Psoriasis Guidelines Call for Tailored Treatment

New Guidelines Say Treatment Plans Should Take Into Account More Than Just Disease Severity

By Salynn Boyles
WebMD Health News

Reviewed by Laura J. Martin, MD

Feb. 18, 2011 -- New guidelines for the treatment of the skin condition psoriasis stress the importance of tailoring therapies to individual patients.

The guidelines were issued by the American Academy of Dermatology.

Ronald L. Moy, MD, president of the American Academy of Dermatology, says disease severity is just one of many factors that need to be considered when developing a treatment plan for psoriasis.

Once thought to be a condition limited to the skin and joints, psoriasis is increasingly recognized as a disorder linked with other medical conditions, including obesity, heart disease, type 2 diabetes, and lymphoma.

"Regular health screenings and continual monitoring by their dermatologist can help psoriasis patients with the early detection of many of these associated conditions," Moy says in a news release.

Early Treatment Prevents Psoriatic Arthritis

About 7 million Americans have psoriasis, a condition characterized by thick, red, scaly patches on the skin that sometimes itch and bleed.

Some patients also develop the related condition psoriatic arthritis, which, like other forms of arthritis, involves joint tenderness, stiffness, pain, and swelling, according to dermatologist Alan Menter, MD, who led the team that developed the new guidelines.

Menter directs the residency program at Baylor University Medical School in Dallas and is past president of the International Psoriasis Council.

"Between one in six and one in eight people with psoriasis will develop fairly destructive joint disease," he tells WebMD. "But by initiating [drug] treatment early, we can stop it in its tracks."

Psoriasis is generally considered mild when less than 5% of the body is involved and severe when the scaly patches cover 10% or more of the skin.

Mild psoriasis is most often treated with topical creams and ointments and, possibly targeted light therapy. Drugs like methotrexate and the biologics Amevive, Enbrel, Humira, Remicade, Simponi, and Stelara tend to be reserved for patients whose psoriasis is considered severe.

But Menter says doctors need to consider factors other than how much of the body is affected when deciding on a treatment.

Patients with lesions on their hands, feet, face, or genitals may be candidates for drug treatment even if their psoriasis is limited because quality of life is so profoundly affected, he says.

"Physicians and patients need to recognize that the impact of psoriasis both physically and emotionally may change the treatment paradigm," he says.

Obesity and Psoriasis

Psoriasis is more common among people who are obese than in the general population, and obesity presents a special treatment challenge.

Menter says obese patients tend to have more severe psoriasis and in female patients, skin lesions are common in breast and abdominal folds. These areas are particularly vulnerable to thinning of the skin from steroid creams, so other treatments may be needed.

Obese patients with psoriasis have a high risk for related conditions such as diabetes, hypertension, and heart disease. These conditions also affect treatment decisions, Menter says.

"The new guidelines recognize real-world issues, such as the fact that patients often have co-morbidities or have psoriasis in unusual places," he says. "The message to patients is there are many treatment options, and you don't have to settle for a tube of ointment if your life is being negatively impacted by this disease."

The new guidelines were published online this week in the Journal of the American Academy of Dermatology.

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SOURCES: Menter, A. Journal of the American Academy of Neurology, published online Feb. 7, 2011.Alan Menter, MD, director of the residency program, Baylor Medical School at Dallas; past president, International Psoriasis Council.News release, American Academy of Dermatology.

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