A committee of top dermatologists suggest a need for a simple, practical approach to classifying psoriasis disease severity, according to the results of a recent Delphi exercise conducted by the International Psoriasis Council.
“Commonly, patient reported severity is misaligned with physician reported severity. Severity measures used in routine practice often under-classify psoriasis severity, resulting in undertreatment," Bruce Strober, MD, PhD, from Yale University School of Medicine and Central Connecticut Dermatology, and colleagues wrote in the study. "Furthermore, there is no consensus regarding the definition for patients affected by lower levels of BSA involvement who, nonetheless, have disease characteristics that may severely impact quality of life and disability."
Psoriasis skin. Source: Getty
The International Psoriasis Council (IPC), which represents psoriasis experts from 32 countries conducted a Delphi exercise to develop a consensus statement on the classification of psoriasis severity.
The Delphi process included a brainstorming stage, two rounds of voting and a consensus meeting.
A total of 78 anonymous statements reflecting views on psoriasis severity across geographic regions were collected and voted on in preferential order by 74 members of the IPC.
The most preferred statement from the members of the IPC rejected the mild, moderate, and severe categories and favored a dichotomous definition.
The preferred consensus is that patients with psoriasis should be classified as either candidates for topical therapy or candidates for systemic therapy. Patients who are categorized as candidates for systematic therapy must have BSA greater than 10%, disease involving special areas, or failure of topical therapy.
While the results of Delphi may be useful for guiding therapeutic decisions in clinical practice and changing enrollment criteria in future, psoriasis research, Strober and colleagues recognize that there were limitations in the study.
The results of the Delphi exercises are limited by those who choose to participate,” Strober and colleagues wrote. “While this effort was large and international, it may have suffered from a lack of representation by all relevant stakeholders, particularly community dermatologists who are not involved in academic research and, importantly, psoriasis patients.”