Fast Five Quiz: Psoriasis Management

Medscape

6 days ago

Effective management of psoriasis is paramount in mitigating symptoms and related comorbidities than can impact disease severity and quality of life. Although many treatment options are available, from topicals to systemic biologic and nonbiologic therapies, each therapy comes with its own advantages, disadvantages, and nuances.
What do you know about the management of psoriasis? Check your knowledge with this quick quiz.
The AAD-NPF recommend limiting the use of ultra-high dose or class 1 corticosteroids to no more than twice daily for up to 4 weeks. While generally safe, high-dose corticosteroids have been associated with adverse events such as skin atrophy, hypopigmentation, adrenal suppression, and Cushing syndrome. However, maintaining use within 4 weeks can minimize these risks. Exceptions to this duration can be made for patients who experience significant flare ups or when treating psoriasis in the palms and soles.
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Patients who are candidates for systemic therapy include those with BSA involvement over 10%, those involving special areas— such as the face, palms, soles, genitalia, nails, or scalp — and failure of topical therapy. This is also consistent with the latest AAD-NPF guidelines, which consider psoriasis to be severe if it impacts the face, hands, feet, scalp, or genitals regardless of BSA involvement and other data indicating that psoriasis lesions on the aforementioned locations is part of the criteria for 'inadequate psoriasis control.'
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Biologic therapy can increase the risk of infections, and tuberculosis is especially associated with the use of TNFIs. As such, the AAD-NPF guidelines specifically recommend screening for latent tuberculosis before starting TNF inhibitor therapy in patients with psoriasis. Testing for other viruses, such as HIV, is suggested at the clinician's discretion and depending on patient risk factors. This is consistent with more current international consensuses. Among other biologic treatments, experts report a higher rate of herpes zoster in patients treated with JAK inhibitors rather than TNF inhibitors. After several years of data, biologic therapy does not seem to increase risk for COVID-19 infection; it, along with influenza, is generally not part of general screening in this setting. However, guidelines recommend patients with psoriasis treated with biologic therapy receive annual vaccinations for COVID-19 and influenza to prevent severe infection.
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Joint AAD-NPF guidelines recommend 'proactive treatment' as a strategy for optimal topical psoriasis management to maintain remission, whereby topical treatments are applied twice weekly to previously affected areas. This is similar to a consensus statement from global experts in psoriasis management recommending once or twice weekly application for maintenance therapy after induction. Further, the AAD-NPF also notes that any topical treatment mentioned for use in their guidelines can be used for proactive management, including certain corticosteroids, calcineurin inhibitors, and vitamin D analogues, among several others.
Learn more about long-term monitoring in psoriasis.
Although biologic therapy can be continued through uncomplicated infections, the AAD-NPF states patients who develop febrile illness, especially when it requires antibiotic treatment, should temporarily discontinue biologics until it resolves. Similarly, biologics can be taken through low-risk surgeries, but the decision to continue biologic therapy through moderate- to high-risk surgery should be made on a case-by-case basis. Similarly, certain systemic nonbiologic therapies have different discontinuation requirements as well.
Learn more about infection in psoriasis.
Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication.