Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies

J Am Acad Dermatol. 2020 Jun;82(6):1445-1486. doi: 10.1016/j.jaad.2020.02.044. Epub 2020 Feb 28.


Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).

Keywords: Clinical guidelines for psoriasis; dermatology; nonbiologic systemic; psoriasis; psoriasis guidelines; skin disease.

Publication types

  • Practice Guideline

MeSH terms

  • Acitretin / therapeutic use
  • Cyclosporine / therapeutic use
  • Drug Monitoring
  • Humans
  • Methotrexate / therapeutic use
  • Piperidines / therapeutic use
  • Psoriasis / drug therapy*
  • Pyrimidines / therapeutic use
  • Thalidomide / analogs & derivatives
  • Thalidomide / therapeutic use


  • Piperidines
  • Pyrimidines
  • Thalidomide
  • Cyclosporine
  • tofacitinib
  • Acitretin
  • apremilast
  • Methotrexate