Malaysian Clinical Practice Guideline for the Management of Psoriasis Vulgaris: Summary of recommendations for management in primary healthcare setting.

Psoriasis is a genetically determined, systemic immune-mediated chronic inflammatory disease that affects primarily the skin and joints. It has been estimated to affect 1-3% of the general population worldwide. There are several distinctive clinical sub-types of psoriasis. Psoriasis vulgaris (Figure 1), the most common type, is seen in 89% of the 6895 patients registered in the Malaysian Psoriasis Registry.1 Psoriatic arthritis is present in 15%. Patients with psoriasis, particularly those with severe disease, are more prone to depression, metabolic syndrome or the individual component of metabolic syndromes namely obesity, diabetes mellitus, dyslipidemia, and hypertension.2-6 Young adults with severe psoriasis have a 3-fold increased risk of developing myocardial infarction (MI) and a reduction of 3-4 years in life expectancy.3,4,7 There is also increasing evidence that controlling chronic inflammation of psoriasis with systemic agents or biologics reduces cardiovascular co-morbidity.3,7-10 Figure 1. Well demarcated erythematous plaques with silvery scales on extensor surfaces of arms Effective treatments are available. Unfortunately, surveys showed that patients frequently received suboptimal care or were on ineffective treatment for longer than neccessary.11-12 To improve care of patients living with psoriasis, the Malaysia Health and Technology Assessment Section of the Ministry of Health recently published a clinical practice guidelines (CPG) for the Management of Psoriasis Vulgaris in adults.13 The aims of this CPG are to assist clinicians and other healthcare professionals (HCPs) in making evidence-based decisions on the management of psoriasis and to implement treatment goals to improve outcome of patients living with psoriasis. This article summarises recommendations on the assessment and management of psoriasis that are relevant to the primary HCP.