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Introduction
Psoriasis is a difficult condition to treat, and it is often accompanied by comorbidities that confound diagnosis and complicate management. The literature on such scenarios is sparse, as patients with unusual or complex disease and comorbidities 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 to identify challenging clinical scenarios and to rank treatment approaches, in an effort to provide guidance to the practicing clinician.
Part 1 in this series presented six scenarios from this Delphi exercise: (1) psoriasis and human papilloma virus (HPV)-induced cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and mortality; (5) older patients (≥65 years of age) with psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy [1].
The current paper presents five additional scenarios of interest to the practicing dermatologist: (1) moderate-to-severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; (2) palmoplantar psoriasis (PPP) 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. These selected scenarios were chosen by the first author (B.E.S.).
The Delphi method
The Delphi method is particularly well suited for addressing healthcare-related issues because the outcome represents the collective judgment of the panel of experts on selected topics. The Delphi method includes three basic characteristics: (1) repeated individual questioning of the experts; (2) the avoidance of direct confrontation among the experts (e.g., anonymity); and (3) interspersed controlled opinion and feedback. Importantly, the Delphi method seeks to achieve consensus on complex scenarios where rigorous data are lacking. Available data on a given topic are reviewed extensively, presented, and discussed amongst the panelists. More importantly, by employing only anonymous voting by the panelists, the Delphi method settles controversy by eliminating the effects of either reputation or “personality.” Consequently, anonymous voting after thorough review of the data allows the panelists to vote for what they truly believe, thus avoiding “groupthink” and sentiment guided more by “eminence,” charisma, and dogmatism.
What follows is an application of the Delphi...