From the academy
Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities

https://doi.org/10.1016/j.jaad.2018.11.058Get rights and content

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.

Key words

alcohol
anxiety
cancer
cardiovascular disease
chronic obstructive pulmonary disease
clinical guidelines for psoriasis
comorbidities
congestive heart failure
depression
dermatology
diabetes
erectile dysfunction
guidelines
hyperlipidemia
hypertension
inflammatory bowel disease
malignancy
metabolic syndrome
obesity
obstructive sleep apnea
psoriasis
psoriatic arthritis
relationships
renal disease
sexual health
skin disease
smoking
uveitis
work productivity

Abbreviations used

aHR
adjusted hazard ratio
aOR
adjusted odds ratio
BMI
body mass index
BMJ
British Medical Journal
BSA
body surface area
CI
confidence interval
CKD
chronic kidney disease
COPD
chronic obstructive pulmonary disease
DLQI
Dermatology Life Quality Index
HR
hazard ratio
IBD
inflammatory bowel disease
IL
interleukin
MACE
major adverse cardiovascular events
MI
myocardial infarction
NAFLD
nonalcoholic fatty liver disease
NMSC
nonmelanoma skin cancer
NPF
National Psoriasis Foundation
NSAID
nonsteroidal anti-inflammatory drug
OR
odds ratio
OSA
obstructive sleep apnea
PASI
Psoriasis Area Severity Index
PsA
psoriatic arthritis
QoL
quality of life
RR
relative risk
SIR
standard incidence rate
TNF
tumor necrosis factor
TNFi
tumor necrosis factor inhibitor

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Funding sources: None.

Disclosure: The American Academy of Dermatology (AAD) strives to produce clinical guidelines that reflect the best available evidence supplemented with the judgment of expert clinicians. Substantial efforts are taken to minimize the potential for conflicts of interest to influence guideline content. The management of conflict of interest for this guideline complies with the Council of Medical Specialty Societies' Code of Interactions with Companies. Funding of guideline production by medical or pharmaceutical entities is prohibited, full disclosure is obtained and evaluated for all guideline contributors throughout the guideline development process, and recusal is used to manage identified relationships. The AAD conflict of interest policy summary may be viewed at https://www.aad.org.

The following information represents the authors disclosed relationship with industry during guideline development. Authors (listed alphabetically) with relevant conflicts of interest with respect to this guideline are noted with an asterisk (*). In accordance with AAD policy, a minimum 51% of work group members did not have any relevant conflicts of interest.

Participation in ≥1 of the following activities constitute a relevant conflict: service as a member of a speaker bureau, consultant, or advisory board for pharmaceutical companies on psoriasis disease state, psoriasis drugs in development, or Food and Drug Administration–approved psoriasis drugs or sponsored research funding or investigator-initiated studies with partial or full funding from pharmaceutical companies on psoriasis disease state or psoriasis drugs in development or Food and Drug Administration approved psoriasis drugs. If a potential conflict was noted, the work group member recused themselves from discussion and drafting of recommendations pertinent to the topic area of interest. Complete group consensus was obtained for draft recommendations. Areas where complete consensus was not achieved are shown transparently in the guideline. Dr Armstrong* received honoraria serving as a consultant for AbbVie, Bristol-Myers Squibb, Celgene Corporation, Genzyme Corporation, GlaxoSmithKline, Janssen-Ortho Inc, Janssen Pharmaceuticals Inc, Leo Pharma Inc, Menlo Therapeutics, Modernizing Medicine, Ortho Dermatologics, Pfizer Inc, Regeneron, Sanofi, and Science 37 Inc; received honoraria speaking for AbbVie, Eli Lilly and Company, Janssen Pharmaceuticals Inc, Regeneron Pharmaceuticals Inc, and Sanofi; received honoraria speaking and providing faculty education for AbbVie, Eli Lilly, and Janssen Pharmaceuticals Inc; received grants/research funding as a principal investigator/investigator for Amgen, Celgene, Dermira, Eli Lilly and Company, Janssen-Ortho Inc, Leo Pharma Inc, National Institutes of Health, Novartis, Regeneron, and UCB; received no compensation as an investigator for Regeneron and Sanofi; received honoraria as an advisory board member for AbbVie, Amgen, Janssen-Ortho Inc, Merck & Co Inc, Novartis, Pfizer Inc, and UCB; and received honoraria serving as a data safety member for Boehringer Ingelheim. Dr Connor has no relationships to disclose. Dr Cordoro* received honoraria serving as a consultant for Valeant and an advisory board member for Anacor Pharmaceuticals Inc and received fees as a consultant for Pfizer Inc and as a member of the Scientific Steering Committee for Celgene. Dr Davis received no compensation serving as an investigator for Regeneron. Dr Elewski* received honoraria serving as a consultant for Boehringer Ingelheim, Celgene Corporation, IntendisGmBH, Lilly ICOS LLC, Merz Pharmaceuticals LLC, Novan, Novartis Pharmaceuticals Corp, Pfizer Inc, Sun Pharmaceutical Industries Ltd, and Valeant Pharmaceuticals International; received grants and research funding serving as a principal investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene Corporation, Eli Lilly and Company, Incyte Corporation, Janssen-Ortho Inc, LEO Pharma, Merck & Co Inc, Novan, Novartis Pharmaceuticals Corp, Pfizer Inc, Sun Pharmaceuticals Ltd, Valeant Pharmaceuticals International, and Vioment; received honoraria as an advisory board member for LEO Pharma; and received fees serving in another role for Hoffman-La Roche Ltd. Dr Elmets received honoraria serving as a consultant for Ferndale Laboratories Inc; received stock/options as a consultant for Vaxin; received fees/honoraria as a consultant/advisory board member for Vertex Pharmaceuticals; received grants/research funding as a principal investigator for the California Association of Winegrape Growers, Kyowa Hakko USA and Solgenix LLC; received grants/research funding as an investigator for Elorac Inc, Idera Pharmaceuticals Inc, Kyowa Hakko USA, and Solgenix LLC; received fees as a data safety monitoring board member for Astellas Pharma US Inc and LEO Laboratories Ltd; received no fees as a stockholder for Medgenics Inc; and received stock as a stockholder for Aevi Genomic Medicine and Immunogen (paid to spouse). Dr Gelfand* received honoraria serving as a consultant for AbbVie, Boehringer Ingelheim, Dermira, Dr Reddy, GlaxoSmithKline, Janssen Pharmaceuticals Inc, Menlo Therapeutics, Novartis Pharmaceuticals Corp, Pfizer Inc, Regeneron, Sanofi US Services, and Valeant Pharmaceuticals North America LLC; received fees as a consultant for BMS; received honoraria as a speaker for AAD; received fees as a speaker/faculty educator for continuing medical education supported by Eli Lilly; receiving grants/research funding as a principal investigator for AbbVie, Celgene, Eli Lilly and Company, Janssen Pharmaceuticals Inc, Novartis Pharmaceuticals Corp, Ortho Dermatologics, Pfizer Inc, Regeneron, and Sanofi/Sanofi US Services; received grants/research funding as an investigator for Sanofi; received honoraria as an advisory board member for Sanofi US Services; received honoraria as a data safety monitoring board member for Coherus Biosciences and Merck & Co Inc; received honoraria serving in another role for the Society for Investigative Dermatology; received no compensation in another role for Elsevier Inc and SID; and received fees in another role for Eli Lilly and UCB. Dr Gordon* received honoraria serving as a consultant for AbbVie, Almirall, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Demira, Dermavant Sciences, Kyowa Hakko Kirin Pharma Inc, Leo Pharma, Ortho Dermatologics, Sun Pharmaceuticals Ltd, and UCB; received fees serving as a consultant for Genzyme; received grants/research funding as a principal investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene Corporation, Eli Lilly and Company, Janssen Pharmaceuticals Inc, Merck & Co Inc, and Novartis Pharmaceuticals Corp; and received honoraria as an advisory board member for Celgene Corporation, Janssen Pharmaceuticals Inc, Lilly ICOS LLC, Novartis Pharmaceuticals Corp, and Pfizer Inc. Dr Gottlieb* received honoraria serving as a consultant for Abbott Laboratories, AbbVie, Akros Pharma Inc, Allergan, Amgen, Amicus Therapeutics, Baxalta Incorporated, Bristol-Myers Squibb, Canfite, Celgene Corporation, CSL Behring, Dermira, Dr Reddy, DUSA Pharmaceuticals Inc, GlaxoSmithKline, Incyte Corporation, KPI Therapeutics, Lilly ICOS LLC, Meiji Seika Pharma Co Ltd, Merck & Co Inc, Mitsubishi Pharma, Novartis Pharmaceuticals Corp, Sanofi-Aventis, Sienna Biopharmaceuticals, Sun Pharmaceutical Industries, Takeda Pharmaceuticals USA Inc, Teva, UCB, Valeant Pharmaceuticals International, Valeant Pharmaceuticals North America LLC, XBiotech, and Xenoport Inc; received no compensation as a consultant for Aclaris Therapeutics Inc, Merck & Co Inc, and XBiotech; received honoraria as a speaker for AbbVie, Eli Lilly, and Janssen Biotech; received grants/research funding as a principal investigator for Abbott Laboratories, AbbVie, Allergan, Amgen, Celgene Corporation, Coronado Biosciences, Immune Control, Incyte Corporation, Janssen-Ortho Inc, LEO Pharma, Lerner Medical Devices Inc, Lilly ICOS LLC, Merck & Co Inc, Novartis Pharmaceuticals Corp, Novo Nordisk A/S, Pfizer Inc, UCB, Xbiotech, and Xenoport Inc; received honoraria as a principal investigator for Janssen-Ortho Inc; received honoraria as an advisory board member for Abbott Laboratories, Actelion, Amgen, Astellas Pharma US Inc, Beiersdorf Inc, BMS, Celgene Corporation, Coronado Biosciences, Dermira, Genentech, Janssen-Ortho Inc, Leo Pharma US, Lilly ICOS LLC, Novartis Pharmaceuticals Corp, Novo Nordisk A/S, Pfizer Inc, and UCB; received grants/research funding in another role for Amgen; received no compensation in another role for Crescendo Bioscience and Karyopharm Therapeutics; received honoraria for serving on the data safety monitoring board for Catabasis Pharmaceuticals Inc; and received honoraria in another role for DermiPsor. Dr Kaplan received no compensation serving as a consultant for Eli Lilly and Company and received fees as a member of the data safety monitoring board for Hapten Pharma. Dr Kavanaugh* received grants/research funding serving as a principal investigator for AbbVie, Amgen, BMS, Celgene Corporation, Eli Lilly and Company, Janssen Biotech, Novartis, Pfizer Inc, and UCB. Dr Kivelevitch has a first-degree relative employed by GlaxoSmithKline and Boehringer Ingelheim. Mr Kiselica has no relationships to disclose. Dr Korman* received honoraria serving as a consultant for Novartis Pharmaceuticals Corp; received fees as a consultant for Dr Reddy's Laboratory; received honoraria as a speaker for AbbVie, Eli Lilly, Janssen, Novartis, and Regeneron; received grants/research funding as a principal investigator for AbbVie, Amgen, Celgene Corporation, Dermira, Eli Lilly and Company, Kyowa Hakko Kirin Pharma Inc, LEO Pharma, Menlo Therapeutics, Pfizer, Prothena, Regeneron, Rhizen Inc, Syntimmune, and UCB; received honoraria as an advisory board member for Amgen, Celgene Corporation, Eli Lilly and Company, Genentech, GlaxoSmithKline, Janssen Pharmaceuticals Inc, Novartis Pharmaceuticals Corp, Pfizer Inc, and Principia Biopharma; received fees as an advisory board member for Immune, Regeneron, Sun Pharma, and Valeant; and received grants/research funding in another role for Janssen Pharmaceuticals Inc. Dr Kroshinsky has no relationships to disclose. Dr Lebwohl* received honoraria serving as a consultant for Allergan, Aqua, Arcutis Inc, Boehringer Ingelheim, Bristol-Myers Squibb, Leo Pharma, Menlo Therapeutics, Mitsubishi Pharma/Neuroderm LTD, Promious/Dr. Reddy, Theravance Biopharma, and Verrica Pharmaceuticals Inc; received grants/research funding as a principal investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene Corporation, Eli Lilly and Company, Incyte Corporation, Janssen Research and Development LLC/Johnson & Johnson, Kadmon Corporation LLC, Leo Pharma, MedImmune/Astra Zeneca, Novartis Pharmaceuticals Corp, Ortho-Dermatologics, Pfizer Inc, SCIDerm, UCB, and ViDac Pharma; and received honoraria in another role for Corrona Inc, Facilitation of International Dermatology Education, and the Foundation for Research and Education in Dermatology. Dr Leonardi* received honoraria serving as a consultant for Celgene Corporation and Dermira; received honoraria as a speaker for AbbVie, Amgen, Celgene Corporation, Eli Lilly and Company, Novartis, and Sun Pharmaceuticals Ltd; received other financial benefits as a principal investigator for Actavis, Amgen, Boehringer Ingelheim, Celgene Corporation, Cellceutix, Coherus Biosciences, Corrona, Dermira, Eli Lilly and Company, Galderma Laboratories LP, Glenmark Generics Inc, Janssen Pharmaceuticals Inc, Leo Pharma Inc, Novartis, Novella, Pfizer Inc, Sandoz a Novartis Company, Sienna Biopharmaceuticals, Stiefel (a GSK company), UCB, and Warner Chillcott; and receiving honoraria as an advisory board member for AbbVie, Amgen, Boehringer Ingelheim, Eli Lilly and Company, Janssen Pharmaceuticals Inc, Leo Pharma A/S, Ortho Dermatologics, Pfizer Inc, Sandoz (a Novartis Company), and UCB. Dr Lichten has no relationships to disclose. Dr Lim received grants/research funding serving as a principal or co-investigator for Estee Lauder, Ferndale Laboratories Inc, Incyte, and Unigen; and received honoraria as a speaker/faculty educator for Pierre Fabre Dermatologie. Dr Mehta* is a full-time US government employee receiving grants/other payments as a consultant for Amgen, Eli Lilly, and Leo Pharma; and received grants/research funding serving as a principal investigator/investigator for AbbVie, Celgene, Janssen Pharmaceuticals Inc, and Novartis; and received grants/research funding as a principal investigator for the National Institutes of Health. Dr Menter* received honoraria serving as a consultant for Abbott Labs, AbbVie, Amgen, Eli Lilly and Company, Galderma USA, Janssen Pharmaceuticals Inc, LEO Pharma US, Menlo Therapeutics, Novartis, Sienna Biopharmaceuticals, and Wyeth Labs; received fees as a consultant for New Enterprise Associates, Promius Pharma LLC, Spherix Global Insights US, UCB, and Valeant Pharmaceuticals North America; received no compensation as a consultant for Afecta Pharmaceuticals; received honoraria as a speaker for Abbott Labs, AbbVie, Amgen, Janssen Biotech, LEO Pharma US, Pfizer Inc, Promius Pharma LLC, Sienna Pharmaceuticals, UCB, and Wyeth Labs; received grant/research funding as a principal investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene Corporation, Eli Lilly and Company, Janssen Pharmaceuticals Inc, Medimetriks Pharmaceuticals Inc, Merck & Co Inc, Novartis Pharmaceutical Corp, and Pfizer Inc; received honoraria as an investigator for Eli Lilly and Company and UCB; recieved grants as an investigator for Abbott Labs, Leo Pharma US, Sienna Biopharmaceuticals; received honoraria as an advisory board member for Abbott Labs, AbbVie, Boehringer Ingelheim, Eli Lilly and Company, Janssen Pharmaceuticals Inc, LEO Pharma US, Medscape, Pfizer Inc, and Sienna Biopharmaceuticals; received grant/research funding as an advisory board member for Amgen; received no compensation as an advisory board member for Afecta Pharmaceuticals; and received fees as an independent contractor for Prime Education. Dr Paller* received honoraria serving as a consultant for Amgen, Amicus Therapeutics, Anacor Pharmaceuticals Inc, Aqua Pharmaceuticals, BridgeBio Pharma, Castle Creek Pharma, Celgene Corporation, Dermira, Eli Lilly and Company, Galderma Laboratories LP, Genentech, Menlo Therapeutics, Novartis Pharmaceuticals Corp, Pfizer Inc, Proctor and Gamble, Regeneron, Scioderm, Shire, Sol-Gel Technologies, Stiefel (a GSK company), Sanofi, UCB, and Valeant Pharmaceuticals North America LLC; received honoraria as a speaker/educator for Expanscience; received no compensation as a principal investigator for AbbVie, Amgen, Anacor Pharmaceuticals, Inc, AnaptysBio, Celgene Corporation, Eli Lilly, Galderma, Janssen Pharmaceuticals, Inc, Leo Pharma, Regeneron, and Scioderm. Dr Parra has no relationships to disclose. Dr Pathy has no relationships to disclose. Dr Prater has no relationships to disclose. Dr Rupani received no compensation serving as speaker for Nutrafol. Dr Siegel has no relationships to disclose. Dr Stoff received fees serving as an investigator for Celtaxsys Inc. Dr Strober* received honoraria serving as a consultant for AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene Corporation, Dermira, Eli Lilly and Company, GlaxoSmithKline, Janssen-Ortho Inc, Leo Pharma Inc, Maruho Co Ltd, Medac Pharma Inc, Menlo Therapeutics, Novartis Pharmaceuticals Corp, Ortho Dermatologics, Pfizer Inc, Sanofi-Regeneron, Sun Pharmaceuticals Industries, and UCB; received fees as a consultant for Affibody, Bristol-Myers Squibb, Meiji Seika Pharma Co Ltd, and UCB; received no compensation as a principal investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene Corporation, Eli Lilly and Company, Janssen-Ortho Inc, Merck & Co, Pfizer Inc, and Sun Pharmaceutical Industries; received grants/research funding as a principal investigator for Galderma Research & Development LLC; received honoraria as an advisory board member for AbbVie, Amgen, Bristol-Myers Squibb, Celgene Corporation, Dermira, Eli Lilly and Company, Janssen-Ortho Inc, Novartis Pharmaceuticals Corp, Pfizer Inc, Sanofi-Regeneron, Sun Pharmaceuticals Industries, and UCB; received fees/honoraria as a consultant/advisory board member for AstraZeneca Pharmaceuticals LP; and received no compensation in another role for AbbVie and Janssen-Ortho, Inc. Dr Wong has no relationships to disclose. Dr Wu* received fees and/or honoraria serving as a consultant for Abbvie, Almirall, Allergan, Amgen, Bristol-Myers Squibb, Celgene, Dermira, Dr Reddy's Laboratories, Eli Lilly and Company, Janssen Biotech, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer Inc, Promius Pharma, Regeneron, Sun Pharmaceutical Industries Ltd, UCB, and Valeant Pharmaceuticals North America LLC; received honoraria as a speaker for AbbVie, Celgene, Novartis, Regeneron, Sun Pharmaceutical Industries Ltd, UCB, and Valeant Pharmaceuticals North America LLC; and received research/grant funding as a principal/investigator for AbbVie, AstraZeneca, Boehringer Ingelheim, Coherus Biosciences, Dermira, Eli Lilly and Company, Janssen Pharmaceuticals Inc, Merck & Co Inc, Novartis, Pfizer Inc, Regeneron, Sandoz (a Novartis Company), and Sun Pharmaceutical Industries Ltd. Dr Hariharan has no relationships to disclose.

Reprints not available from the authors.

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