Psoriasis: assessment and management

Assessing the evidence

We found 91 studies through surveillance of this guideline.

We found evidence in the following areas that could potentially add to existing recommendations: the effect of weight loss through diet and exercise on psoriasis; a medicated adhesive plaster containing betamethasone valerate (a potent corticosteroid); and a foam formulation of calcipotriol monohydrate plus betamethasone dipropionate. However, we have decided to await further evidence before considering an update. In making this decision, it was noted that the guideline in its current form does not preclude the use of any of these interventions. Additionally, the current recommendations broadly cover the interventions. For example: diet and exercise is covered by recommendations to offer healthy lifestyle information in line with NICE guidance on obesity and physical activity; the betamethasone plaster is covered by recommendations to offer a potent corticosteroid; and the foam formulation is covered by recommendations to offer a combined product containing calcipotriol monohydrate and betamethasone dipropionate.

We also found evidence that could affect NICE's recommendations on the use of biological agents for psoriasis. However, recommendations on the first-line use of biological agents are covered by NICE technology appraisals. Review of technology appraisals is outside the remit of the surveillance process, therefore information has been passed to the NICE technology appraisals team for consideration as part of a review proposal process. Knowing the outcome of this process would be beneficial before any updates to the NICE guideline on psoriasis are considered.

We also identified other areas where evidence was not consistent with, or not covered by, current recommendations, but the evidence was not considered to impact on the guideline at this time. See appendix A for full details of all evidence considered and a discussion of the impact on recommendations.

We did not find any evidence related to risk of skin cancer with coal tar, phototherapy, or systemic non-biological or biological therapy.

For any evidence relating to published, ongoing or proposed NICE technology appraisals, the guideline surveillance review deferred to the technology appraisal decision (where available). This included evidence on apremilast, adalimumab, briakinumab, brodalumab, dimethyl fumarate, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, tildrakizumab, tofacitinib and ustekinumab.

All other evidence was deemed consistent with current recommendations.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the evidence and views of topic experts and stakeholders, we decided that no update is necessary for this guideline.

See how we made the decision for further information.