Resetting the Research Agenda for Psoriasis

Abstract

Psoriasis is one of man's commonest inflammatory dermatoses, and the ability to manage it in all its clinical diversity is an important component of a dermatologist's specialist skills. The tools needed to do so include, crucially, a sound knowledge of how the many different treatments used in psoriasis compare with each other in terms of efficacy, side-effects and patient acceptability. The EDEN (European Dermato-Epidemiology Network) survey of randomized controlled trials (RCTs) in psoriasis by Naldi and colleagues in this issue of the Journal highlights how deficient our collective knowledge is. The authors acknowledge that their survey does not attempt to be comprehensive, in that they restricted themselves to RCTs of psoriasis management published in the last quarter of the twentieth century (1977–2000) in 14 leading general medical and dermatological journals from Europe and North America. This strategy would have missed over 20% of the 111 RCTs that we were able to find for a recent systematic review of treatments for severe psoriasis (Griffiths et al, 2000). In contrast to a traditional review, however, the EDEN survey involved hand-searching every volume of the selected journals to ensure that no relevant trials were missed. Each trial was then analyzed in detail for quality of design, execution and reporting. Their survey thus gives us the opportunity to review the performance of the dermatology community over the past quarter century and its efforts to evaluate treatments for psoriasis.