# Highlights of the Brazilian Society of Dermatology’s Brazilian Consensus on Psoriasis

## TL;DR

The 2024 Brazilian Consensus on Psoriasis updates treatment guidelines with new biologics, algorithms, and considerations for specific patient situations.

## Contribution

The paper introduces an updated treatment algorithm and includes new biologics and small molecule inhibitors for psoriasis management.

## Key findings

- Spesolimab and cyclosporine are now first-line treatments for generalized pustular psoriasis.
- Acitretin was removed from the plaque psoriasis treatment sequence.
- The consensus includes treatment lines for immunobiologicals in adult and pediatric populations.

## Abstract

The 2024 Brazilian Consensus on Psoriasis and Treatment Algorithm of the Brazilian Society of Dermatology (SBD, Sociedade Brasileira de Dermatologia) comes four years after the release of the last Consensus, published in 2020. This new consensus now includes 43 chapters and has the participation of 85 professionals from across Brazil, including dermatologists and rheumatologists working in university hospitals, research centers, and public and private healthcare systems. The concept of Cumulative Life Course Impairment (CLCI), the inclusion of new biologics approved in Brazil after 2020, the update on psoriasis treatment in specific situations (such as pregnancy and surgery), and the discussion on "Response Predictors" are examples of updates addressed in this Consensus. The updated treatment algorithm used experts’ responses through the Delphi method and, among other modifications, removed acitretin from the plaque psoriasis treatment sequence, defined treatment lines for choosing immunobiologicals in both adult and pediatric populations, and included spesolimab and cyclosporine as first-line treatments for generalized pustular psoriasis. Finally, the new Consensus addresses the place of small molecule inhibitors in the algorithm and discusses future treatment options for plaque psoriasis.