International Psoriasis Council

Advancing Knowledge. Enhancing Care.

Advancing Knowledge. Enhancing Care.

Recategorization of Psoriasis Severity

IMPROVING THE CLASSIFICATION OF PSORIASIS SEVERITY

Project Description

The current clinical definitions of psoriasis severity are narrowly defined and overlook the unique challenges faced by each patient, which may include localized lesions in specific areas and/or comorbidities. A more specific clinical severity classification is needed and would guide clinical decision-making to be more practical, meaningful, and better aligned with the true severity of a patient’s disease; strengthen psoriasis treatment guidelines and guide future clinical trials of drugs targeting various severities of psoriasis.

In Phase I of the project, the Delphi method was used to come to consensus, among IPC’s network of key opinion leaders, on a definition for each category of disease severity. As the result of the reclassification Delphi, IPC recommends that patients be considered a candidate for topical-only therapy or a candidate for systemic therapy.

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.

In Phase II of the project, the working group is focusing on implementing studies that quantify the statement in real-world practice.  In addition, significant work is being done to educate clinicians and patients on the new classification. Future work in Phase II will focus on educating regulatory bodies and developing additional activities to educate clinicians and patients.

Project Leaders

Bruce Strober

Bruce

Strober

,

MD, PhD

Central Connecticut Dermatology

Avon

,

Connecticut

,

United States

Chair

Lone

Skov

,

MD, PhD

Herlev and Gentofte Hospital, University of Copenhagen

Hellerup

,

Denmark

Co-chair

Working Group Members

  • Matthias Augustin, Germany
  • Andy Blauvelt, United States
  • Cristina Echeverría, Argentina
  • Marcus Schmitt-Egenolf, Sweden
  • Peter van de Kerkhof, Netherlands, IPC CMO
  • Christy Langan, United States, IPC CEO

Project Results

PSORIASIS SEVERITY: COMMONLY USED CLINICAL THRESHOLDS MAY NOT ADEQUATELY CONVEY PATIENT IMPACT  

Golbari NM, van der Walt JM, Blauvelt A, Ryan C, van de Kerkhof P, Kimball AB. J Eur Acad Dermatol Venereol. 2020 Sep 25. doi: 10.1111/jdv.16966.

ABSTRACT

Background

Psoriasis severity is usually evaluated using quantitative and qualitative measures, including percent body surface area (BSA) involvement, the Psoriasis Area and Severity Index (PASI), and the Dermatology Life Quality Index (DLQI), a patient -reported questionnaire. However, standardized definitions for psoriasis severity categories have not been well established. A PASI of 10 or 12 has remained the minimal severity threshold defining eligibility for psoriasis treatments. In the present study, the validity of this cut-off was re-evaluated in the context of quality of life.
 
Objective
To determine if the thresholds commonly used to define moderate psoriasis (PASI of 10-12 and BSA of 10) are supported by patient-reported DLQ I data. 
 
Methods
A systematic review of randomized controlled trials that enrolled mild or moderate patients published between January 2000 – June 2017 was used to assess correlations between provider and patient-generated severity at baseline. 
 
Results
For subject groups with high impact on quality of life (DLQI >10), the mean weighted BSA was 7.6 (Range: 7.1 -8.4) and the mean weighted DLQI was 11 (Range: 10.2 – 12.2). Similarly, the mean weighted PASI for patients with DLQI >10 was 8.7 (Range: 7.1 – 10.1) and the mean weighted DLQI was 10.9 (Range: 10.1 -12.2). Conclusion: Patients with PASI or BSA scores less than 10 can have major quality of life impairment. In general, the objective measures of BSA and PASI alone, when excluding DLQI, may not fully capture the impact of disease severity.

Link to PubMed

RECATEGORIZATION OF PSORIASIS SEVERITY: DELPHI CONSENSUS FROM THE INTERNATIONAL PSORIASIS COUNCIL

Strober B, Ryan C, van de Kerkhof P, van der Walt J, Kimball AB, Barker J, Blauvelt A. Journal of the American Academy of Dermatology (2019), doi: https://doi.org/10.1016/ j.jaad.2019.08.026.

View more resources on utilizing this new categorization in your clinic.