Improving the classification of psoriasis severity
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 consensus is needed to define each category of disease severity in order to improve the care of all patients with psoriasis worldwide.
A more specific clinical severity classification would:
The Delphi method was used among IPC’s network of key opinion leaders in order to achieve consensus on the classification of psoriasis severity. Using this approach, participants were able to suggest severity statements or possible alternative terminology that refine or even replace current definitions of mild, moderate, and severe psoriasis. A consensus meeting of the Delphi’s participants took place during the IPC Think Tank in December 2018. The results of these activities were published in a peer-reviewed manuscript.
Bruce Strober, MD, PhD Central Connecticut Dermatology, Cromwell, CT and Yale University, Department of Dermatology New Haven, Connecticut, United States IPC Secretary/Treasurer
Bruce E. Strober, MD, PhD, is a Clinical Professor at Yale University, Department of Dermatology. He received his medical and graduate degrees from Columbia University College of Physicians and Surgeons in New York, NY, and completed his postgraduate training in dermatology at New York University in New York, NY. Dr. Strober is board certified by the American Board of Dermatology, a fellow of the American Academy of Dermatology, and a past member of the medical board of the National Psoriasis Foundation. He is the Co-Scientific Director of the Corrona Psoriasis Registry and Editor-in-Chief of the Journal of Psoriasis and Psoriatic Arthritis. Dr. Strober has authored numerous journal articles and book chapters. He has also spoken extensively to both physician and patient audiences in the field of dermatology.
Last Updated: Sep 21, 2020
Lone Skov, MD, PhD University of Copenhagen Hellerup, Denmark
Lone Skov is a Consultant Dermatologist in the Department of Dermato-Allergology, Gentofte Hospital Faculty of Health Sciences, at the University of Copenhagen, Denmark. She received her medical degree from the University of Copenhagen's medical school and completed her PhD thesis at the same university. Her specialty is dermatovenereology. In addition to her current positions, her distinguished career includes serving as daily leader of the outpatient clinic at Gentofte Hospital's Department of Dermatology and Venereology. She led the effort to organize theoretical education in dermatology in Denmark and has served as head of the hospital's Department of Dermatology and Venereology. She has served as a teacher and lecturer in dermatology and venereology, published 88 papers in peer-reviewed journals and three book chapters and has served as a reviewer for a number of scientific and medical journals.
Last Updated: Jan 26, 2018
Matthias Augustin, Germany Andy Blauvelt, USA Cristina Echeverria, Argentina Marcus Schmitt Egenolf, Sweden Peter van de Kerkhof, Netherlands, IPC CMO Christy Langan, USA, IPC CEO Staff liaison: Tina Burke, USA
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. Link to PubMed>