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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA
Rivista di Dermatologia e Malattie Sessualmente Trasmesse
Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Giornale Italiano di Dermatologia e Venereologia 2015 Jan 14
Tuscany consensus for the diagnosis, treatment and follow-up of moderate-to-severe psoriasis
Prignano F. 1, Tripo L. 1, Amato L. 2, Bagnoni G. 3, Bartoli L. 4, Battistini S. 5, Bellini M. 5, Brandini L. 2, Caproni M. 1, Cardinali C. 6, Castelli A. 7, Cecchi R. 4, Cervadoro G. 8, Dini V. 8, Fimiani M. 9, Eberle O. 3, Fabbri P. 1, Lo Scocco G. 6, Martini P. 10, Marsili F. 11, Mazzatenta C. 10, Niccoli M. C. 6, Peccianti C. 12, Pellegrino M. 9, Romanelli M. 8, Sirna R. 12, Taviti F. 6,
Volpi V. 1, Pimpinelli N. 1
1 Division Dermatology, Department of Surgery and Translational Medicine, University of Florence, Dermatology Units, Florence Local Health District;
2 Dermatology Unit, San Giuseppe Hospital, Empoli, Local Health District 11;
3 Dermatology Unit, Livorno Hospital, Local Health District 6;
4 Dermatology Unit, San Jacopo Hospital, Pistoia, Local Health District 3;
5 Dermatology Unit, Giacomo e Cristoforo Hospital, Massa, Local Health District 1;
6 Dermatology Unit, Prato Hospital, Local Health District 4;
7 Dermatology Unit, San Donato Hospital, Arezzo, Local Health District 8;
8 Division of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa;
9 Section of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena;
10 Dermatology Unit, Campo di Marte Hospital, Lucca, Local Health District 2;
11 Dermatology Unit, Versilia Hospital, Local Health District 12;
12 Dermatology Unit, Misericordia Hospital, Grosseto, Local Health District 9
BACKGROUND: Psoriasis is traditionally defined as an inflammatory chronic-relapsing disease of the skin. It is also - as widely demonstrated - a disease 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.
OBJECTIVE: All the leading experts in Tuscany have come together with the aim of ● defining regional universally accepted guidelines for the diagnosis, treatment, follow-up and management of psoriasis ● providing practical guidance / protocol on diagnosis, treatment, follow up and management of special cases of moderate-to-severe plaque psoriasis.
METHODS: ● working groups ● discussion on the main topics and approval by plenary vote.
RESULTS: The diagnosis includes 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 the follow-up, proper monitoring of systemic therapy and its management in the long term have also been considered. 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 ) (TAB.1).
CONCLUSIONS: The main aim of the CONSENSUS was to find out the criteria for the diagnosis, treatment and follow up of psoriasis, shared by all the Dermatology Therapeutic Units of Tuscany. The need to create an easier way for the patient to access to specialized dermatological outpatient services and to reduce the waiting list and the costs related to the management of such a disease has been highlighted. The most important fact that came out during the CONSENSUS was the shared opinion of all the participants on the central role of the patient and the need of a multidisciplinary management of the disease, among the various specialists and the regional centers, in order to build on the gained experiences.