Background: Currently, no formalized international consensus guidelines exist to direct optimal topical

treatment including long-term treatment.

Objective: In this survey, we aim to examine if and which topicals are used in clinical practice in

long-term continuous treatment of psoriasis and how topicals are used in treating specific sites of

the body.

Methods: A questionnaire was distributed electronically to dermatologists from the International

Psoriasis Council (IPC) representing 26 countries.

Results: The top three topicals used across all severities of disease were topical corticosteroids, vitamin

D analogs, and potent topical corticosteroids in combination with vitamin D analogs. On locations

where the skin is thin, flexural and genital psoriasis, lower potency topical corticosteroids were

used, whereas on other sites, in particular in palmoplantar psoriasis, superpotent topical corticosteroids

and combination vitamin D analogs/corticosteroids were used.

Conclusions: It is relevant to optimize localized therapy for all severities of psoriasis reconciling disease

activity (stable vs. unstable disease), localization of the lesions and the individual patient and

his/her perspectives on disease control. Topical therapies are valuable treatments for classical mild disease

and may have a position in some patients with more severe manifestations.

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ABSTRACT

The Psoriasis Symptom Inventory (PSI) is a patient-reported outcome measure designed to assess psoriasis signs and symptoms.

Objectives
The aim was to assess the usefulness of the PSI in enhancing patient care in the clinical setting.

Methods
Eight dermatology clinics in six countries enrolled adults representing the full spectrum of psoriasis severity who regularly received care at the clinic. Patients were administered the eight-item PSI (score range 0–32; higher scores indicate greater severity) while waiting for the physician; the physician conducted a static physician global assessment (sPGA) and estimated psoriasis-affected body surface area (BSA) at the same visit. Physicians completed a brief questionnaire after each patient visit, and were interviewed about the PSI after all patients were seen.

Results
The clinics enrolled 278 patients; mean [standard deviation (SD)] psoriasis-affected BSA was 7.6% (11.4). Based on BSA, 47.8% had mild psoriasis, 29.1% had moderate psoriasis, and 23.0% had severe psoriasis. Based on sPGA, 18.7% were clear/almost clear, 67.3% were mild/moderate, and 14.0% were severe/very severe. The mean (SD) PSI total score was 12.2 (8.3). Physicians spent a mean (SD) 4.9 (4.8) min discussing PSI findings with their patients (range 0–20 min). Key benefits of PSI discussions included the following: new information regarding symptom location and severity for physicians; prompting of quality-of-life discussions; better understanding of patient treatment priorities; change in treatment regimens to target specific symptoms or areas; and improvement of patient–physician relationship.

Conclusions
The PSI was useful for treated and untreated patients to enhance patient–physician communication, and influenced treatment decisions.

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ABSTRACT

Psoriasis is a systemic, relapsing, inflammatory disease associated with serious comorbidities including mood problems and/or unhealthy lifestyle behaviours. Cutaneous and systemic abnormalities in innate and acquired immunity play a role in its pathogenesis. The exact pathogenetic mechanism remains elusive. Evidence is accumulating that TNF-alpha, IL-17 and IL-23 signalling are highly relevant as targeting these pathways reduces disease activity. Evidence suggests a strong link between psoriasis and depression in adults. The International Psoriasis Council (IPC) held a roundtable event, “Psoriasis and Mental Health”, in Barcelona, Spain which focused on the presence of depression and suicidality, plus the role of neuroinflammation in psoriasis, sleep disruption and the impact of depression on cardiovascular disease outcomes. We summarize here the expert presentations to provide additional insight into the understanding of psychiatric comorbidities of psoriasis and of the impact of chronic, systemic inflammation on neuro- and cardiovascular outcomes. the associations between psoriasis and other psychiatric comorbidities are still controversial and warrant further attention.

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ABSTRACT

BACKGROUND:
Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies. However, due to the heterogeneity of severity classifications and their lack of consideration for the impact of psoriasis involvement of special areas or past treatment history, patients may be mis-categorized, which can lead to under-treatment of psoriasis.

OBJECTIVE:
To develop a consensus statement on the classification of psoriasis severity.

METHODS:
A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity.

RESULTS:
After completion of the exercise, seven severity definitions were preferentially ranked. This most preferred statement rejects the mild, moderate and severe categories in favor of a dichotomous definition: Psoriasis patients should be classified as either candidates for topical therapy or candidates for systemic therapy; the latter are patients who meet at least one of the following criteria: 1) BSA > 10%, 2) Disease involving special areas, 3) Failure of topical therapy.

LIMITATIONS:
This effort might have suffered from a lack of representation by all relevant stakeholders, including patients.

CONCLUSION:
The consensus statement describes two categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.

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ABSTRACT

Corticosteroid therapy is regarded as first-line therapy for treating mild psoriasis and recalcitrant lesions. Members of the IPC Topical Therapies Working Group reviewed available international topical corticosteroids guidelines in order to understand current information and to identify areas that would benefit from greater practical guidance for dermatologists. The results of their review were published online by the Journal of Dermatological Treatment in May. The researchers reviewed corticosteroid guidelines from 10 countries: New Zealand, Norway, Malaysia, United Kingdom, the Netherlands, Scotland, Canada, the United States, Germany, and South Africa. In their article, the authors revealed that a broad consensus exists across guidelines regarding the choice of steroid potency for specific body sites and the duration of steroid use in the short term. However, the review demonstrated that there are gaps in the recommendations for long-term treatment, as well as in the utility of tapering of topical corticosteroids and breaks in treatment. The authors call for an international collaboration to develop a consensus opinion that would outline effective and safe real-world practice in the use of topical corticosteroids. Such a consensus would maximize the appropriate use of steroids for the benefit of patients with psoriasis.

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Abstract

Psoriasis in children can be a challenging diagnosis: the clinical presentation is often more subtle, may occur in covered sites and can be an unexpected diagnosis as psoriasis if often thought to occur at older ages. Poor recognition and delayed diagnosis of psoriasis in children can lead to inadequate treatment and lack of monitoring for comorbidities including juvenile psoriatic arthritis. Diagnostic criteria would help both clinical practice and clinical research, but to date none are available.

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