Morita Akimichi, Okubo Yukari, Imafuku Shinichi, Tada Yayoi, Abe Masatoshi, Gibson A E J, Becker Frauke, Bogoeva Nataliya, Ohtsuki Mamitaro
Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Dermatology, Tokyo Medical University, Tokyo, Japan.
J Dermatol. 2025 Jan;52(1):56-66. doi: 10.1111/1346-8138.17444. Epub 2024 Sep 4.
Our objective was to establish consensus on (1) which patients with plaque psoriasis and limited skin involvement (body surface area [BSA] <10%) are suitable for systemic treatment, and (2) a definition of 'topical therapy failure'. A steering committee refined 13 statements drawn from literature related to the study objectives. An independent panel of 45 clinical experts from Japan indicated their agreement to each statement using a 10-point Likert scale (Round 1; strong consensus, ≥70% of responses = 7-10 and median value ≥8). The steering committee reviewed Round 1 results and refined the statements for Round 2, as necessary. In Round 2, the panel indicated their agreement to each statement using a 3-point scale (strong consensus, ≥70% of responses and median value of 3) and were shown Round 1 responses before voting. Forty-five clinicians participated in Round 1 and 41 of those (91%) participated in Round 2. Consensus was achieved on the criteria of eligibility for systemic treatment among patients with limited skin involvement as disease involvement at special or difficult to treat areas, psoriasis-induced psychological distress, uncontrolled symptoms (e.g., scaling, bleeding, pruritus, insomnia) affecting their social life, psoriatic arthritis, or failure of topical therapy. Consensus on criteria for topical failure were persistent symptoms (e.g., itchiness, pain) and plaques, poor patient satisfaction with treatment, a need to increase medication quantity or application time after treatment with two topicals for 4 weeks; or if the Psoriasis Area Severity Index score of >3 or Physician Global Assessment Score of ≥2 after 8 weeks treatment. Our Delphi panel proposes criteria to help physicians identify patients with psoriasis and limited skin involvement who would benefit from systemic therapy and suggests a definition for topical therapy 'failure' which could indicate a move to systemic treatment is warranted.
（1）哪些斑块状银屑病且皮肤受累面积有限（体表面积[BSA]<10%）的患者适合进行系统治疗；（2）“局部治疗失败”的定义。一个指导委员会对从与研究目标相关的文献中提取的13条陈述进行了完善。一个由45名来自日本的临床专家组成的独立小组使用10分制李克特量表对每条陈述表明他们的同意程度（第一轮；强烈共识，≥70%的回答为7 - 10分且中位数≥8）。指导委员会审查了第一轮结果，并在必要时对第二轮的陈述进行完善。在第二轮中，该小组使用3分制量表对每条陈述表明他们的同意程度（强烈共识，≥70%的回答且中位数为3），并且在投票前展示第一轮的回答。45名临床医生参与了第一轮，其中41名（91%）参与了第二轮。对于皮肤受累有限的患者，在以下情况下达成了系统治疗的资格标准共识：疾病累及特殊或难治区域、银屑病引起的心理困扰、影响其社交生活的未控制症状（如鳞屑、出血、瘙痒、失眠）、银屑病关节炎或局部治疗失败。关于局部治疗失败标准的共识包括持续症状（如瘙痒、疼痛）和斑块、患者对治疗的满意度低、在使用两种局部药物治疗4周后需要增加药物剂量或用药时间；或者在治疗8周后银屑病面积严重程度指数评分>3或医生整体评估评分≥2。我们的德尔菲小组提出了一些标准，以帮助医生识别那些皮肤受累有限的银屑病患者，这些患者将从系统治疗中获益，并提出了“局部治疗失败”的定义，这可能表明有必要转向系统治疗。
