Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness
Abstract
:1. Introduction
2. Materials and Methods
3. Current Challenges in Disease Severity and Treatment Goals
3.1. Body Surface Area (BSA)
3.2. Physician‘s Global Assessment (PGA)
3.3. The Psoriasis Area and Severity Index (PASI)
3.4. The Investigator Global Assessment (IGA) Scale
3.5. The Dermatology Life Quality Index (DLQI)
3.6. The Psoriasis Scalp Severity Index (PSSI)
3.7. The Nail Psoriasis Severity Index (NAPSI)
3.8. The Erythema, Scaling, Induration, and Fissuring (ESIF)
4. The Challenges of Individualized Treatment and Evaluating the Treatment Success
5. Treatment Goals and Treat-to-Target
6. Treatment Success or Failure for Patients with Difficult-to-Treat Areas
7. Discussion
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Guideline | Moderate to Severe Psoriasis Treatment Aim Definitions | Treatment Response and/or Failure Definitions, with Changes in Those Suffering from Moderate to Severe Psoriasis |
---|---|---|
European guideline of systemic therapy | Any psoriasis treatment should aim at eliminating all symptoms of skin inflammation.Necessary: minimum improvement and particular drug analysis times. | Throughout the phases of induction and maintenance:
|
French guideline of systemic therapy | Factors when establishing treatment goals for systemic therapy:
| An adequate treatment response: PASI 75 (from the baseline), or PASI 50 with DLQI ≤ 5. |
British guideline of systemic therapy | Treatment choice according to the patient and other factors:
|
|
Spanish consensus of systemic therapy | The ideal outcome is to achieve: PASI 90 and a PGA ≤ 1, or as an alternative, a minimal, topical treatment controllable localized disease (PGA ≤ 2 and PASI < 5), DLQI ≤ 1, prolonged remissions without loss of efficacy, no worsening of comorbidities. Criteria for an appropriate response initially and in the long term (more than 6 months), 1 of: PASI 75, PASI < 5, PGA ≤ 1 and DLQI < 5. Criteria for the minimum efficacy required: PASI 50, PASI < 5. | Therapeutic failure during initiation of the treatment:
|
Difficult-to-Treat Areas | % of Patients with Mild Psoriasis | % of Patients with Moderate Psoriasis | % of Patients with Severe Psoriasis |
---|---|---|---|
scalp | 48.1% | 57.8% | 66.1% |
face | 27.6% | 41.8% | 53.3% |
palms | 13.5% | 22.9% | 19.5% |
nails | 25.6% | 31.1% | 42.4% |
genitals | 12.5% | 18.1% | 27.2% |
soles | 16.7% | 24.7% | 22.1% |
Main Area | Additional Areas | Severity Assessment |
---|---|---|
trunk BSA less than < 10% severity 4 for erythema, induration and scaling PASI = 3.6 | scalp >70% severity 4 for erythema, induration and scaling | PASI = 8 → PSO moderate or PSSI = 48 → PSO severe |
nails matrix and nail bed completely affected 10 nails | PASI = 6 → PSO moderate or NAPSI = 80 → PSO severe | |
palmo-plantar both hands or both soles severity 4 for erythema, induration, scaling, fissuring | PASI = 8 → PSO moderate or ESIF = 24 → PSO severe |
Severity Scores to Achieve | Quality of Life | |
---|---|---|
Treatment goals (assessed after 10–16 weeks and then every 8 weeks treatment goals | PASI 90 or PASI ≤ 2 PGA clear or almost clear | DLQI < 2 |
minimum efficacy (lowest hurdle for treatment modification) | PASI 50 | DLQI < 5 or DLQI improvement ≥ 5 |
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Nicolescu, A.C.; Ionescu, M.-A.; Constantin, M.M.; Ancuta, I.; Ionescu, S.; Niculet, E.; Tatu, A.L.; Zirpel, H.; Thaçi, D. Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness. Life 2022, 12, 2050. https://doi.org/10.3390/life12122050
Nicolescu AC, Ionescu M-A, Constantin MM, Ancuta I, Ionescu S, Niculet E, Tatu AL, Zirpel H, Thaçi D. Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness. Life. 2022; 12(12):2050. https://doi.org/10.3390/life12122050
Chicago/Turabian StyleNicolescu, Alin Codrut, Marius-Anton Ionescu, Maria Magdalena Constantin, Ioan Ancuta, Sinziana Ionescu, Elena Niculet, Alin Laurentiu Tatu, Henner Zirpel, and Diamant Thaçi. 2022. "Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness" Life 12, no. 12: 2050. https://doi.org/10.3390/life12122050