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      Definition of treatment goals for moderate to severe psoriasis: a European consensus


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          Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is <50%. In a situation where the therapeutic response improved ≥50% but <75%, as assessed by PASI, therapy should be modified if the DLQI is >5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians.

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          Most cited references20

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          Translating the science of quality of life into practice: What do dermatology life quality index scores mean?

          This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score = 4.86 (range 0-30, standard deviation (SD) = 5.83). Mean GQ score = 1.22 (range 0-4, SD = 1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and kappa coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0-1 = no effect on patient's life (GQ = 0, n = 754); DLQI scores 2-5 = small effect on patient's life (GQ = 1, n = 611); DLQI scores 6-10 = moderate effect on patient's life (GQ = 2, n = 327); DLQI scores 11-20 = very large effect on patient's life (GQ = 3, n = 242); DLQI scores 21-30 = extremely large effect on patient's life (GQ = 4, n = 59); kappa coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions.
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            European S3-guidelines on the systemic treatment of psoriasis vulgaris.

            Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.
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              British Association of Dermatologists' guidelines for biologic interventions for psoriasis 2009.


                Author and article information

                +49-431-5971508 , +49-431-5971543 , umrowietz@dermatology.uni-kiel.de
                Arch Dermatol Res
                Archives of Dermatological Research
                Springer-Verlag (Berlin/Heidelberg )
                21 September 2010
                21 September 2010
                January 2011
                : 303
                : 1
                : 1-10
                [1 ]Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
                [2 ]Department of Dermatology, Århus University Hospital, Århus, Denmark
                [3 ]Dermatologikum Hamburg, Hamburg, Germany
                [4 ]Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
                [5 ]Dermatology Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
                [6 ]Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité-Universitätsmedizin, Campus Berlin-Mitte, Berlin, Germany
                [7 ]A. Sygros Hospital, University of Athens Medical School, Athens, Greece
                [8 ]Department of Dermatology, School of Medicine, Charles University, Prague, Czech Republic
                [9 ]Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
                [10 ]Centre of Dermatovenereology, Clinic of Infectious Diseases, Dermatovenereology and Microbiology, Vilnius University, Vilnius, Lithuania
                [11 ]Centro de Dermatologia Epidermis, Faculty of Medicine, Instituto CUF, Porto, Portugal
                [12 ]Department of Dermatology, Hospital Universitario La Princesa, Madrid, Spain
                [13 ]Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
                [14 ]Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
                [15 ]Hôpital LARREY, Toulouse, France
                [16 ]Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
                [17 ]Department of Dermatology and Allergology, Päijät-Häme Central Hospital, Lahti, Finland
                [18 ]Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
                [19 ]Dermatology Clinic Rosenbach and Partner, Osnabrück, Germany
                [20 ]Dermatology Department, University Hospital Leuven, Leuven, Belgium
                [21 ]St John’s Institute of Dermatology, London, UK
                [22 ]Dermatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
                [23 ]Department of Dermatology, Sozialmedizinisches Zentrum Ost, Donauspital, Vienna, Austria
                [24 ]Department of Dermatology, Bern University Hospital, University of Bern, Bern, Switzerland
                © Springer-Verlag 2010
                Special Article
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                © Springer-Verlag 2011

                treatment goals,consensus,psoriasis,severity,patient care
                treatment goals, consensus, psoriasis, severity, patient care


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