Psoriasis Management Guidelines

Initial Assessment and Diagnosis

The American Academy of Dermatology recommends diagnosis based on characteristic erythematous, scaly plaques in typical distributions, with laboratory investigations rarely helpful and not delaying treatment 3
The British Medical Journal suggests assessing severity using two components: the patient's perception of disability and objective body surface area involvement using body mapping or PASI scoring 3, 4
The National Institute for Health and Care Excellence recommends screening for triggers and exacerbating medications, including alcohol, beta-blockers, NSAIDs, lithium, chloroquine, and mepacrine 3, 4, 5

The American College of Dermatology recommends applying clobetasol propionate 0.05% or betamethasone dipropionate 0.05% twice daily to thick plaques for maximum 2-4 weeks 1, 5
The National Psoriasis Foundation suggests combining topical corticosteroids with calcipotriol for synergistic effect superior to either agent alone 1, 2, 5
The British Association of Dermatologists recommends adding tazarotene with moderate-to-high potency corticosteroids for body plaques to reduce irritation while enhancing efficacy 1, 5

The American Academy of Dermatology recommends photochemotherapy (PUVA) as the least toxic systemic agent and generally considered first-choice systemic treatment 7
The National Institute for Health and Care Excellence suggests starting PUVA at 70% of minimum phototoxic dose, increasing successive doses by 40% of preceding dose if no erythema, with response expected within 4 weeks 7, 2
The British Medical Journal recommends adalimumab (TNF-α inhibitor) for moderate-to-severe chronic plaque psoriasis in adults who are candidates for systemic therapy or phototherapy when other systemic therapies are medically less appropriate 2

The American College of Dermatology recommends never prescribing systemic corticosteroids for psoriasis, as they precipitate erythrodermic psoriasis, generalized pustular psoriasis, or very unstable disease upon discontinuation 2, 5
The National Psoriasis Foundation suggests avoiding lithium, chloroquine, and mepacrine, as they are associated with severe, potentially fatal psoriasis deterioration 3, 4, 5

The British Association of Dermatologists recommends addressing compliance issues before switching therapies, as perceived "tachyphylaxis" to topical corticosteroids is usually poor adherence, not true receptor down-regulation 2, 5
The American Academy of Dermatology suggests trialing alternative topical agents before escalating to systemic therapy, as patients failing one topical agent may respond to another 3, 4, 2