These updated Saudi guidelines cover moderate-to-severe plaque psoriasis in adults and children, built with GRADE methodology from 31 PICO questions and a 2020-2026 literature search, yielding 27 recommendations and 4 good-practice statements. Psoriasis affects about 5.3% of the Saudi population, which is high, and the guideline is written for a health system that has to treat at that scale.
Two recommendations matter beyond the country they were written for. The first is a strong recommendation to adopt PASI 90 rather than PASI 75 as the primary treatment target. That is a real shift in what counts as an adequate response: a patient at PASI 80 has, under the old target, succeeded, and under the new one has not, and should be escalated. The second is for children — early initiation of biologic therapy, with etanercept, secukinumab, ixekizumab and adalimumab named as preferred options, rather than the conventional sequence through systemic conventional agents.
A national guideline is shaped by what a national formulary funds, so the specific agents named will not map onto every setting. The PASI 90 target does transfer, and it is the part worth acting on: it costs nothing to change the threshold at which you consider a treatment to have worked, and in a clinic where the recorded goal is still PASI 75, patients with residual disease are being signed off as controlled.
- Record PASI at each review and treat PASI 90, not PASI 75, as the threshold for adequate response
- Reconsider escalation in patients previously classed as responders under a PASI 75 target
- In children with moderate-to-severe disease, raise biologics earlier rather than exhausting conventional systemics first
- Match the named agents to what is actually available and funded in your setting before quoting the recommendation
- GRADE-based and recent, but a national guideline reflects national formulary constraints as well as evidence
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