title: A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 2.
abstract: BACKGROUND
  Clinicians may be confronted with difficult-to-treat psoriasis cases for which there are scant data to rely upon for guidance. To assist in managing such patients, who are typically excluded from clinical trials, a consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise.
  
  
  METHODS
  The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting.
  
  
  RESULTS
  Five of the 24 discussed case scenarios are presented in this article: (1) moderate-to-severe psoriasis that has failed to respond to all currently approved therapies for psoriasis; (2) palmoplantar psoriasis that is unresponsive to topical therapy and phototherapy; (3) erythrodermic psoriasis; (4) pustular psoriasis; and (5) the preferred therapeutic choice to combine with low-dose methotrexate. A previous article (part 1) presented six other scenarios.
  
  
  CONCLUSIONS
  The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with patients with challenging cases of psoriasis.
authors.affiliation: Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT 06032 USA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Strober
authors.forename: Jennifer
authors.initials: J
authors.lastname: Clay Cather
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Crowley
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Gordon
authors.forename: Alice B
authors.initials: AB
authors.lastname: Gottlieb
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Kavanaugh
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Korman
authors.forename: Gerald G
authors.initials: GG
authors.lastname: Krueger
authors.forename: Craig L
authors.initials: CL
authors.lastname: Leonardi
authors.forename: Sergio
authors.initials: S
authors.lastname: Schwartzman
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sobell
authors.forename: Gary E
authors.initials: GE
authors.lastname: Solomon
authors.forename: Melodie
authors.initials: M
authors.lastname: Young