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Cover of Psoriasis

Psoriasis

Assessment and Management of Psoriasis

NICE Clinical Guidelines, No. 153

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Excerpt

Psoriasis is a common, chronic disease, which for many people, is associated with profound functional, psychological and social morbidity and important comorbidities. Effective treatments are available. Some treatments are expensive; all require appropriate monitoring and some may only be accessed in specialist care settings. Evidence indicates that a substantial proportion of people with psoriasis are currently dissatisfied with their treatment.

This guideline aims to provide clear recommendations on the assessment and management of psoriasis for all people with psoriasis. The diagnosis of psoriasis has not been included within the scope, partly for pragmatic reasons given that to cover psoriasis management itself is a considerable task, but also because there are no agreed diagnostic criteria or tests available and accurate diagnosis remains primarily a clinical one. In considering which specific aspects of psoriasis management to address, the guideline development group have focussed on areas most likely to improve the management and delivery of care for a majority of people affected, where practice is very varied and/or where clear consensus or guidelines on treatments are lacking. We have therefore addressed how to holistically assess people with psoriasis at all stages in the treatment pathway, the use of first, second and third line interventions and when to escalate therapy, and the role of psychological interventions and self-management strategies. We have avoided categorical description of what constitutes particular levels of disease severity, for example ‘mild’ or ‘moderate and severe’ excepting disease severity criteria for plaque psoriasis already described by NICE in order to qualify for biological therapy. There are no widely accepted definitions that are applicable to all situations and it is a contentious subject. Instead we emphasise the importance of measuring disease severity and impact to individualise care, and plan and evaluate management. There are also a number of key areas that we have not addressed for a variety of reasons. First, we have not evaluated the role of emollients in the treatment of psoriasis. These are widely prescribed and clinical experience suggests that they are used with benefit by patients. In the absence of robust RCT or high quality studies to inform recommendations to change this practice, and the fact that all placebo controlled trials involving topicals use a vehicle (which will have emollient properties) in the placebo arm, the treatment pathway starts on the assumption that when appropriate, emollients have already been prescribed. Secondly, we have not included fumaric acid esters in our evaluation of second line therapies. This intervention is not licensed for any indication in the UK and therefore cannot be included.

Contents

Copyright © National Clinical Guideline Centre - October 2012.

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Bookshelf ID: NBK247829PMID: 25340247

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