Clinical practice guideline for psoriasis management in Latin America

Psoriasis care in Latin America is heterogeneous, and access to systemic agents, biologics, phototherapy, and monitoring resources varies widely across countries.

To develop a regional, evidence-based clinical practice guideline for psoriasis management using GRADE methodology.

The Latin American Psoriasis Society (SOLAPSO) convened a guideline development group, an extended expert panel, patients, and an independent methodological team. We framed clinical questions using PICO, conducted systematic literature reviews, rated certainty of evidence with GRADE, and formulated recommendations through structured Evidence-to-Decision deliberations incorporating benefits and harms, patient values, feasibility, equity, and resource use. Independent external reviewers assessed clarity and methodological quality.

The guideline provides measurable therapeutic targets for plaque psoriasis and key phenotypes, including nail psoriasis, generalized pustular psoriasis, and other special forms. It recommends first-line conventional systemic options (methotrexate, cyclosporine, acitretin) and phototherapy, and it defines indications for escalation to biologic agents or small molecules after inadequate response, intolerance, or contraindications to conventional therapy. It addresses selection across biologic classes, use of biosimilars, and strategies for primary and secondary therapeutic failure. Additional recommendations cover high-impact areas (scalp, nails, palmoplantar, inverse, genital) and special situations (pregnancy, cancer, chronic viral infections, HIV, latent tuberculosis, pediatric psoriasis), plus nonpharmacologic interventions (weight reduction and structured psychological support).

Limitations include heterogeneity in the availability of regional evidence, indirect evidence for some special populations, and variability in access to therapies across Latin American health systems.

This guideline offers an actionable framework for comprehensive psoriasis care in Latin America, balancing best available evidence with regional constraints to support equitable, patient-centered implementation in routine clinical practice.