GUIDELINES   

Giornale Italiano di Dermatologia e Venereologia 2017 April;152(2):99-108

DOI: 10.23736/S0392-0488.16.05005-7

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Tuscan consensus on the diagnosis, treatment and follow-up of moderate-to-severe psoriasis

Francesca PRIGNANO ¹, Lara TRIPO ¹, Lauretta AMATO ², Giovanni BAGNONI ³, Laura BARTOLI ⁴, Silvio BATTISTINI ⁵, Mauro BELLINI ⁵, Luca BRANDINI ², Marzia CAPRONI ¹, Carla CARDINALI ⁶, Antonio CASTELLI ⁷, Roberto CECCHI ⁴, Gregorio CERVADORO ⁸, Valentina DINI ⁸, Michele FIMIANI ⁹, Olimpia EBERLE ³, Paolo FABBRI ¹, Giovanni LO SCOCCO ⁶, Patrizia MARTINI ¹⁰, Franco MARSILI ¹¹, Carlo MAZZATENTA ¹⁰, Maria C. NICCOLI ⁶, Camilla PECCIANTI ¹², Michele PELLEGRINO ⁹, Marco ROMANELLI ⁸, Riccardo SIRNA ¹², Franca TAVITI ⁶, Valter VOLPI ¹, Nicola PIMPINELLI ¹ ✉

¹ Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy; ² Dermatology Unit, San Giuseppe Hospital, ASL 11, Empoli, Italy; ³ Dermatology Unit, Livorno Hospital, ASL 6, Livorno, Italy; ⁴ Dermatology Unit, San Jacopo Hospital, ASL 3, Pistoia, Italy; ⁵ Dermatology Unit, Santi Giacomo e Cristoforo Hospital, ASL 1, Massa, Italy; ⁶ Dermatology Unit, Prato Hospital, ASL 4, Prato, Italy; ⁷ Dermatology Unit, San Donato Hospital, ASL 8, Arezzo, Italy; ⁸ Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; ⁹ Section of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy; ¹⁰ Dermatology Unit, Campo di Marte Hospital, ASL 2, Lucca, Italy; ¹¹ Dermatology Unit, Versilia Hospital, ASL 12, Lido di Camaiore, Lucca, Italy; ¹² Dermatology Unit, Misericordia Hospital, ASL 9, Grosseto, Italy

BACKGROUND: Psoriasis is traditionally defined as an inflammatory chronic-relapsing disease of the skin. As widely demonstrated, this disease is also associated with multiple comorbidities: arthropathy, inflammatory bowel disease, metabolic, cardiovascular, ocular and psychological disorders. The disease also has a significant impact on patients’ quality of life, whose work ability decreases considerably with clear consequences for the social costs. Therefore, if we consider that in Tuscany, more than 100,000 people out of 3,672,202 suffer from psoriasis, it is of paramount importance focusing the attention on a rational model of clinical and therapeutic management of the disease. All the leading experts in Tuscany have come together with the aim of defining unanimously accepted regional guidelines for the diagnosis, treatment, follow-up and management of psoriasis, and of providing practical guidance/protocol on diagnosis, treatment, follow-up and management of special cases of moderate-to-severe plaque psoriasis.
METHODS: In a working group formed ad hoc, the main topics have been discussed and approved by plenary vote.
RESULTS: Diagnosis must include a proper general health condition overview, a careful evaluation of skin and joints, the assessment and management of other comorbidities and the definition of disease severity. With regards to the therapy the best time to start a systemic treatment, the therapeutic goal, the most appropriate drug and blood tests to be performed in case of moderate severe-psoriasis have been taken into account. During follow-up, proper monitoring of systemic therapy and its management in the long term has also been suggested. Eventually, the experts have addressed the problem of how to manage the disease in special conditions, such as during surgery, pregnancy, in children and in case of infections (HBV, HCV, HIV).
CONCLUSIONS: The main aim of this Consensus was to find agreement on the criteria for diagnosis, treatment and follow-up of psoriasis, shared by all the Dermatologic Therapy Units of Tuscany. A need to create an easier way for the patient to access specialized dermatology outpatient services, and to reduce the waiting list and costs related to the management of psoriasis has been stressed. Most importantly, during the Consensus all of the participants agreed on the central role of the patient, and on the need of a multidisciplinary management of the disease which requires communication among specialists and regional centers in order to build on existing experience.

KEY WORDS: Arthritic psoriasis - Consensus - Diagnosis - Disease management