AAD/NPF joint guidelines for psoriasis treatment
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The American Academy of Dermatology and the National Psoriasis Foundation paired up together to propose a considerable set of guidelines for the management and treatment of psoriasis with topical therapy, complementary and alternative medicine modalities for psoriasis severity measures.

The guideline covers clinical questions about the efficacy and safety of 12 oral-systemic, non-biologic medications.

-Methotrexate is recommended for the treatment of moderate to severe psoriasis in adults and is less effective than adalimumab and infliximab for cutaneous psoriasis. The current guideline also provides revised monitoring guidance for methotrexate associated hepatotoxicity recommending new non-invasive tests to evaluate for hepatic fibrosis.

-Apremilast is recommended for the treatment of moderate to severe psoriasis in adults.

-Cyclosporine is recommended for patients with severe, recalcitrant psoriasis. It can also be used for the treatment of erythrodermic, generalized pustular psoriasis and/ or palmoplantar psoriasis.

-Acitretin is recommended as a monotherapy or as a combination therapy with PUVA or UVB. Acitretin should not be used in patients who are pregnant or intend to become pregnant or nursing.

This guideline addresses multiple phototherapy treatment options ranging from widely used ultraviolet modalities to the combined use of photosensitizing agents to newer and less prevalent choices, which have demonstrated promise. The recommended dosing regimen, efficacy, and adverse effects of the various phototherapy modalities used as monotherapy or in combination with other psoriasis therapies to treat moderate-to-severe psoriasis in adults was assessed for each of the following phototherapy treatments:
-Narrowband UVB
-Broadband UVB
-Targeted UVB
-Excimer laser
-Excimer light
-Targeted narrowband UVB light
-UVA with psoralens (PUVA)
-Topical
-Oral
-Bath
-Photodynamic therapy
-Grenz ray
-Climatotherapy
-Visible light
-Goeckerman therapy (not a form of phototherapy)
-Pulsed dye laser (PDL)

A prior guideline was last published in 2009. This update provides significant additional scope including:

-Evidence-based use of phototherapy in different types of psoriasis.
-Evidence-based use of phototherapy in combination with other treatment modalities.
-New modalities and specific applications identified within the past decade
-Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the US population.

Psoriasis is associated with several comorbidities, many of which first manifest as skin disease.This guideline addresses the assessment and management of major comorbid conditions associated with psoriasis, including arthritis, heart disease, metabolic syndrome, smoking, excessive alcohol intake, inflammatory bowel disease, and psychiatric disorders.

Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice.

Kindly refer to the original publication here:
https://www.aad.org/member/clinical-quality/guidelines/psoriasis
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