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Treatment goals for moderate to severe psoriasis: An A ustralian consensus
Author(s) -
Baker Christopher,
Mack Alexandra,
Cooper Alan,
Fischer Gayle,
Shumack Stephen,
Sidhu Shireen,
Soyer Peter,
Wu Jason,
Chan Jonathan,
Nash Peter,
Rawlin Morton,
Radulski Barbara,
Foley Peter
Publication year - 2013
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/ajd.12014
Subject(s) - psoriasis , medicine , dermatology life quality index , psoriasis area and severity index , quality of life (healthcare) , severity of illness , dermatology , incidence (geometry) , family medicine , nursing , physics , optics
Abstract Background/Objectives The high incidence of comorbidities in patients with psoriasis, significant impact on quality of life and patients' dissatisfaction with treatment led a European group to develop a consensus position on psoriasis treatment goals. There is an evident need for similar treatment goals in A ustralia. The aim of this project was to develop Australian treatment goals that reflect the local environment.Methods A panel of 12 representatives was drawn from across A ustralia consisting of nine dermatologists and a rheumatologist, a dermatology nurse and a general practitioner ( GP) /dermatology trainee. The group met on three occasions between S eptember 2011 and M arch 2012. The panel undertook a literature review and critically examined available evidence‐based treatment goals. A questionnaire relating to psoriasis assessment and specific treatment outcomes was developed. Following discussion and debate, recommended treatment goals for psoriasis patients in A ustralia were determined. Results The panel agreed by consensus on recommended psoriasis treatment goals in the Australian environment. There was recognition that in addition to psoriasis area severity index ( PASI) assessment, a quality of life assessment was highly relevant in determining psoriasis severity and treatment outcome. Mild psoriasis was defined as PASI ≤ 10 and a dermatology life quality index ( DLQI) ≤ 10, with moderate to severe psoriasis defined as PASI > 10 and/or DLQI > 10. The presence of certain definedclinical features would elevate a patient's classification from mild to moderate/severe. The target for treatment was defined as a maintained change in PASI ≥ 75% improvement and DLQI ≤ 5. These largely concurred with the European treatment goals. A flow chart for psoriasis management in A ustralia based on outcome measures was developed. Conclusions There is a need to identify and articulate treatment goals for psoriasis. Assessment of psoriasis severity requires both physical scoring ( PASI ) and consideration of quality of life measures ( DLQI ). Identification of treatment goals will guide clinicians in treatment decision‐making, enhance the availability and appropriate use of therapies and increase patient satisfaction with their care.