Expert Recommendations on Treating Psoriasis in Special Circumstances (Part II)

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• 作者：J.M. Carrascosa^a ; ^{jmcarrascosac@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; M. Galá ; n^b ; R. de Lucas^c ; A. Pé ; rez-Ferriols^d ; M. Ribera^e ; I. Yanguas^f
• 关键词：Biologics ; Psoriasis ; Pediatric psoriasis ; Palmoplantar psoriasis ; Psoriasis of the scalp ; Quality of life
• 刊名：Actas Dermo-Sifiliográficas (English Edition)
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：107
• 期：9
• 页码：712-729
• 全文大小：1274 K

文摘

There is insufficient information on how best to treat moderate to severe psoriasis in difficult clinical circumstances.

Material and methods

We considered 5 areas where there is conflicting or insufficient evidence: pediatric psoriasis, risk of infection in patients being treated with biologics, psoriasis in difficult locations, biologic drug survival, and impact of disease on quality of life. Following discussion of the issues by an expert panel of dermatologists specialized in the management of psoriasis, participants answered a questionnaire survey according to the Delphi method.

Results

Consensus was reached on 66 (70.9%) of the 93 items analyzed; the experts agreed with 49 statements and disagreed with 17. It was agreed that body mass index, metabolic comorbidities, and quality of life should be monitored in children with psoriasis. The experts also agreed that the most appropriate systemic treatment for this age group was methotrexate, while the most appropriate biologic treatment was etanercept. Although it was recognized that the available evidence was inconsistent and difficult to extrapolate, the panel agreed that biologic drug survival could be increased by flexible, individualized dosing regimens, continuous treatment, and combination therapies. Finally, consensus was reached on using the Dermatology Quality of Life Index to assess treatment effectiveness and aid decision-making in clinical practice.

Conclusions

The structured opinion of experts guides decision-making regarding aspects of clinical practice for which there is incomplete or conflicting information.