Practical Saudi Guidelines on management of moderate-to-severe psoriasis: 2026 update.
This GRADE-based Saudi practice guideline provides 27 recommendations and four good-practice statements for moderate-to-severe psoriasis, including early biologic therapy with selected agents for pediatric patients.
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This GRADE-based Saudi practice guideline provides 27 recommendations and four good-practice statements for moderate-to-severe psoriasis, including early biologic therapy with selected agents for pediatric patients.
Research significance
The record supports use of selected biologics for pediatric psoriasis but provides no evidence or stated hypothesis that these therapies prevent, treat, or improve outcomes in pediatric cancer; any oncology application would be unsupported inference.
Source abstract
BACKGROUND: Psoriasis is a chronic, immune-mediated inflammatory skin disease that affects approximately 5.3% of the population in the Kingdom of Saudi Arabia (KSA). Thus, we aim to develop updated evidence-based clinical practice guidelines for the management of adults and pediatric patients with moderate-to-severe plaque psoriasis in the KSA. METHODS: These guidelines followed the "Grading of Recommendations, Assessment, Development, and Evaluation" (GRADE) methodology. We conducted a systematic literature review of PubMed, EMBASE, and the Cochrane Library for high-quality evidence published between 2020 and 2026. The panel developed 31 PICO questions that address key treatment considerations for moderate-to-severe psoriasis. RESULTS: We established 27 evidence-based recommendations and 4 good-practice statements addressing key aspects of moderate-to-severe psoriasis management. These guidelines strongly recommend adopting the Psoriasis Area and Severity Index (PASI) 90 as the primary treatment goal over PASI 75. For adult patients, the guidelines recommend biologic therapies, including interleukin (IL)-17 inhibitors, IL-23 inhibitors, IL-12/23 inhibitors, and tumor necrosis factor (TNF)-α inhibitors, for better disease control. For pediatric patients, the guidelines recommend early initiation of biologic therapy, with etanercept, secukinumab, ixekizumab, and adalimumab as preferred options. CONCLUSION: These Saudi national guidelines offer a comprehensive, evidence-based framework for managing moderate-to-severe psoriasis in adults and pediatric patients.