patients in Indian Scenario - Ovid", "detail": "journals.lww.com", "url": "https://journals.lww.com/idoj/fulltext/2021/12050/systemic_management_of_psoriasis_patients_in.2.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "The criteria for the re-initiation of therapy as suggested by the experts: Physician Global Assessment (PGA)>2 The body surface area (BSA)>10 Psoriasis Area", "score": 0.44680908 }, { "number": 7, "title": "Psoriasis clinical guideline", "detail": "staging.aad.org", "url": "https://staging.aad.org/member/clinical-quality/guidelines/psoriasis", "authors": "staging.aad.org", "host": "staging.aad.org", "snippet": "Title: Psoriasis clinical guideline\nDonate For Public and Patients Store Sign In Search. Explore the Academy's new and improved Learning Center, with enhanced ease of use for the education you trust. Review current clinical guidelines, those in development, and guidelines that the AAD has coll", "score": 0.86080295 }, { "number": 8, "title": "Treatment Sequencing After Failure of the First Biologic in Cost-Effectiveness Models of Psoriasis: A Systematic Review of Published Models and Clinical Practice Guidelines - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3964298", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "We found seven North American and European psoriasis guidelines published in English (Table 3). These guidelines included two for North America [36–38] and five for Europe [39–44]. The guidelines provided recommendations for the place of biologics in treatment for psoriasis, recommendations for what", "score": 0.7999589 }, { "number": 9, "title": "Psoriasis clinical guideline - American Academy of Dermatology", "detail": "www.aad.org", "url": "https://www.aad.org/member/clinical-quality/guidelines/psoriasis", "authors": "www.aad.org", "host": "www.aad.org", "snippet": "##### Biologics\n\n Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the US population.\n Based on current evidence, this guideline addresses important clinical questions regarding biologic agents used as monotherapy or in combination with other psoriasis therapies ", "score": 0.77096564 }, { "number": 10, "title": "Risk of psoriasis in people with hidradenitis suppurativa: A systematic review and meta-analysis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9752046", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Identifying comorbidities in hidradenitis suppurativa (HS) is critical to give patients recommendations for the screening for comorbidities. Recently, HS has been reported to have a strong association with psoriasis. However, some evidence seemed to be controversial and the current guidelines for co", "score": 0.7657514 }, { "number": 11, "title": "Biologic Treatment Algorithms for Moderate-to-Severe Psoriasis with Comorbid Conditions and Special Populations: A Review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8051287", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "## -17 inhibitors, ustekinumab (an IL-12/23 inhibitor), and IL-23 inhibitors. Data from clinical trials and studies of the safety and efficacy of biologics provide essential information for the personalization of patient care. We discuss the benefits and disadvantages of biologics as a first-line tr", "score": 0.7382357 }, { "number": 12, "title": "Recommendations for Management of Childhood Psoriasis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8664175", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Pediatric psoriasis co-morbidity screening guidelines (2017) and the American Academy of Dermatology-National Psoriasis Foundation (AAD-NPF) guidelines are clear on the need for comorbidity screening at various points during the disease course. Major emphasis has been made on the point of educating ", "score": 0.72768575 }, { "number": 13, "title": "Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/32119894", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. Federal government websites often end in ", "score": 0.6693348 }, { "number": 14, "title": "Plaque Psoriasis - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK430879", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "This activity is designed to provide healthcare professionals with an in-depth review of plaque psoriasis, including its pathophysiology, genetic and environmental triggers, clinical presentation, diagnostic considerations, and evidence-based treatment modalities. Emphasis is placed on both conventi", "score": 0.59089786 }, { "number": 15, "title": "[PDF] 29 October 2024 WHO Expert Committee on the Selection and Use ...", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/2025-eml-expert-committee/addition-of-new-medicines/a.31_ustekinumab.pdf", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "and may take one of two forms. Firstly, chronic plaque psoriasis may gradually progress as plaques become confluent and extensive. Secondly, erythroderma may be a manifestation of unstable psoriasis precipitated by infection, drugs, or withdrawal of corticosteroids34. Erythroderma may lead to compli", "score": 0.5617203 }, { "number": 16, "title": "1. Application to Add Ustekinumab to the ...", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/essential-medicines/2023-eml-expert-committee/applications-for-addition-of-new-medicines/a51_ustekinumab.pdf?sfvrsn=5cc9bf75_2", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "is multigenic. At least 80 chromosomal loci are described in association with psoriasis of which the strongest is HLA Cw6, particularly in Caucasians with early onset disease. Psoriasis can present at any age and has been reported at birth and in older people of advanced age. But the mean age of ons", "score": 0.47592255 }, { "number": 17, "title": "[PDF] Application for inclusion of calcipotriol (calcipotriene)", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/essential-medicines/2021-eml-expert-committee/applications-for-addition-of-new-medicines/a.6_calcipotriol.pdf?sfvrsn=c0e37cb4_6", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "presenting as chronic, stable plaques or it may present acutely, with rapid progression and widespread skin involvement. 6 Psoriasis may be symptomatic with patients complaining of intense pruritus or burning. The severity of psoriasis, which is important in determining appropriate therapies may be ", "score": 0.4069804 }, { "number": 18, "title": "Book of abstracts", "detail": "cdn.who.int", "url": "https://cdn.who.int/media/docs/default-source/ntds/skin-ntds/first-who-global-skin-ntds-meeting-book-of-abstracts.pdf?sfvrsn=1e0b45b0_5&download=true", "authors": "cdn.who.int", "host": "cdn.who.int", "snippet": "and other major skin diseases, and availability of different treatment options. Psoriasis patients’ demographics, socioeconomics, disease characteristics, treatment history, and severity are collected. Data analysis allows for inter-country comparison on the prevalence and severity of psoriasis (PAS", "score": 0.25661114 }, { "number": 19, "title": "[PDF] Appendix A: Summary of evidence from surveillance | NICE", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg153/evidence/appendix-a-summary-of-evidence-from-surveillance-pdf-4483318862", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "daily or vitamin D or a vitamin D analogue applied once daily for up to 8 weeks does not result in clearance, near clearance or satisfactory control of scalp psoriasis offer:  a very potent corticosteroid applied up to twice daily for 2 weeks for adults only or  coal tar applied once or twice dail", "score": 0.59796065 }, { "number": 20, "title": "[PDF] Psoriasis Guideline Consultation Comments Table - NICE", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/cg153/documents/psoriasis-consultation-comments-table2", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "monthly for the first 6 months of treatment followed by every 3 months as a minimum whilst on therapy. SH Abbott Laboratories 26.19 Full 55 33 Abbott welcomes the GDG guidance on methotrexate and monitoring for hepatotoxicity (recommendations 91,92,93,94 and 95). However, it is Abbott’s view that th", "score": 0.572078 }, { "number": 21, "title": "Roflumilast (Zoryve) - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK624205", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "The management of plaque psoriasis of the scalp and body in Canada follows a stepwise approach that begins with over-the-counter emollients and medicated shampoos, and progresses to prescription topical therapies, phototherapy where available, and systemic drugs for patients with more extensive or r", "score": 0.5622973 }, { "number": 22, "title": "Systemic pharmacological treatments for chronic plaque psoriasis", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011535.pub2/references", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "Acitretin plus methotrexate in the treatment of moderate to severe psoriasis vulgaris. Acitretin has visible side effects. treatment of psoriasis", "score": 0.46935064 }, { "number": 23, "title": "Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. - Abstract", "detail": "pubmed.ncbi.nlm.nih.gov", "url": "https://pubmed.ncbi.nlm.nih.gov/29295598", "authors": "pubmed.ncbi.nlm.nih.gov", "host": "pubmed.ncbi.nlm.nih.gov", "snippet": "There is solid epidemiologic evidence linking psoriasis and psoriatic arthritis (PsA) to cardiovascular risk factors and an increased risk of developing cardiovascular disease. Chronic inflammation, with shared pathways and cytokines common to metabolic syndrome, atherosclerosis and psoriasis, might", "score": 0.68191797 }, { "number": 24, "title": "Psoriatic Arthritis - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK547710", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Associations and Comorbidities\n\n Inflammatory bowel disease, and particularly Crohn disease, is associated with an increased risk of psoriatic arthritis.(#article-27964.r41)\n Psoriatic arthritis has been associated with several comorbidities, the most prevalent of which are hypertension, metabolic s", "score": 0.61779 } ], "publishedAt": "2026-09-15T23:43:41.110253+00:00", "updatedAt": "2026-09-15T23:43:41.110253+00:00", "readingMinutes": 7, "slug": "psoriasis" }