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This entire www. The creators of this Web site along with the services provided are released of all liabilities. If you do not agree to these terms, click 'Disagree' to go back to the Straight. Get the latests news, prebuys and contest updates. I agree to be contacted by the Georgia Straight. We agree that cyclosporine and infliximab appear to be the most rapidly acting agents for the treatment of erythrodermic psoriasis.

No data on use of risankizumab nor tildrakizumab were found. We do not recommend the use of fumarates, however, in the systemic treatment of erythrodermic psoriasis patients, due to their slow mode action and potential hypersensitivity reactions worsening the disease.


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Overall, recent data suggest that newer biologics are less affected by a history of previous failure to another biologic. Regarding biologics, we recommend continuous systemic treatment for patients with psoriasis when the patient is still receiving benefit. Should a psoriasis patient wish to stop and then restart systemic treatment, we advise that it is possible to do so, particularly with etanercept and ustekinumab.

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There is robust evidence that demonstrates these drugs can be stopped and then restarted with equivalent efficacy and without increased risk of flare of disease. For adalimumab, certolizumab pegol, guselkumab, risankizumab and tildrakizumab, ixekizumab, secukinumab and brodalumab, the evidence is less clear. Fumarates can also be used intermittently although they exhibit a slow onset of action.

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There is currently insufficient evidence to support stopping and then restarting treatment with other biological drugs, including adalimumab, certolizumab pegol and tildrakizumab. We advise caution with this approach until these data are available. However, we recommend against stopping and restarting infliximab due to reduced efficacy on restarting treatment as a result of the development of antidrug antibodies. From a safety perspective, there is also an increased risk of serious infusion reactions with intermittent infliximab dosing.

From an efficacy and safety perspective, we advise that it is possible to switch from TNF antagonist reference drugs, infliximab, adalimumab and etanercept, to their respective biosimilar. In case of new biologics, data are often still lacking. Recommendations for systemic psoriasis treatments according to comorbidities, psoriasis subtypes and intermittent treatment.

Levels of evidence: A high level of evidence , B moderate level of evidence , C low level of evidence. Results of the studies: 1. Green : preserved efficacy without increased adverse events or worsening of the comorbidity; 2.

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In metabolic syndrome, several conventional drugs including cyclosporine, acitretin and methotrexate exhibit an unfavourable effect on lipids, hypertension and liver injury. However, as most issues are manageable by accurate intervention e. Nonetheless, apremilast and biologics seem often a more favourable choice in patients with metabolic syndrome. No clear data have shown a convincing different response of systemic treatments in nail psoriasis compared to psoriasis vulgaris.

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In Belgium, an extensive BSA involvement is not a requirement for reimbursement of fumarates which makes it a reasonable option despite limited reports on nail psoriasis. Pustular and erythrodermic psoriasis display a different disease pattern requiring a tailored approach. Acitretin is the only licensed drug in generalized pustular psoriasis, although often combination therapy with corticosteroids is necessary, and it is contraindicated in women of childbearing age. In the latter case, acitretin may be the safest option until the final diagnosis is established. A limitation of these recommendations is that only the viewpoint of dermatologists was taken into account.

The expert group emphasized the need for a multidisciplinary approach in patients with important comorbidities. Given the rapid evolution of the therapeutic landscape of psoriasis, readers should be aware that this project is a living guideline that will require a regular update based on new data. Figure S1. These companies were, however, not involved in the making of the manuscript.

Authors have no conflict of interest with regard to the topic of this manuscript. Read article at publisher's site DOI : This data has been text mined from the article, or deposited into data resources. To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. Medical Advisory Secretariat. Free to read. Cited by: 22 articles PMID: Eur J Pediatr , 10 , 23 Aug Cited by: 9 articles PMID: Beani JC , Jeanmougin M.

Ann Dermatol Venereol , 1 , 29 Dec Cited by: 12 articles PMID: Coronavirus: Find the latest articles and preprints. Europe PMC requires Javascript to function effectively.


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Lambert JLW 1 ,. S Segaert Private practice, Tremelo, Belgium. Search articles by 'S Segaert'. Segaert S 2 ,. Search articles by 'P D Ghislain'. Ghislain PD 3 ,.

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Hillary T 4 ,. Search articles by 'A Nikkels'. Nikkels A 5 ,. Search articles by 'F Willaert'. Willaert F 6 ,. Search articles by 'J Lambert'. Lambert J 7 ,. Speeckaert R 1. Affiliations 2 authors 1. Private practice, Tremelo, Belgium. Share this article Share with email Share with twitter Share with linkedin Share with facebook.

Treatments include topical steroids, phototherapy, conventional, synthetic disease-modifying drugs and an expanding list of biologics. METHODS:Evidence-based recommendations were formulated using a quasi-Delphi methodology after a systematic search of the literature and a consensus procedure involving 8 psoriasis experts. RESULTS:In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed.

J Eur Acad Dermatol Venereol. Published online Jul PMID: Lambert , 1 S. Segaert , 2 P. Ghislain , 3 T. Hillary , 4 A. Nikkels , 5 F. Willaert , 6 J. Lambert , 7 and R. Speeckaert 1. Author information Article notes Copyright and License information Disclaimer. Lambert, Email: eb. Corresponding author.

E-mail : eb. Received Feb 2; Accepted May This article has been cited by other articles in PMC. Go to:. Table S1. Eligibility criteria for study screening. Background Impressive progress in new therapeutic options has been made for psoriasis. Results In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed.

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