Dr. Jashin J. Wu discusses notable changes in the latest AAD/NPF Psoriasis Guidelines.
Jashin J. Wu, MD, FAAD, is Founder and CEO, Dermatology Research and Education Foundation; and Founder and Course Director of Skin Cancer Symposium + Symposium for Inflammatory Skin Disease, San Diego Dermatology Symposium, and Dermatology Refresher Symposium.
“I was lucky enough to be part of the [AAD/NPF Psoriasis Guidelines] authorship list… from the AAD and NPF, 2019 to 2021. We reviewed articles from 2008 to 2017 and updated some guidelines,” says Jashin J. Wu, MD, FAAD.
Dr. Wu sat down with The Dermatology Digest to discuss notable changes found in the updated AAD/NPF Psoriasis Guidelines based on his presentation, “Pearls From the AAD/NPF Psoriasis Guidelines 2019-2021,” at this year’s inaugural Symposium for Inflammatory Skin Disease, a planned annual virtual meeting, for which he was also course director.
Among these pearls is the change in guidance for annual CBC and complete metabolic panels. While it’s still advised to conduct baseline screening of these plus testing for TB, hepatitis B and C, and HIV testing for patients with HIV risk factors, the need for the annual CBC and complete metabolic panel is not supported by evidence, says Dr. Wu, and is, therefore, no longer recommended.
“The only one would be infliximab, [for] which we do recommend checking LFTs every three months, but nowadays most people are not going to be on infliximab anymore for psoriasis.”
Similarly, annual TB testing is no longer a recommendation, unless patients are at high risk or on a TNF inhibitor.
Other noteworthy changes include recommendations for liver imaging rather than liver biopsy in patients after receiving cumulative 3.5 g to 4 g methotrexate, and screening pediatric patients for uveitis, as it is a comorbidity in this population.
The biologic guidelines also address risk in patients with a history of a solid tumor. According to Dr. Wu, these patients can be put on a TNF inhibitor or ustekinumab with no known risk of recurrence.
There is no mention of interleukin (IL)-17 or IL-23 inhibitors, he says, in the guidelines, “…mostly because those have not been out long enough. But I suspect that those would also be safe in a setting like that.”
For more information on the Symposium for Inflammatory Skin Disease: https://www.dermrefoundation.org