General practice recommendations for the topical treatment of psoriasis: a modified-Delphi approach

Diamant Thaçi; Pablo de la Cueva; Andrew E Pink; Ahmad Jalili; Siegfried Segaert; Kasper F Hjuler; Piergiacomo Calzavara-Pinton

doi:10.3399/bjgpopen20X101108

General practice recommendations for the topical treatment of psoriasis: a modified-Delphi approach

BJGP Open. 2020 Dec 15;4(5):bjgpopen20X101108. doi: 10.3399/bjgpopen20X101108. Print 2020 Dec.

Authors

Diamant Thaçi¹, Pablo de la Cueva², Andrew E Pink³, Ahmad Jalili⁴, Siegfried Segaert⁵, Kasper F Hjuler⁶, Piergiacomo Calzavara-Pinton⁷

Affiliations

¹ Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany.
² Department of Dermatology, University Hospital Infanta Leonor de Madrid, Madrid, Spain.
³ St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ Department of Dermatology, Bürgenstock Medical Center, Obbürgen, Switzerland.
⁵ Consultant Dermatologist, Bonheiden, Belgium.
⁶ Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Dermatology, University of Brescia, Brescia, Italy piergiacomo.calzavarapinton@unibs.it.

Abstract

Background: Although GPs are usually the first port of call for patients with psoriasis, there is a lack of consistent and up-to-date clinical recommendations for interventions for patients with mild-to-moderate disease.

Aim: To provide practical recommendations for GPs to optimise psoriasis treatment with topical therapies in four key areas: patient identification; treatment decision making with topical theory; topical treatment outcomes; and optimising patient adherence.

Design & setting: A consensus-seeking programme (modified-Delphi approach) was undertaken to assess the literature and develop recommendations for GPs, based on evidence and expert opinion.

Method: Three dermatologists compiled 47 questions that were subsequently ranked and refined according to clinical relevance or importance using an online survey. Thereafter, 19 dermatologists from different European countries developed statements and clinical recommendations for the top seven ranked topical treatment and GP-relevant questions based on literature research and clinical experience. The final recommendations were based on 100% agreement among a final panel of seven experts.

Results: The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy, in addition to good physician-patient communication, are important for optimising patient adherence and maximising efficacy. Topical treatments combining corticosteroids and vitamin D analogues (administered as fixed combination) are well-established first-line treatments in mild-to-moderate psoriasis.

Conclusion: Simple but detailed practical guidance is provided, which is formed from evidence and expert clinical recommendations, to assist GPs with the optimal use of topical agents based on efficacy, tolerability, disease severity, site of psoriasis, patient lifestyle and preferences, and intended duration of treatment.

Keywords: adherence; general practitioners; primary health care; psoriasis; recommendations; topical treatment.