What is the diagnosis and treatment for Psoriasis?

From the Guidelines

Psoriasis is a chronic autoimmune skin condition that requires ongoing management, and the primary treatment approach involves topical medications, with systemic treatments for more severe cases, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1.

Diagnosis of Psoriasis

Psoriasis is characterized by well-demarcated, red plaques with silvery scale, commonly involving the scalp, elbows, knees, and presacral region, though any area of skin might be involved, including the palms, soles, nails, and genitalia 1. The severity of psoriasis is defined in part by the total body surface area (BSA) involved, with <3% BSA considered mild, 3%-10% BSA considered moderate, and ≥10% BSA considered severe disease.

Treatment of Psoriasis

For mild to moderate psoriasis:

• Start with topical corticosteroids (e.g., betamethasone 0.05% cream) applied twice daily for 2-4 weeks.
• Combine with a vitamin D analog (e.g., calcipotriene 0.005% ointment) once daily.
• Use moisturizers regularly to reduce scaling and itching. For moderate to severe psoriasis:
• Consider phototherapy (UVB light) 2-3 times per week.
• For widespread disease, oral medications like methotrexate (starting at 7.5 mg weekly) or biologics such as adalimumab (initial dose 80 mg, then 40 mg every other week) may be necessary, as suggested by the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities 1.

Lifestyle Modifications

• Maintain a healthy weight
• Avoid triggers like stress and alcohol
• Quit smoking if applicable Regular follow-ups with a dermatologist are essential to monitor treatment efficacy and adjust as needed. The goal of treatment is to slow skin cell growth, reduce inflammation, and alleviate symptoms, with a focus on improving quality of life and reducing morbidity and mortality associated with psoriasis 1.

From the FDA Drug Label

HUMIRA is a tumor necrosis factor (TNF) blocker indicated for: Plaque Psoriasis (Ps) (1. 7): treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate.

Plaque Psoriasis or Adult Uveitis (2.5): Adults: 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose.

The diagnosis of Psoriasis is not explicitly stated in the drug label, but it is implied that the diagnosis is made prior to treatment with adalimumab (HUMIRA). The treatment for Plaque Psoriasis is adalimumab (HUMIRA) 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose 2.

From the Research

Diagnosis of Psoriasis

• Psoriasis is a chronic and relapsing inflammatory skin disease, clinically characterized by erythematous and scaly plaques 3
• The diagnosis of psoriasis is mainly driven by disease severity, though several factors should be considered in order to identify the optimal therapeutic choice 3

Treatment of Psoriasis

• Topical therapies play an important role in the treatment of psoriasis, especially in patients with mild to moderate disease 4
• Main treatment options include:
  • Topical steroids
  • Systemic therapies
  • Topical vitamin D treatments such as vitamin D3 ointment
  • Retinoids
  • Phototherapy
  • Biologic therapies
  • Other topical therapies such as coal tar, anthralin, calcineurin inhibitors, keratolytics, and emollients 4
• Topical treatments combining corticosteroids and vitamin D analogues (administered as fixed combination) are well-established first-line treatments in mild-to-moderate psoriasis 5
• Aloe vera cream may be more effective than 0.1% triamcinolone acetonide cream in reducing the clinical symptoms of psoriasis, however, both treatments have similar efficacy in improving the quality of life of patients with mild to moderate psoriasis 6

Treatment Recommendations

• The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy, in addition to good physician-patient communication, are important for optimising patient adherence and maximising efficacy 5
• Simple but detailed practical guidance is provided, which is formed from evidence and expert clinical recommendations, to assist GPs with the optimal use of topical agents based on efficacy, tolerability, disease severity, site of psoriasis, patient lifestyle and preferences, and intended duration of treatment 5
• Optimal use of topical therapy requires an awareness of the range and efficacy of all products 7