title: Tuscan consensus on the diagnosis, treatment and follow-up of moderate-to-severe psoriasis.
abstract: BACKGROUND
  Psoriasis is traditionally defined as an inflammatory chronic-relapsing disease of the skin. As widely demonstrated, this disease is also associated with multiple comorbidities: arthropathy, inflammatory bowel disease, metabolic, cardiovascular, ocular and psychological disorders. The disease also has a significant impact on patients' quality of life, whose work ability decreases considerably with clear consequences for the social costs. Therefore, if we consider that in Tuscany, more than 100,000 people out of 3,672,202 suffer from psoriasis, it is of paramount importance focusing the attention on a rational model of clinical and therapeutic management of the disease. All the leading experts in Tuscany have come together with the aim of defining unanimously accepted regional guidelines for the diagnosis, treatment, follow-up and management of psoriasis, and of providing practical guidance/protocol on diagnosis, treatment, follow-up and management of special cases of moderate-to-severe plaque psoriasis.
  
  
  METHODS
  In a working group formed ad hoc, the main topics have been discussed and approved by plenary vote.
  
  
  RESULTS
  Diagnosis must include a proper general health condition overview, a careful evaluation of skin and joints, the assessment and management of other comorbidities and the definition of disease severity. With regards to the therapy the best time to start a systemic treatment, the therapeutic goal, the most appropriate drug and blood tests to be performed in case of moderate severe-psoriasis have been taken into account. During follow-up, proper monitoring of systemic therapy and its management in the long term has also been suggested. Eventually, the experts have addressed the problem of how to manage the disease in special conditions, such as during surgery, pregnancy, in children and in case of infections (HBV, HCV, HIV).
  
  
  CONCLUSIONS
  The main aim of this Consensus was to find agreement on the criteria for diagnosis, treatment and follow-up of psoriasis, shared by all the Dermatologic Therapy Units of Tuscany. A need to create an easier way for the patient to access specialized dermatology outpatient services, and to reduce the waiting list and costs related to the management of psoriasis has been stressed. Most importantly, during the Consensus all of the participants agreed on the central role of the patient, and on the need of a multidisciplinary management of the disease which requires communication among specialists and regional centers in order to build on existing experience.
authors.affiliation: Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy - francesca.prignano@unifi.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Prignano
authors.affiliation: Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Tripo
authors.affiliation: Dermatology Unit, San Giuseppe Hospital, ASL 11, Empoli, Italy.
authors.forename: Lauretta
authors.initials: L
authors.lastname: Amato
authors.affiliation: Dermatology Unit, Livorno Hospital, ASL 6, Livorno, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bagnoni
authors.affiliation: Dermatology Unit, San Jacopo Hospital, ASL 3, Pistoia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bartoli
authors.affiliation: Dermatology Unit, Santi Giacomo e Cristoforo Hospital, ASL 1, Massa, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Battistini
authors.affiliation: Dermatology Unit, Santi Giacomo e Cristoforo Hospital, ASL 1, Massa, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bellini
authors.affiliation: Dermatology Unit, San Giuseppe Hospital, ASL 11, Empoli, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Brandini
authors.affiliation: Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Caproni
authors.affiliation: Dermatology Unit, Prato Hospital, ASL 4, Prato, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Cardinali
authors.affiliation: Dermatology Unit, San Donato Hospital, ASL 8, Arezzo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Castelli
authors.affiliation: Dermatology Unit, San Jacopo Hospital, ASL 3, Pistoia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cecchi
authors.affiliation: Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Cervadoro
authors.affiliation: Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Dini
authors.affiliation: Section of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Fimiani
authors.affiliation: Dermatology Unit, Livorno Hospital, ASL 6, Livorno, Italy.
authors.forename: Olimpia
authors.initials: O
authors.lastname: Eberle
authors.affiliation: Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fabbri
authors.affiliation: Dermatology Unit, Prato Hospital, ASL 4, Prato, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lo Scocco
authors.affiliation: Dermatology Unit, Campo di Marte Hospital, ASL 2, Lucca, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Martini
authors.affiliation: Dermatology Unit, Versilia Hospital, ASL 12, Lido di Camaiore, Lucca, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Marsili
authors.affiliation: Dermatology Unit, Campo di Marte Hospital, ASL 2, Lucca, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mazzatenta
authors.affiliation: Dermatology Unit, Prato Hospital, ASL 4, Prato, Italy.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Niccoli
authors.affiliation: Dermatology Unit, Misericordia Hospital, ASL 9, Grosseto, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Peccianti
authors.affiliation: Section of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pellegrino
authors.affiliation: Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Romanelli
authors.affiliation: Dermatology Unit, Misericordia Hospital, ASL 9, Grosseto, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sirna
authors.affiliation: Dermatology Unit, Prato Hospital, ASL 4, Prato, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Taviti
authors.affiliation: Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Volpi
authors.affiliation: Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, ASL Firenze, Florence, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Pimpinelli
mesh_terms: D015897:Comorbidity; D003880:Dermatology / Q000379:methods; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007558:Italy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D011565:Psoriasis / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D011788:Quality of Life; D012720:Severity of Illness Index