The Psoriasis Decision Tree

Abstract

Psoriasis, an inflammatory disorder of the skin, is associated with an increased risk of systemic diseases, such as psoriatic arthritis, psychiatric disorders, malignancy, and cardiometabolic and inflammatory bowel diseases. Careful consideration of the presence of these comorbidities should guide selection of appropriate therapy. The evolution of therapeutic targets for the treatment of psoriasis has significantly advanced available treatment options, potentially leading to uncertainty when selecting the optimal treatment for each patient. In this article, we review evidence-based guidelines for the use of psoriasis treatments in patients with distinct comorbidities, and group appropriate therapeutic options into a visual aid. An easy-to-use visual tool incorporating treatment options best suited for specific comorbidities can increase physicians' confidence when selecting the most appropriate treatment on an individualized basis.

Keywords: Psoriasis; acitretin; biologics; brodalumab; comorbidities; cyclosporine; depression; guselkumab; inflammatory bowel disease; ixekizumab; kidney disease; liver disease; methotrexate; multiple sclerosis; pregnancy; psoriatic arthritis; risankizumab; secukinumab; tildrakizumab; ustekinumab.