To address the lack of standardized management guidelines in the treatment of psoriasis, the National Psoriasis Foundation conducted a study among psoriasis experts in an effort to define consensus based treatment targets.

The process consisted of 3 stages; literature review, pre-Delphi question selection and input from general dermatologists and patients, and finally 4 Delphi rounds, in which a total of 25 psoriasis experts took part in — including current members of the National Psoriasis Foundation (NPF). The Delphi process is a widely accepted form of achieving consensus among a panel of experts.

The outcomes of the Delphi consensus showed that the preferred assessment instrument in clinical practice was body surface area (BSA). The participants were asked to indicate their preferred level of acceptable vs. target treatment response for each proposed measure at 3 months after treatment initiation. 

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The new guidelines state that an initial goal should be to reduce psoriasis BSA to ≤1% within 3 months of starting treatment, however if after 3 months a patient is seeing improvement but is not down to the 1% level, an “acceptable response” is defined as 75% improvement in BSA. During the maintenance period, the consensus on the target response was BSA ≤1% at every 6-month assessment interval

The guidelines do not specifically endorse or exclude therapies, as final treatment decisions should be determined by clinicians and patients. For patients who do not meet the recommended targets outlined in the guidelines, it is recommended that clinicians focus on individualizing treatment, discussing options with patients, and managing patient expectations. 

The authors of the study acknowledged the limitation of BSA, although it is feasible in practice, it does not encompass health-related quality of life, costs, and risks of side-effects. They conclude that with defined treatment targets, “clinicians and patients can regularly evaluate treatment responses and perform benefit-risk assessments of therapeutic options individualized to the patient.”

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