Standard Treatment Workflow for Psoriasis

Standard Treatment Workflow PSORIASIS ICD ten L forty

*GENERAL PRINCIPLES OF MANAGEMENT

· Establish the diagnosis

· Usually clinical and by bedside tests (Auspitz sign, Grattage test)

· If in doubt, refer to higher centre for evaluation and skin biopsy

· Assess for psoriatic arthritis and metabolic syndrome (obesity, dyslipidemia, diabetes, hypertension)

· Counsel about variable natural course of disease and expected treatment outcome, and lifestyle modifications (including weight reduction, avoidance of smoking and alcohol)

· Assess for requirement of systemic treatment, in addition to topical treatment

· Advise regular use of emollients and moisturizers. Antihistamines if pruritic

· Avoid Methotrexate and Cyclosporine A in children scheduled for live vaccines

· Rule out tuberculosis, HIV, Hepatitis B and C infections before systemic immunosuppressive treatment

· Pregnancy test prior to systemic therapy (Acitretin avoided in childbearing age group)

· Systemic steroids should not be given for the treatment of psoriasis, except for generalized pustular psoriasis of pregnancy

· If first-line treatment options fail or are contraindicated, refer to tertiary care center for combination. Baseline investigations to be carried out

These principles should be used only as a general guide to choose a treatment; final decision should be made on case-to-case basis

PSORIASIS IS COMPLETELY TREATABLE BUT HAS A CHRONIC COURSE

This STW has been prepared by national experts of India with feasibility considerations for various levels of healthcare system in the country. These broad guidelines are advisory, and are based on expert opinions and available scientific evidence. There may be variations in the management of an individual patient based on his or her specific condition, as decided by the treating physician. There will be no indemnity for direct or indirect consequences. Kindly visit the website of DHR for more information for more information.