Recategorization of Psoriasis Severity
Disease severity criteria can significantly impact a psoriasis patient’s eligibility for treatment. While their disease may profoundly affect their quality of life, the current clinical definition of psoriasis severity is narrow. It does not account for the many potential challenges the disease may cause in a patient’s life.
In 2019, IPC began its disease severity reclassification project to redefine the criteria used for assessing disease severity that would better guide clinical decision-making to be more meaningful, practical, and better aligned with the actual severity of a patient’s disease.
This project seeks to challenge using the standard definitions of “mild, moderate, and severe” to determine treatment pathways. Through a robust Delphi process, IPC’s network of experts developed a consensus statement that redefines the criteria for patients who are candidates for systemic therapy. The statement is as follows:
Patients that meet one or more of the following criteria are candidates for systemic therapy:
- Psoriasis lesions on 10% or more of body surface; OR
- Psoriasis lesions on sensitive areas of the body (i.e., hands/feet, face, genitals, scalp); OR
- Topical therapy failed to control symptoms.
Fast Facts
- Typically, patients must have a PASI of 10 or 12 to be eligible for systemic treatments.
- Despite this, patients with a PASI or BSA score below ten can experience significant impairment in their quality of life.
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Reclassification allows for more specific clinical severity criteria that guide clinical decision-making to be more practical, meaningful, and better aligned with the severity of a patient’s disease.
IPC Resources
PUBLICATIONS AND RESEARCH
VIDEOS
ARTICLES
Why a New Psoriasis Disease Severity Classification System Will Better Serve Psoriasis Patients
International Psoriasis Councils’ Psoriasis Severity Reclassification Project aims to change the classification of psoriasis severity. IPC’s network of key opinion leaders agreed on a definition for each category of disease severity.
Common clinical tools to assess psoriasis severity may not capture full impact of disease
The IPC Disease Severity Working Group concluded that the objective measures of two commonly used clinical tools to determine psoriasis severity may not fully capture the impact of the disease on the individual in a new review published in the Journal of The Academy of Dermatology and Venerology (JEADV).
Commentary: Psoriasis treat to target: defining outcomes in psoriasis
In moderate to severe psoriasis, there has been a long-lasting tradition to define outcome as a relative change from baseline PASI, with the classical PASI 75 being more recently replaced by PASI 90 or 100. However, this concept is dated, mainly due to the impressive development of anti-interleukin therapies and an increasing interest in real-world evidence.
IPC EXPERTS
Additional Resources
Below are resources from other organizations that support IPC’s recategorization of psoriasis severity.
Evolution of Patient Perceptions of Psoriatic Disease: Results from the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) Survey.
Lebwohl M, Langley RG, Paul C, Puíg L, Reich K, van de Kerkhof P, Wu HL, Richter S, Jardon S, Gisondi P.Dermatol Ther (Heidelb). 2022 Jan;12(1):61-78. doi: 10.1007/s13555-021-00635-4. Epub 2021 Oct 25.PMID: 34704231
The proportion of patients with at least a moderate effect of psoriasis on quality of life was greater among patients with involvement in at least one special area versus no special area involvement. In this international population study, the impact of the various special areas on quality of life is reported.
Impact of Psoriatic Disease on Quality of Life: Interim Results of a Global Survey
April Armstrong 1, Barbra Bohannan 2, Sicily Mburu 3, Ivette Alarcon 4, Torben Kasparek 4, Jihen Toumi 5, Susan Frade 4, Silvia Fernandez Barrio 6, Matthias Augustin 7 Dermatol Ther (Heidelb). 2022 Apr;12(4):1055-1064. doi: 10.1007/s13555-022-00695-0.Epub 2022 Mar 14.
The IPC disease severity recategorization is not a data-driven but a practice-driven categorization. To a large extent, psoriasis is a systemic disease that requires dermatologists to look more than skin deep. As systemic treatment for psoriasis may be indicated in patients with mild skin involvement suffering from systemic comorbidity, the holistic approach in the IPC definition is crucial.
VIDEOS AND PODCASTS
Listen as IPC Board Member and Vice President/President-Elect Bruce Strober discusses the categorization of psoriasis severity and its part in determining the correct therapy, in this Dialogues in Dermatology podcast.
In this three-part video series by Novartis, Dr. Bruce Strober and Dr. Andrew Blauvelt discuss the new IPC classification.
Listen as IPC Board Member Dr. Bruce Strober and IPC Councilor Dr. Andrew Blauvelt discuss the International Psoriasis Council’s rationale for changing psoriasis severity classification for treatment decisions and clinical trials in this NPF podcast.