Guideline sources The following summarized guidelines for the evaluation and management of psoriasis are prepared by our editorial team based on guidelines from the National Psoriasis Foundation (NPF/AAD 2021; 2020; 2019), the British Association of Dermatologists (BAD 2020), the European Society for the Study of Coeliac Disease (ESsCD 2019), the American Academy of Dermatology (AAD 2019), the European Academy of Dermatology and Venereology (EADV 2017), and the American Association of Family Physicians (AAFP 2013). 1 2 3 4 5 6 7 8 9 Calculator Psoriasis Epidemiology Screenin Guidelines https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 1/12 6/29/23, 11:33 PM Psoriasis Pathway 1. Classification and risk stratification Serverity assessment: measure BSA of involved skin as an important measure of psoriasis severity to risk stratify patient for future. B Show 4 more 2. Diagnostic investigations Initial assessment: evaluate patients with psoriasis for comorbidities, including psychological conditions. B Screening for psoriatic arthritis: As per BAD 2020 guidelines, screen for psoriatic arthritis in patients without this diagnosis using a validated tool, such as the PEST, and recognize that the PEST may not detect axial arthritis/inflammatory back pain. A As per AAD 2019 guidelines: Suspect psoriatic arthritis in all patients with cutaneous psoriasis. B Evaluate patients with signs and symptoms suspicious for psoriatic arthritis. Initiate appropriate psoriatic arthritis therapy if comfortable with the diagnosis or otherwise consult with a rheumatologist for assessment and management. B Screening for viral infections: Obtain testing for hepatitis B (surface antigen and core antibody), hepatitis C (IgG) and human immunodeficiency virus (human immunodeficiency virus-1 and human immunodeficiency virus-2 antibodies and human immunodeficiency virus-1 antigen) in patients starting biologic therapy. A Obtain VZV antibody in patients with a negative or uncertain history for chickenpox before starting biologic therapy. Consider giving varicella vaccination before starting biologic therapy in varicella non-immune patients and seek expert advice. Be aware of the indications of postexposure prophylaxis with varicella zoster immunoglobulin or oral aciclovir/valaciclovir in varicella zoster-susceptible patients taking biologics. E Screening for tuberculosis: Consider screening for latent tuberculosis with an IGRA alone, or with an IGRA and concurrent Mantoux test. Be aware of the individual's risk factors for tuberculosis when interpreting results. C Apply local policy on the use of a plain CXR for screening for tuberculosis to rule out abnormalities at baseline including granulomas indicative of prior infection and other confounding lung diseases. Assess for active tuberculosis and/or management of latent tuberculosis in consultation with a tuberculosis specialist, if positive. A Screening for cardiovascular diseases: assess cardiovascular risk by screening for hypertension, diabetes and hyperlipidemia in all patients with psoriasis according to national guidelines. B Show 5 more Screening for metabolic syndrome: inform patients with psoriasis about their increased risk for metabolic syndrome. Evaluate metabolic syndrome status according to national guidelines https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 2/12 6/29/23, 11:33 PM Psoriasis Pathway by an appropriate healthcare professional. B Show 4 more Screening for inflammatory bowel disease: inform patients with psoriasis about the association of psoriasis and IBD. B Show 3 more Screening for anxiety and depression: inform patients with psoriasis about the association of psoriasis and anxiety and depression. B Show 3 more Evaluation before biologic therapy: Assess people with psoriasis prior to, and during treatment with, biologic therapy with respect to: their past or current history of cancer and/or any future risk of cancer. A Assess people with psoriasis prior to, and during treatment with, biologic therapy with respect to: risk factors for infection (such as comorbidities, cotherapy, lifestyle and travel) known infections (past or current) signs or symptoms suggestive of infection. A 3. Medical management Topical therapy, corticosterids: As per NPF/AAD 2021 guidelines, offer class 1-5 topical corticosteroids for up to 4 weeks for the treatment of patients with plaque psoriasis not involving intertriginous areas. A Show 3 more As per AAFP 2013 guidelines, offer topical corticosteroids in patients with mild psoriasis. A Topical therapy, vitamin D analogs: As per NPF/AAD 2021 guidelines, offer long-term topical vitamin D analogs (up to 52 weeks) including calcipotriene/calcipotriene, calcitriol, tacalcitol, and maxacalcitol for the treatment of patients with mild-to-moderate psoriasis. B Show 2 more As per AAFP 2013 guidelines, offer topical vitamin D analogs in patients with mild psoriasis. A Topical therapy, tazarotene: As per NPF/AAD 2021 guidelines: Consider offering topical tazarotene for the treatment of patients with mild-to-moderate psoriasis. C Consider offering topical tazarotene for the treatment of patients with nail psoriasis. C As per AAFP 2013 guidelines, offer topical tazarotene in patients with mild psoriasis. A Topical therapy (calcineurin inhibitors): consider offering 0.1% tacrolimus (off-label use) for up to 8 weeks in patients with psoriasis involving the face as well as inverse psoriasis. B https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 3/12 6/29/23, 11:33 PM Psoriasis Pathway Show 3 more Topical therapy (combination with topicals): offer combination therapy with vitamin D analogs and potent class 2-3 topical corticosteroids for up to 52 weeks for the treatment of patients with psoriasis. B Show 7 more Topical therapy (combination with systemic therapy): offer adding topical calcipotriene to standard dose methotrexate therapy for the treatment of patients with moderate-to-severe psoriasis. Recognize that it may lead to lower cumulative doses of methotrexate and increased time to relapse following methotrexate discontinuation. A Show 3 more Topical therapy (salicylic acid): Consider offering topical salicylic acid for 8-16 weeks for the treatment of patients with mild- to-moderate psoriasis. C Consider offering salicylic acid with topical corticosteroids for the treatment of patients with moderate-to-severe psoriasis. (BSA 20%). B Topical therapy (coal tar): offer coal tar preparations for the treatment of mild-to-moderate psoriasis. B Topical therapy (anthralin): consider offering topical anthralin for 8-12 weeks for the treatment of patients with mild-to-moderate psoriasis. Ensure short contact (up to 2 hours/day) anthralin to limit side effects. C Non-biologic agents (methotrexate): offer methotrexate for the treatment of adult patients with moderate-to-severe psoriasis. B Show 5 more Non-biologic agents (acitretin): consider offering acitretin as monotherapy in patients with plaque psoriasis. C Show 3 more Non-biologic agents (apremilast): offer apremilast for the treatment of adult patients with moderate-to-severe psoriasis. A Non-biologic agents (cyclosporine): offer cyclosporine in patients with severe, recalcitrant psoriasis. B Show 2 more Initiating biologic therapy, general considerations: As per BAD 2020 guidelines: Offer biologic therapy in patients with psoriasis requiring systemic therapy if methotrexate and ciclosporin have failed, are not tolerated or are contraindicated and the disease has a large impact on physical, psychological or social functioning (for example, DLQI or Children's DLQI > 10 or clinically relevant depressive or anxiety symptoms) and one or more of the following disease severity criteria apply: extensive psoriasis (defined as BSA > 10% or Psoriasis Area and Severity Index 10) severe psoriasis at localized sites and associated with significant functional impairment and/or high levels of distress (for example nail disease or involvement of high-impact and difficult-to treat sites, such as the face, scalp, palms, soles, flexures and genitals). A https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 4/12 6/29/23, 11:33 PM Psoriasis Pathway Consider offering biologic therapy earlier in the treatment pathway if methotrexate has failed, is not tolerated or is contraindicated in patients with psoriasis fulfilling the disease severity criteria and having active psoriatic arthritis or psoriasis that is persistent - relapses rapidly (defined as > 50% baseline disease severity within 3 months of completion of any treatment) off a therapy that cannot be continued in the long-term (such as narrowband UV B and ciclosporin). C As per BAD 2020 guidelines, initiate and supervise biologic therapy in patients with psoriasis by specialist physicians experienced in the diagnosis and treatment of psoriasis. Consider delegating routine monitoring to other healthcare professionals, for example, clinical nurse specialists. Manage psoriatic arthritis and/or multimorbidity in consultation with relevant healthcare professionals. A Show 2 more As per AAFP 2013 guidelines, use systemic biologic therapies as effective treatments for moderate-to-severe psoriasis. A Initiating biologic therapy (contraindications): do not use TNF antagonists in patients with demyelinating diseases and consider offering alternative interventions in patients having a first- degree relative with demyelinating disease. D Show 6 more Initiating biologic therapy, choice of agent: As per BAD 2020 guidelines, consider switching to an alternative therapy, including another biologic therapy, if any of the following applies: the minimum response criteria are not achieved subsequent loss of response after initial response (secondary failure) the current biologic therapy cannot be tolerated or becomes contraindicated. C Show 8 more As per NPF/AAD 2020 guidelines, prefer adalimumab and infliximab over methotrexate in patients with cutaneous psoriasis. B Biologic agents, etanercept: As per BAD 2020 guidelines, consider offering etanercept if a TNF antagonist is indicated and other available biologic agents have failed or cannot be used, or where a short half-life is important. C As per AAD 2019 guidelines, offer etanercept as a monotherapy treatment option in adult patients with: moderate-to-severe plaque psoriasis, including when affecting the scalp and the nails plaque psoriasis of any severity when associated with significant psoriatic arthritis. A Show 2 more Biologic agents, infliximab: As per BAD 2020 guidelines, reserve infliximab for patients with very severe disease, or if other available biologic agents have failed or cannot be used, or if weight-based dosing is a priority. A As per AAD 2019 guidelines, offer infliximab as a monotherapy treatment option in adult patients with: https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 5/12 6/29/23, 11:33 PM Psoriasis Pathway moderate-to-severe plaque psoriasis plaque psoriasis of any severity associated with significant psoriatic arthritis (infliximab also inhibits radiographically detected damage of joints). A Show 3 more Biologic agents (adalimumab): Offer adalimumab as a monotherapy treatment option in adult patients with: moderate-to-severe plaque psoriasis, including when affecting the nails or plaque-type palmoplantar psoriasis plaque psoriasis of any severity associated with psoriatic arthritis. A Show 2 more Biologic agents (ustekinumab): Offer ustekinumab as a monotherapy treatment option in adult patients with: moderate-to-severe plaque psoriasis plaque psoriasis of any severity associated with psoriatic arthritis. A Show 4 more Biologic agents (secukinumab): offer secukinumab as a monotherapy treatment option in adult patients with moderate-to-severe plaque psoriasis, inluding when affecting the nails and plaque-type palmoplantar psoriasis. A Show 2 more Biologic agents (ixekizumab): offer ixekizumab as a monotherapy treatment option in adult patients with moderate-to-severe plaque psoriasis, including when associated with psoriatic arthritis. A Show 2 more Biologic agents (brodalumab): offer brodalumab as a monotherapy treatment option in adult patients with moderate-to-severe plaque psoriasis. A Show 2 more Biologic agents (guselkumab): Offer guselkumab as a monotherapy treatment option in adult patients with moderate-to- severe plaque psoriasis, including when affecting the scalp, the nails and plaque-type palmoplantar psoriasis. A Administer guselkumab at a dose of 100 mg as self-administered subcutaneous injections at week 0, week 4, and every 8 weeks thereafter. A Biologic agents (tildrakizumab): Offer tildrakizumab as a monotherapy treatment option in adult patients with moderate-to- severe plaque psoriasis. A Administer tildrakizumab at a dose of 100 mg given as in-office physician-administered subcutaneous injections at week 0 and week 4 and every 12 weeks thereafter. A Biologic agents (risankizumab): Consider offering risankizumab as a monotherapy treatment option in adult patients with moderate-to-severe plaque psoriasis, but it is not approved by the U.S. FDA. C Be aware that the approved dose will likely be 150 mg given as self-administered subcutaneous injections at week 0, week 4, and then every 12 weeks. A https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 6/12 6/29/23, 11:33 PM Psoriasis Pathway Combination therapy, etanercept in combinations: As per NPF/AAD 2021 guidelines, offer adding an ultra-high potency (class 1) topical corticosteroid to standard dose etanercept for 12 weeks for the treatment of patients with moderate-to-severe psoriasis. A As per AAD 2019 guidelines: Offer a combination of etanercept with one of the following options to augment the efficacy of treatment of patients with moderate-to-severe plaque psoriasis: topicals, such as high-potency corticosteroids with or without a vitamin D analogue A methotrexate. B Consider offering a combination of etanercept with one of the following options to augment efficacy for the treatment of patients with moderate-to-severe plaque psoriasis: acitretin C apremilast C cyclosporine, when clinically indicated C narrowband UV B. C Combination therapy (infliximab in combinations): Consider offering a combination of infliximab with one of the following options to augment the efficacy of treatment of patients with moderate-to-severe plaque psoriasis: topicals, such as high-potency corticosteroids with or without a vitamin D analogue C acitretin C methotrexate C apremilast, when clinically indicated. C Combination therapy, adalimumab in combinations: As per NPF/AAD 2021 guidelines, offer adding calcipotriene/betamethasone to standard dose adalimumab for 16 weeks for the treatment of patients with moderate-to-severe psoriasis to accelerate clearance of psoriatic plaques. B As per AAD 2019 guidelines, consider offering a combination of adalimumab with one of the following options to augment the efficacy of treatment of patients with moderate-to-severe plaque psoriasis: topicals, such as high-potency corticosteroids with or without a vitamin D analogue C acitretin C methotrexate C apremilast C cyclosporine C narrowband UV B. C Combination therapy (ustekinumab in combinations): Consider offering a combination of ustekinumab with one of the following options to augment the efficacy of treatment of patients with moderate-to-severe plaque psoriasis: topicals, such as high-potency corticosteroids with or without a vitamin D analogue C acitretin C methotrexate C https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 7/12 6/29/23, 11:33 PM Psoriasis Pathway apremilast C cyclosporine C narrowband UV B. C 4. Nonpharmacologic interventions Lifestyle modifications: encourage patients already being monitored for obesity to maintain a healthy lifestyle and keep regularly scheduled follow-up visits with their primary care provider and/or dermatologist. B Show 5 more 5. Therapeutic procedures Narrowband ultraviolet B phototherapy (indications): offer narrowband UV B phototherapy as monotherapy in adult patients with plaque psoriasis. B Show 6 more Narrowband ultraviolet B phototherapy (dosing): Determine the starting dose of narrowband UV B phototherapy in adult patients with generalized plaque psoriasis based on the minimal erythema dose or by using a fixed dose or skin phototype protocol. B Offer 3 times weekly dosing of narrowband UV B phototherapy during the treatment phase in adult patients with generalized plaque psoriasis. B Narrowband ultraviolet B phototherapy, combination therapy: As per NPF/AAD 2021 guidelines, consider offering topical tazarotene with narrowband UV B to reduce the total usage of narrowband UV B. C As per NPF/AAD 2019 guidelines, consider offering concomitant topical therapy with vitamin D analogs, retinoids and corticosteroids during narrowband UV B phototherapy with a potential to improve efficacy. C Show 3 more Narrowband ultraviolet B phototherapy (cautions): use genital shielding in all patients during narrowband UV B phototherapy to reduce the risk of genital skin cancer. B Show 3 more Broadband ultraviolet B phototherapy (indications): offer BB-UVB phototherapy as monotherapy in adult patients with generalized plaque psoriasis, if narrowband UV B is unavailable. B Show 2 more Broadband ultraviolet B phototherapy (combination therapy): consider offering combination therapy with acitretin and BB-UVB in adult patients with generalized plaque psoriasis. C Broadband ultraviolet B phototherapy (cautions): use genital shielding in all patients during BB-UVB phototherapy to reduce the risk of genital skin cancer. B Show 2 more https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 8/12 6/29/23, 11:33 PM Psoriasis Pathway Targeted ultraviolet B phototherapy (indications): offer targeted UV B phototherapy, including excimer laser (308 nm), excimer light (308 nm) and targeted narrowband UV B light (311-313 nm) in adult patients with localized plaque psoriasis (< 10% BSA), individual lesions or more extensive disease. B Show 3 more Targeted ultraviolet B phototherapy (dosing): Consider determining the starting dose of targeted UV B phototherapy in adult patients with localized plaque psoriasis based on the minimal erythema dose or by using a fixed dose or skin phototype protocol. B Offer targeted UV B phototherapy 2-3 times weekly to achieve maximal efficacy in adult patients with localized plaque psoriasis. A Targeted ultraviolet B phototherapy (combination therapy): consider offering combination therapy with topical corticosteroids and excimer laser for the treatment of adult patients with plaque psoriasis. C Psoralen-ultraviolet A phototherapy: prefer short-term PUVA monotherapy over narrowband UV B in adult patients with psoriasis. B Show 3 more Other phototherapies: consider offering pulsed dye laser in patients with nail psoriasis. C Show 5 more 6. Specific circumstances Patients considering conception, pregnancy, and breastfeeding: advise female patients of childbearing potential starting biologic therapy for psoriasis to use effective contraception and to discuss conception plans with the consultant supervising their care. Insufficient evidence about the interactions between biologic therapies and contraceptive methods. A Show 6 more Patients with vulvar psoriasis: advise using emollients to reduce local irritation induced by other topical treatment and to maintain the therapeutic results. A Show 6 more Patients with hepatitis B or C infection: consult a hepatitis specialist when treating patients with biologic therapy having hepatitis B or C infection, whether newly diagnosed or previously known. A Patients with HIV infection: provide treatment options to human immunodeficiency virus seropositive patients with psoriasis on a case-by-case basis. Be aware that severe psoriasis can occur in people with uncontrolled human immunodeficiency virus infection. Involve relevant specialists and ensure human immunodeficiency virus viral load is suppressed on antiretroviral therapy before initiating biologic therapy. A Patients with latent tuberculosis: aim to complete a 2-month treatment in patients requiring treatment for latent tuberculosis (3 months of isoniazid with pyridoxine and rifampicin, or 6 months of isoniazid with pyridoxine) before initiating biologic therapy. E https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 9/12 6/29/23, 11:33 PM Psoriasis Pathway Patients at higher risk of cancer: Exercise caution and discuss with the relevant cancer specialist when prescribing biologics in people with psoriasis and: a history of cancer, particularly if this has been diagnosed and treated less than 5 years previously and/or where the baseline risk of skin cancer is increased. A Patients with gluten intolerance: consider advising adherence to a gluten-free diet in patients with psoriasis and serological evidence of gluten intolerance, even in the absence of clinical signs of celiac disease. C 7. Patient education General counseling: As per BAD 2020 guidelines, agree and formalize arrangements for drug administration, monitoring and follow-up between healthcare providers and the patient receiving treatment. A Show 5 more As per AAD 2019 guidelines, inform patients with psoriasis about the association between psoriasis and psoriatic arthritis. B 8. Preventative measures Immunizations: do not give live vaccines to patients on biologic therapy and to infant patients (up to 6 months of age) whose mothers have received biologic therapy beyond 16 weeks of gestation. Check individual drug's summary of product characteristics. D Show 4 more 9. Follow-up and surveillance Switching between biologic agents: Take into consideration the following when switching from one drug therapy to another, or when commencing with a therapy washout: pharmacology of the drugs that are being stopped and started patient's clinical circumstances patient's views on the risks and benefits of switching options. A Show 2 more Monitoring during biologic therapy: consider delegating routine monitoring of biologic therapy in patients with psoriasis to other healthcare professionals, for example, clinical nurse specialists. B Show 8 more Surveillance for infectious complications: consider obtaining ongoing screening (such as annually) for hepatitis B, hepatitis C and human immunodeficiency virus, particularly in patients at increased risk of infection. C Show 3 more https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 10/12 6/29/23, 11:33 PM Psoriasis Pathway Studies 2023 Effect of Vitamin D on psoriasis severity In adults with active plaque psoriasis and 25-hydroxyvitamin D levels < 24 ng/mL, vitamin D was not superior to placebo with respect to reduction in psoriasis area severity index score. Marita Jenssen et al. JAMA Dermatol. 2023 Mar 29. References 1. Craig A Elmets, Neil J Korman, Elizabeth Farley Prater et al. Joint AAD NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol. 2021 Feb;84 2 432 470. Open 2. Abdulbaqi Al-Toma, Umberto Volta, Renata Auricchio et al. European Society for the Study of Coeliac Disease ESsCD guideline for coeliac disease and other gluten-related disorders. United European Gastroenterol J. 2019 Jun;7 5 583 613. Open 3. Nancy Weigle, Sarah McBane. Psoriasis. Am Fam Physician. 2013 May 1;87 9 626 33. Open 4. C H Smith, Z Z N Yiu, T Bale et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020 a rapid update. Br J Dermatol. 2020 Oct;183 4 628 637. Open 5. Menter A, Strober BE, Kaplan DH et al. Joint AAD NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019 Apr;80 4 1029 1072. Open 6. Elmets CA, Lim HW, Stoff B et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019 Sep;81 3 775 804. Open 7. Alan Menter, Joel M Gelfand, Cody Connor et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020 Jun;82 6 1445 1486. Open 8. Craig A Elmets, Craig L Leonardi, Dawn M R Davis et al. Joint AAD NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019 Apr;80 4 1073 1113. Open 9. van der Meijden WI, Boffa MJ, Ter Harmsel WA et al. 2016 European guideline for the management of vulval conditions. J Eur Acad Dermatol Venereol. 2017 Jun;31 6 925 941. Open 10. Smith CH, Jabbar-Lopez ZK, Yiu ZZ et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol. 2017 Sep;177 3 628 636. Open 11. Michelle A Lowes, Mayte Su rez-Fari as, James G Krueger. Immunology of psoriasis. Annu Rev Immunol. 2014;32 227 55. Open 12. Jeremy M Hugh, Jeffrey M Weinberg. Update on the pathophysiology of psoriasis. Cutis. 2018 Nov;102 5S 6 12. Open 13. Erica B Lee, Kevin K Wu, Michael P Lee et al. Psoriasis risk factors and triggers. Cutis. 2018 Nov;102 5S 18 20. Open 14. I M G J Bronckers, A S Paller, M J van Geel et al. Psoriasis in Children and Adolescents: Diagnosis, Management and Comorbidities. Paediatr Drugs. 2015 Oct;17 5 373 84. Open https://web.pathway.md/diseases/recwGLRFJVUGC9xKR 11/12 6/29/23, 11:33 PM Psoriasis Pathway 15. Adriana Rendon, Knut Sch kel. Psoriasis Pathogenesis and Treatment. Int J Mol Sci. 2019 Mar 23;20 6 1475. Open 16. Wolf-Henning Boehncke. Systemic Inflammation and Cardiovascular Comorbidity in Psoriasis Patients: Causes and Consequences. Front Immunol. 2018 Apr 5;9 579. Open 17. Jochen Schmitt, Gottfried Wozel. The psoriasis area and severity index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology. 2005;210 3 194 9. Open 18. Philip S Helliwell. Psoriasis Epidemiology Screening Tool PEST a report from the GRAPPA 2009 annual meeting. J Rheumatol. 2011 Mar;38 3 551 2. Open 19. Alan Menter, Kelly M Cordoro, Dawn M R Davis et al. Joint American Academy of Dermatology- National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020 Jan;82 1 161 201. Open 20. Anand Padmanabhan, Laura Connelly-Smith, Nicole Aqui et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher. 2019 Jun;34 3 171 354. Open 21. Marita Jenssen, Anne-Sofie Furberg, Rolf Jorde et al. Effect of Vitamin D Supplementation on Psoriasis Severity in Patients With Lower-Range Serum 25 Hydroxyvitamin D Levels: A Randomized Clinical Trial. JAMA Dermatol. 2023 Mar 29;e230357. Open 22. Alen Zabotti #, Gabriele De Marco #, Laure Gossec et al. EULAR points to consider for the definition of clinical and imaging features suspicious for progression from psoriasis to psoriatic arthritis. Ann Rheum Dis. 2023 Jun 9;ard-2023 224148. 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