Background: Currently, no formalized international consensus guidelines exist to direct optimal topical

treatment including long-term treatment.

Objective: In this survey, we aim to examine if and which topicals are used in clinical practice in

long-term continuous treatment of psoriasis and how topicals are used in treating specific sites of

the body.

Methods: A questionnaire was distributed electronically to dermatologists from the International

Psoriasis Council (IPC) representing 26 countries.

Results: The top three topicals used across all severities of disease were topical corticosteroids, vitamin

D analogs, and potent topical corticosteroids in combination with vitamin D analogs. On locations

where the skin is thin, flexural and genital psoriasis, lower potency topical corticosteroids were

used, whereas on other sites, in particular in palmoplantar psoriasis, superpotent topical corticosteroids

and combination vitamin D analogs/corticosteroids were used.

Conclusions: It is relevant to optimize localized therapy for all severities of psoriasis reconciling disease

activity (stable vs. unstable disease), localization of the lesions and the individual patient and

his/her perspectives on disease control. Topical therapies are valuable treatments for classical mild disease

and may have a position in some patients with more severe manifestations.

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ABSTRACT

BACKGROUND:
Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies. However, due to the heterogeneity of severity classifications and their lack of consideration for the impact of psoriasis involvement of special areas or past treatment history, patients may be mis-categorized, which can lead to under-treatment of psoriasis.

OBJECTIVE:
To develop a consensus statement on the classification of psoriasis severity.

METHODS:
A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity.

RESULTS:
After completion of the exercise, seven severity definitions were preferentially ranked. This most preferred statement rejects the mild, moderate and severe categories in favor of a dichotomous definition: Psoriasis patients should be classified as either candidates for topical therapy or candidates for systemic therapy; the latter are patients who meet at least one of the following criteria: 1) BSA > 10%, 2) Disease involving special areas, 3) Failure of topical therapy.

LIMITATIONS:
This effort might have suffered from a lack of representation by all relevant stakeholders, including patients.

CONCLUSION:
The consensus statement describes two categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.

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