This first part of the updated German S3 guideline on the treatment of psoriasis vulgaris covers the sections on treatment recommendations, treatment goals, and monitoring of therapies. The recommendations are based on the current Cochrane network meta-analysis, the results of which are also summarized. When selecting systemic therapies for psoriasis vulgaris, the guideline emphasizes consideration of efficacy, safety, comorbidities, and individual patient factors. The decision framework is presented in the treatment options overview, and in this updated version, the possibility of first-line therapy with biologics or novel targeted small molecules is more prominently highlighted. Standardized instruments for assessing disease severity, as well as patient-centered treatment goals, are underscored. A Psoriasis Area and Severity Index (PASI) 75 response is defined as the minimum therapeutic target, while PASI 90 or an absolute PASI <2 are considered desirable goals. Since the last version, two newly approved agents, bimekizumab and deucravacitinib, have been incorporated, accompanied by specific usage recommendations. Among the established therapies, guidance on methotrexate has been extensively revised, particularly regarding administration, dosing, and monitoring. This guideline aims to provide clinicians with an evidence-based framework for therapy selection and monitoring, while strengthening shared decision-making with patients.
