title: Expert recommendations on treating psoriasis in special circumstances.
abstract: OBJECTIVE
  A great amount of information on systemic and biologic therapies for moderate to severe psoriasis is now available. However, applying the evidence in numerous clinical scenarios has engendered debate; under these circumstances, the consensus of experts is useful.
  
  
  METHODS
  A scientific committee systematically reviewed the literature relevant to 5 clinical scenarios. An online Delphi survey of dermatologists with experience treating moderate to severe psoriasis was then carried out in order to shed light on questions that remained unresolved by the available evidence.
  
  
  RESULTS
  Twenty-three dermatologists responded to the survey and consensus was reached on 37 (56%) of the 66 statements proposed. These results led to consensus on various clinical situations even though firm evidence was lacking. Thus, intermittent therapeutic regimens and strategies for reducing the intensity of treatment are considered appropriate for optimizing biologic treatment and reducing costs. The measurement of drug and antidrug antibody levels should be included routinely when following patients on biologics to treat psoriasis. Concomitant psoriatic arthritis or a history of cardiovascular conditions will influence the choice of biologic; in these situations, an agent with anti-tumor necrosis factor properties will be preferred. Tailored management is important when the patient is pregnant or intends to conceive; drug half-life and disease severity are important factors to take into consideration in these scenarios.
  
  
  CONCLUSIONS
  A combination of systematic review of the literature and structured discussion of expert opinion facilitates decision-making in specific clinical scenarios.
authors.affiliation: Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España. Electronic address: jmcarrascosac@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Carrascosa
authors.affiliation: Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: I
authors.initials: I
authors.lastname: Belinchón
authors.affiliation: Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España.
authors.forename: P
authors.initials: P
authors.lastname: de-la-Cueva
authors.affiliation: Servicio de Dermatología, Hospital Universitario Basurto, Universidad del País Vasco, Bilbao, España.
authors.forename: R
authors.initials: R
authors.lastname: Izu
authors.affiliation: Servicio de Dermatología, Hospital Universitario ParcTaulí de Sabadell, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Luelmo
authors.affiliation: Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: R
authors.initials: R
authors.lastname: Ruiz-Villaverde
mesh_terms: D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001691:Biological Therapy; D000066491:Clinical Decision-Making; D002986:Clinical Trials as Topic; D003697:Delphi Technique; D003880:Dermatology; D057915:Drug Substitution; D000068800:Etanercept / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D015337:Multicenter Studies as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011565:Psoriasis / Q000188:drug therapy*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D000068800:Etanercept
keywords: Artritis psoriásica; Biologic therapy; Consenso; Consensus; Factor de necrosis tumoral alfa; Psoriasis; Psoriatic arthritis; Terapia biológica; Tumor necrosis factor alpha