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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infection by the coronavirus SARS-CoV-2 and the associated disease&#44; COVID-19&#44; constitute a serious public health problem&#46; Considerable uncertainty surrounds the way in which this problem will affect inflammatory diseases such as psoriasis and&#44; in particular&#44; patients treated with selective immunomodulators and immunosuppressants&#46; Based on the scarce scientific evidence available and consistent with the position of other national and international scientific societies &#40;European Academy of Dermatology and Venereology-Skin Inflammation and Psoriasis International Network&#44; International Psoriasis Council&#44; American Academy of Dermatology&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> the Psoriasis Group of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41; issued a statement through the AEDV &#40;GPs-COVID-19&#41;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with the aim of guiding dermatologists who treat psoriasis&#44; especially in cases where patients are receiving treatment or are about to initiate treatment with selective immunomodulators or immunosuppressants&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The SARS-CoV-2 pandemic has affected&#44; and will continue to affect&#44; at least for some time&#44; the management of patients with psoriasis and the functioning of specialist psoriasis clinics&#46; Given that the situation is gradually coming under control&#44; it is worth considering the conditions for and limitations to resuming care services in these clinics in a scenario where the virus continues to circulate&#44; with occasional or seasonal exacerbations&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to minimize risk for and maximize benefits to patients and optimize the functioning of psoriasis clinics&#44; the Psoriasis Group has developed a series of recommendations based on scientific evidence and on recommendations from other scientific societies&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In any case&#44; whether or not these recommendations are applied will depend on scientific evidence and the progress of the pandemic&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Recommendations</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patient Management</span><p id="par0025" class="elsevierStylePara elsevierViewall">Data available on previous and current outbreaks of coronavirus infection &#40;severe acute respiratory syndrome&#44; Middle East respiratory syndrome&#44; COVID-19&#41; enable us to suggest that the risk of severe manifestations and complications of COVID-19 is no greater in immunodepressed patients than in the general population&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The main interleukins &#40;IL&#41; involved in the pathogenesis of psoriasis &#40;tumor necrosis factor &#91;TNF&#93; alfa&#44; IL-17&#44; and IL-23&#41; have not been proven to affect the course of the viral infection&#44; although they could be involved in the onset of the cytokine storm&#44; which is associated with the severity of the infection&#46; Therefore&#44; at least in terms of pathogenesis&#44; specific inhibition of these proteins does not seem to imply a risk with respect to the clinical course of patients taking specific immunomodulators&#46; The impact of broad-spectrum immunomodulators &#40;methotrexate&#44; ciclosporin&#41; and their inhibition is less well-known&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Proposals for the management of patients with psoriasis are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Psoriasis Clinic During the SARS-CoV-2 Pandemic<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">In-person specialist psoriasis clinic</span><p id="par0035" class="elsevierStylePara elsevierViewall">The conditioning factors and restrictions affecting in-person visits to the specialist psoriasis clinic will be those that are appropriate and acknowledged for any in-person visit to the dermatology clinic while the pandemic lasts &#40;recommendations of the institutions themselves and of the AEDV&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Specialist psoriasis clinic online</span><p id="par0040" class="elsevierStylePara elsevierViewall">The new situation brought about by the COVID-19 pandemic&#44; where in-person visits are expected to be restricted&#44; could provide an opportunity for the development and appropriate adaptation of complementary strategies &#40;e&#46;g&#46;&#44; telemedicine&#44; in the screening&#44; management&#44; and follow-up of psoriasis&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The activities that each unit will now address online should preferably be supervised by the professionals who see patients at the in-person visits and have appropriate knowledge and experience in the management of these patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">An in-person approach should continue to be used&#44; at least for the initial visits or until the skin disease is well-controlled&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Online visits could be alternated with in-person visits for the follow-up of well-managed patients whose disease is controlled with the treatment prescribed at the in-person visits&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore&#44; we believe that it would be of interest to set out the main uses of teledermatology in the specialist psoriasis clinic &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">Dr&#46; I&#46; Belinch&#243;n has acted as a consultant and&#47;or speaker for and&#47;or has participated in clinical trials sponsored by the following companies&#58; Janssen Pharmaceuticals Inc&#46;&#44; Almirall SA&#44; Lilly&#44; AbbVie&#44; Novartis&#44; Celgene&#44; Amgen&#44; LEO Pharma&#44; Pfizer-Wyeth&#44; UCB&#44; and MSD&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dr&#46; Ll&#46; Puig has acted as a consultant and&#47;or speaker for and&#47;or has participated in clinical trials sponsored by the following companies&#58; AbbVie&#44; Almirall&#44; Amgen&#44; Baxalta&#44; Biogen&#44; Boehringer Ingelheim&#44; Celgene&#44; Gebro&#44; Janssen&#44; JS BIOCAD&#44; LEO Pharma&#44; Lilly&#44; Merck-Serono&#44; MSD&#44; Mylan&#44; Novartis&#44; Pfizer&#44; Regeneron&#44; Roche&#44; Sandoz&#44; Samsung-Bioepis&#44; Sanofi&#44; and UCB&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Dr&#46; L&#46; Ferr&#225;ndiz has acted as a consultant and&#47;or speaker for and&#47;or has participated in clinical trials sponsored by the following companies&#58; Janssen Pharmaceuticals Inc&#46;&#44; Almirall SA&#44; Lilly&#44; AbbVie&#44; Novartis&#44; Amgen&#44; LEO Pharma&#44; UCB&#44; and Gebro Pharma&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Dr&#46; P&#46; de la Cueva has acted as a consultant and&#47;or researcher for the following companies&#58; AbbVie&#44; Almirall&#44; Astellas&#44; Biogen&#44; Boehringer&#44; Celgene&#44; Janssen&#44; LEO Pharma&#44; Lilly&#44; MSD&#44; Novartis&#44; Pfizer&#44; Roche&#44; Sanofi&#44; and UCB&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Dr&#46; J&#46;M&#46; Carrascosa has acted as a consultant and&#47;or speaker for and&#47;or has participated in clinical trials sponsored by the following companies&#58; Janssen Pharmaceuticals Inc&#46;&#44; Almirall SA&#44; Lilly&#44; AbbVie&#44; Novartis&#44; Celgene&#44; Amgen&#44; LEO Pharma&#44; Pfizer-Wyeth&#44; Sandoz&#44; Amgen&#44; Biogen&#44; and Mylan&#46;</p></span></span>"
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              "identificador" => "sec0020"
              "titulo" => "In-person specialist psoriasis clinic"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Belinch&#243;n I&#44; Puig L&#44; Ferr&#225;ndiz L&#44; de la Cueva P&#44; Carrascosa JM&#46; Recomendaciones del Grupo de Psoriasis de la AEDV sobre el manejo de la consulta de psoriasis durante la pandemia por COVID-19&#46; Actas Dermosifiliogr&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.ad.2020.05.004">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;ad&#46;2020&#46;05&#46;004</span></p>"
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                  \t\t\t\t">In general&#44; patients with psoriasis can continue their treatment during the COVID-19 pandemic in order to avoid flare-ups that would directly affect the patient and necessitate greater use of health care resources&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Small-molecule immunosuppressants and biologics should generally be suspended if a patient is suspected of having active COVID-19 infection&#46; Initiating these treatments in cases of active infection is contraindicated&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">If a patient lives in areas with a high incidence of COVID-19 or is in close contact with confirmed cases&#44; temporary suspension of some selective immunomodulators or immunosuppressants should be considered&#8212;taking into account factors such as age and comorbid conditions&#8212;until the infection has been confirmed or ruled out&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">There is no evidence&#8212;or restriction to date&#8212;with respect to the use of topical treatments in the management of patients with psoriasis&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">We currently lack data on the impact of psoriasis therapy on susceptibility to or severity of COVID-19&#46; Therefore&#44; health professionals should be guided by their previous clinical experience and their understanding of the mechanism of action of the treatment they prescribe&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">The new situation brought about by the pandemic may affect the advisability of and restrictions associated with phototherapy as an option for treatment of psoriasis&#46; The Photobiology Group of the Spanish Academy of Dermatology and Venereology has drafted a specific document in this area&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Screening of patients in order to evaluate the need for in-person care in the psoriasis unit&#46; The most efficient approach in this case is store-and-forward teledermatology&#44; which is based on clinical images taken in the health center and requested by the family physician&#46; Thus&#44; a virtual screening appointment makes it possible to identify patients with moderate to severe psoriasis who are candidates for systemic treatment or phototherapy and can be seen at an in-person visit&#46; The general evaluation of the patient should take into account the impact on quality of life&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Follow-up of the response to therapy via direct teledermatology between physician and patient&#44; with digital images taken by the patient or via a video visit&#46; The optimal approach should include an online history&#44; access to additional tests via the online history&#44; electronic prescription&#44; and basic additional tests in the hospital or primary care center&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Reporting of incidents&#46; In the case of chronically ill patients&#44; teledermatology is also useful for early reporting of incidents associated with the disease &#40;e&#46;g&#46;&#44; loss of response&#44; early onset of comorbid conditions&#41; or with treatments &#40;e&#46;g&#46;&#44; detection of toxicity&#44; dispensing incidents&#41;&#46; The patient should be able to contact the psoriasis unit without having to travel&#44; according to well-established protocols&#44; and using any means of communication &#40;e&#46;g&#46;&#44; telephone&#44; direct virtual consultation with images sent by the patient&#44; app&#41; that enables a suitable response&#46; Reporting should fulfill the requirements of confidentiality&#44; encryption&#44; and connection with the computer system set out by the individual health service&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Teledermatology models should always be supported by guaranteed in-person care&#46; Therefore&#44; irrespective of the stage of care&#44; patients will benefit from in-person or virtual visits depending on the modality that best meets their needs and their personal&#44; occupational&#44; and social situation&#46;&nbsp;\t\t\t\t\t\t\n
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