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