Content area
Abstract
Introduction
Clinicians may be confronted with difficult-to-treat psoriasis cases for which there are scant data to rely upon for guidance. To assist in managing such patients, who are typically excluded from clinical trials, a consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise.
Methods
The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting.
Results
Five of the 24 discussed case scenarios are presented in this article: (1) moderate-to-severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; (2) palmoplantar psoriasis that is unresponsive to topical therapy and phototherapy; (3) erythrodermic psoriasis; (4) pustular psoriasis; and (5) the preferred therapeutic choice to combine with low-dose methotrexate. A previous article (part 1) presented six other scenarios.
Conclusion
The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with patients with challenging cases of psoriasis.
Details
1 University of Connecticut School of Medicine, Department of Dermatology, Farmington, USA (GRID:grid.208078.5) (ISNI:0000000419370394)
2 Baylor University Medical Center, Modern Dermatology, Division of Dermatology, Department of Internal Medicine, Dallas, USA (GRID:grid.411588.1) (ISNI:0000000121679807)
3 NYU Langone Medical Center, Department of Dermatology, New York, USA (GRID:grid.240324.3) (ISNI:0000000121094251)
4 Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, USA (GRID:grid.240324.3)
5 Northwestern University Feinberg School of Medicine, Department of Dermatology, Chicago, USA (GRID:grid.465264.7)
6 Tufts Medical Center, Tufts University School of Medicine, Department of Dermatology, Boston, USA (GRID:grid.67033.31) (ISNI:0000000089344045)
7 University of California, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, San Diego, USA (GRID:grid.266100.3) (ISNI:0000000121074242)
8 Case Western Reserve University School of Medicine, Department of Dermatology, Cleveland, USA (GRID:grid.67105.35) (ISNI:0000000121643847)
9 University of Utah, Department of Dermatology, Salt Lake City, USA (GRID:grid.223827.e) (ISNI:0000000121930096)
10 St. Louis University School of Medicine, Department of Dermatology, St. Louis, USA (GRID:grid.262962.b) (ISNI:0000000121143893)
11 Hospital for Special Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, USA (GRID:grid.239915.5) (ISNI:0000000122858823)
12 NYU Langone School of Medicine, Department of Rheumatology, New York, USA (GRID:grid.137628.9) (ISNI:0000000419368753)
13 University of Texas at Arlington, Graduate School of Nursing, and Modern Dermatology, Dallas, USA (GRID:grid.267315.4) (ISNI:0000000121819515)