Guidelines For Treatment Of Psoriasis Research Articles

A critical appraisal of evidence-based guidelines for the treatment of psoriasis vulgaris: ‘AGREE-ing’ on a common base for European evidence-based psoriasis treatment guidelines

To further improve the standard of care provided to psoriasis patients in Europe, the European Dermatology Forum and the European Academy of Dermatology and Venereology have initiated a project to develop common European psoriasis guidelines. This paper aims to assess the methodological quality and suitability of evidence-based psoriasis guidelines as a base of common European treatment guidelines. A systematic literature search of the National Guidelines Clearinghouse, MEDLINE, EMBASE and GIN database for evidence-based psoriasis treatment guidelines published between 2001 and 2007 was performed and the AGREE instrument was used to assess the methodological quality. Out of 166 hits, we identified three evidence-based guidelines. A Dutch guideline that includes systemic treatments and photo(chemo)therapy, a British guideline that includes biologics only, and a German guideline that includes systemic therapy, photo(chemo)therapy and topical therapy. For the majority of the 23 AGREE items assessed, all three guidelines rated high (3-4/4). The highest score was obtained by the British guidelines with 75 points out of 92, followed by the German guidelines with 74 points and the Dutch guidelines with 73 points. All guidelines showed weaknesses in the field of 'applicability'. The three guidelines that could be included rated high enough to be considered 'strongly recommended' and were included to serve as a basis for the new common European guidelines. During the development of the European guidelines, special attention should be paid to meet the requirements of good 'applicability'.

Translating psoriasis treatment guidelines into clinical practice – the need for educational interventions and strategies for broad dissemination

Evidence-based guidelines can make a substantial contribution to improving medical care. However, it is important to ensure that guidelines are: (1) developed in areas in which they are needed the most; and (2) translated effectively into everyday clinical practice. To evaluate the need for guidelines in the treatment of psoriasis vulgaris, the success of the dissemination activities undertaken to date, and the potential benefits of educational interventions in encouraging guideline compliance. All dermatologists working in the Berlin-Brandenburg region of Germany were invited to attend a workshop on the psoriasis treatment guidelines. Participants could take part in a survey examining the general need for psoriasis guidelines and the success of previous dissemination activities. A total of 42% of survey participants had not received a copy of the guidelines prior to the workshop. Of those who had received a copy, only 15% had studied the guidelines in detail. In total, 76% of survey participants felt that physicians' low levels of confidence in administering systemic treatments had resulted in these treatment options being used less frequently than they should. Seventy-nine per cent of survey participants believed that the guidelines would be helpful in improving physicians' confidence and ultimately lead to an increased use of systemic treatments. The results of the present study indicate that there is a great need for guidelines on the treatment of psoriasis vulgaris in Germany, especially in light of dermatologists' low levels of confidence administering systemic treatments. Strategies for broad dissemination are essential for proper guideline implementation.

Practical guidelines for the long-term treatment of psoriasis with efalizumab

Greater understanding of the immunopathogenesis of psoriasis, combined with advances in molecular technology, has led to the development of biologic agents that target specific steps underlying this disease.1 Biologics, which include T-cell inhibitors, such as efalizumab and alefacept, and tumor necrosis factor-α inhibitors, such as etanercept, infliximab, and adalimumab, differ from traditional therapies in terms of their mechanisms of action, modes of administration, and relative benefit:risk profiles favorable for safe, long-term control of disease.