Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany.
Arch Dermatol Res. 2011 Jan;303(1):1-10. doi: 10.1007/s00403-010-1080-1. Epub 2010 Sep 21.
Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is <50%. In a situation where the therapeutic response improved ≥50% but <75%, as assessed by PASI, therapy should be modified if the DLQI is >5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians.
中重度银屑病患者治疗不足。为解决这一长期存在的问题，开展了共识项目，以确定全身性银屑病治疗的目标，并改善患者的护理。进行了一次专家共识会议和一项合作 Delphi 程序。来自不同欧洲国家的 19 名皮肤科医生进行了面对面的讨论，并通过四轮 Delphi 过程定义了项目。斑块型银屑病的严重程度分为轻度和中重度疾病。轻度疾病定义为体表面积（BSA）≤10 且银屑病面积和严重程度指数（PASI）≤10 且皮肤病生活质量指数（DLQI）≤10，中重度疾病为（BSA>10 或 PASI>10）和 DLQI>10。特殊临床情况可能会将轻度银屑病转变为中重度，包括可见区域受累或严重指甲受累。对于斑块型银屑病的系统性治疗，定义了两个治疗阶段：（1）诱导阶段，即治疗期至第 16 周；然而，根据所使用的药物类型和剂量方案，该阶段可能延长至第 24 周；（2）维持阶段，所有药物的定义为诱导阶段后的治疗期。对于斑块型银屑病治疗目标的定义，使用从基线到评估时间的 PASI 变化（ΔPASI）和绝对 DLQI。在诱导期和维持治疗期间，如果 PASI 减少≥75%，则可以继续治疗。如果 PASI 改善<50%，则应修改治疗方案。如果 PASI 改善≥50%但<75%，则根据 PASI 评估，治疗应进行修改，但如果 DLQI>5，则可以继续，如果 DLQI≤5，则可以继续。该方案首次使用 19 名欧洲专家的正式共识来定义斑块型银屑病的严重程度。此外，还确定了中重度疾病的治疗目标。在银屑病的日常管理中实施治疗目标将改善患者的护理，并减轻治疗不足的问题。计划在后续的涉及患者和医生的项目中评估这些治疗目标的实施情况。
