Candidate for topical treatment (mild plaque psoriasis) | If BSA ≤10% and PASI ≤10 and DLQI ≤10 Treat with topical therapy | |||
Determine response | ||||
If Psoriasis remains mild continue treatment regimen | If condition worsens treat as for moderate/severe psoriasis | |||
Candidate for systemic treatment (moderate to severe plaque psoriasis) | If BSA >10% or PASI >10 or PASI ≤10 and DLQI >10 Initiate systemic (non-biologic) therapy and/or phototherapy | |||
Determine response (measured by percentage change in PASI score)* | ||||
Good = ∆PASI ≥75 and DLQI ≤5 Continue treatment regimen | Partial = ∆PASI ≥50 <75 and DLQI ≤5, continue treatment regimen and DLQI >5, modify treatment regimen | Failed = ∆PASI ≤50 Modify treatment regimen | ||
If the patient failed the treatment or has a contraindication or intolerance to conventional systemic therapy Initiate biologic therapy | ||||
Determine response (measured by percentage change in PASI score)* | ||||
Good = ∆PASI ≥75 and DLQI ≤5 Continue treatment regimen | Partial = ∆PASI ≥50 <75 and DLQI ≤5, continue treatment regimen and DLQI >5, modify treatment regimen | Failed = ∆PASI ≤50 Modify treatment regimen | ||
Modification strategies: · Increase the dose · Shorten intervals between doses · Add a topical · Add another systemic · Change the drug | ||||