Adjunctive gentle skin care is sometimes mentioned in the pediatric psoriasis literature, possibly due to the general focus on gentle skin care in children.10,11 This review aims to summarize distinct features of psoriasis in populations with SOC and provide recommendations on the role of skin care in treating psoriasis across a broad spectrum of diverse populations.
MATERIALS AND METHODS
The present review involved using the Delphi communication technique for interactive decision-making for medical projects.12,13 On February 12, 2022, an expert panel composed of 6 dermatologists who commonly treat psoriasis patients with SOC was convened in Miami Beach, Florida. In preparation for the meeting, a literature review was conducted on the management of psoriasis in patients with SOC, and the potential role of skin care in psoriasis treatment.
Literature Review
A structured search of the English-language literature on skin care in psoriasis and psoriasis in patients with SOC was performed on April 7, 2022, using PubMed, with Google Scholar as a secondary source. The search included literature on current best practices in the management of psoriasis patients with SOC, skin barrier function in psoriasis, and the use of nonprescription skin care, including cleansers and moisturizers as adjuncts to prescription treatment. Guidelines, consensus papers, and reviews published in the English language from 2010 to 2022 were included in the search. Publications from various regions with predominant SOC populations were also identified.
Articles with no original data (except in cases where a review was the best available evidence); articles on prescription therapy alone (without discussion of non-prescription skin care); and publication language other than English were excluded from the search.
Search terms used: Psoriasis and racial/ethnic skin; OR Psoriasis and SOC; OR sequela of psoriasis and SOC; OR Psoriasis and SOC barrier structure and function(s); OR Psoriasis and skin lipids and ceramides; OR SOC and treatment tolerance; OR SOC and psoriasis treatment outcomes; OR SOC and cleansers; OR SOC and moisturizers; OR SOC and cleanser and moisturizer ingredients; OR SOC psoriasis and OTC skincare; OR SOC psoriasis and skincare efficacy, safety, tolerability; OR SOC psoriasis and irritation from skincare.
The searches yielded 33 clinically relevant papers to inform current best practices in psoriasis patients with SOC and skincare use. Unfortunately, robust comparative studies on skin care used as monotherapies or adjuncts to prescription therapies are scarce and did not allow for a systematic review. However, the recommendations on skin care given in clinical guidelines, consensus papers, and algorithms providing valuable clinical information were summarized. Similarly, there was a paucity of studies involving psoriasis in specific populations with SOC.
Literature Review
A structured search of the English-language literature on skin care in psoriasis and psoriasis in patients with SOC was performed on April 7, 2022, using PubMed, with Google Scholar as a secondary source. The search included literature on current best practices in the management of psoriasis patients with SOC, skin barrier function in psoriasis, and the use of nonprescription skin care, including cleansers and moisturizers as adjuncts to prescription treatment. Guidelines, consensus papers, and reviews published in the English language from 2010 to 2022 were included in the search. Publications from various regions with predominant SOC populations were also identified.
Articles with no original data (except in cases where a review was the best available evidence); articles on prescription therapy alone (without discussion of non-prescription skin care); and publication language other than English were excluded from the search.
Search terms used: Psoriasis and racial/ethnic skin; OR Psoriasis and SOC; OR sequela of psoriasis and SOC; OR Psoriasis and SOC barrier structure and function(s); OR Psoriasis and skin lipids and ceramides; OR SOC and treatment tolerance; OR SOC and psoriasis treatment outcomes; OR SOC and cleansers; OR SOC and moisturizers; OR SOC and cleanser and moisturizer ingredients; OR SOC psoriasis and OTC skincare; OR SOC psoriasis and skincare efficacy, safety, tolerability; OR SOC psoriasis and irritation from skincare.
The searches yielded 33 clinically relevant papers to inform current best practices in psoriasis patients with SOC and skincare use. Unfortunately, robust comparative studies on skin care used as monotherapies or adjuncts to prescription therapies are scarce and did not allow for a systematic review. However, the recommendations on skin care given in clinical guidelines, consensus papers, and algorithms providing valuable clinical information were summarized. Similarly, there was a paucity of studies involving psoriasis in specific populations with SOC.
RESULTS
The advisors developed and adopted ten statements for key insights and recommendations on the role of skincare for psoriasis as well as nuances for treating psoriasis patients with SOC. A summary of key data and expert opinion for each statement is included.
Statement 1
Psoriasis is a chronic immune-mediated dermatologic disorder with multisystemic comorbidities. In the US, the psoriasis prevalence in adults between ages 20 and 59 years was highest in White individuals at 3.6%, followed by African American individuals (1.9%), Hispanic individuals (1.6%), and others (1.4%).
Psoriasis is a chronic immune-mediated dermatologic disorder that is associated with multisystem comorbidities, such as psoriatic arthritis, metabolic syndrome, diabetes, and cardiovascular disease.1 Psoriasis can substantially impact morbidity, mortality, and QoL. Recent studies indicate that psoriasis is more common in people with SOC than was previously thought. In a cross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2010, the prevalence of psoriasis among adults aged 20 to 59 years was highest in White individuals at 3.6% (95% CI: 2.7%-4.4%), followed by African American individuals (1.9%; 95% CI: 1.0%–2.8%), Hispanic individuals (1.6%; 95% CI 0.5% 2.8%), and others (1.4%; 95% CI 0.3% 2.6%).1 Further data is needed to help clarify the burden of psoriatic disease in our diverse population.
Statement 2
Epidermal barrier abnormalities in lesional skin of psoriasis have been reported.
Inflammatory skin diseases such as psoriasis are often associated with defects in epidermal barrier function, although the cause-and-effect relationship is unclear.14
Alterations to epidermal differentiation complex genes and several structures in the epidermal barrier in psoriasis may be responsible for barrier dysfunction, leading to hyperproliferation of the epidermis in an attempt to repair the skin barrier.15 There is an association between psoriasis and gene mutations within the epidermal differentiation complex, which are crucial for epidermal development, maturation, cornification, cross-linking, and terminal differentiation (Table 1). Genetic associations linked to psoriasis may differ among races and ethnicities. PSORS1–PSORS9 have been confirmed as psoriasis susceptibility loci in independent genetic studies on
Statement 1
Psoriasis is a chronic immune-mediated dermatologic disorder with multisystemic comorbidities. In the US, the psoriasis prevalence in adults between ages 20 and 59 years was highest in White individuals at 3.6%, followed by African American individuals (1.9%), Hispanic individuals (1.6%), and others (1.4%).
Psoriasis is a chronic immune-mediated dermatologic disorder that is associated with multisystem comorbidities, such as psoriatic arthritis, metabolic syndrome, diabetes, and cardiovascular disease.1 Psoriasis can substantially impact morbidity, mortality, and QoL. Recent studies indicate that psoriasis is more common in people with SOC than was previously thought. In a cross-sectional study using National Health and Nutrition Examination Survey data from 2009 to 2010, the prevalence of psoriasis among adults aged 20 to 59 years was highest in White individuals at 3.6% (95% CI: 2.7%-4.4%), followed by African American individuals (1.9%; 95% CI: 1.0%–2.8%), Hispanic individuals (1.6%; 95% CI 0.5% 2.8%), and others (1.4%; 95% CI 0.3% 2.6%).1 Further data is needed to help clarify the burden of psoriatic disease in our diverse population.
Statement 2
Epidermal barrier abnormalities in lesional skin of psoriasis have been reported.
Inflammatory skin diseases such as psoriasis are often associated with defects in epidermal barrier function, although the cause-and-effect relationship is unclear.14
Alterations to epidermal differentiation complex genes and several structures in the epidermal barrier in psoriasis may be responsible for barrier dysfunction, leading to hyperproliferation of the epidermis in an attempt to repair the skin barrier.15 There is an association between psoriasis and gene mutations within the epidermal differentiation complex, which are crucial for epidermal development, maturation, cornification, cross-linking, and terminal differentiation (Table 1). Genetic associations linked to psoriasis may differ among races and ethnicities. PSORS1–PSORS9 have been confirmed as psoriasis susceptibility loci in independent genetic studies on
