As noted in the Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies, speed of onset is a significant consideration when choosing systemic therapies for many patients with plaque psoriasis, particularly for those with inflammatory or erythrodermic psoriasis. In other cases, individual patient circumstances and comorbidities, such as concomitant obesity, psoriatic arthritis, inflammatory bowel disease, and infections, including viral hepatitis, latent tuberculosis, and HIV, may be compelling reasons to avoid or select specific medications.
According to the consensus study "From the Medical Board of the National Psoriasis Foundation: Treatment Targets for Plaque Psoriasis," the use of BSA to assess disease severity should be complemented by assessments of patient-reported measures of quality of life and symptoms, such as pruritus and pain, which have been shown to affect patients' perception of disease severity. Of note, disease severity is defined not just by the extent of BSA involved but also by the patient's perception and acceptance of the disease.
Systemic therapies should be considered for patients with extensive psoriasis, or greater than 3% BSA involvement. It may also be an option for patients whose daily functioning is adversely affected by psoriasis, who have psoriatic arthritis, and/or whose quality of life is impaired due to the disease. Additionally, systemic therapies may be appropriate for patients with mild psoriasis (ie, ≤ 3% BSA involvement) who have an inadequate response to topical therapy or phototherapy, in cases where phototherapy is unfeasible, or when quality of life is negatively affected to the degree that the benefits of systemic therapy outweigh its potential risks.
Learn more about the management of plaque psoriasis.
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Cite this: Chris G. Adigun, William James. Fast Five Quiz: Systemic Treatments for Plaque Psoriasis - Medscape - Dec 21, 2021.