Identifying and Managing Patients with Moderate Psoriasis

In this episode, "Identifying and Managing Patients with Moderate Psoriasis," the expert dermatologists explore the challenges of classifying psoriasis severity and the practical framework for identifying which patients are candidates for systemic therapy.

Dr. Stein Gold opens by highlighting the confusion surrounding severity classification, noting that BSA and Investigator's Global Assessment can yield very different conclusions for the same patient. By BSA, moderate psoriasis is defined as 3 to 10% body surface area involvement, yet clinical trials typically require at least 10% BSA for inclusion. She points out that the International Psoriasis Council guidelines recognize that many moderate patients fall below that threshold.

Dr. Crowley elaborates on this gap, citing clinical trial data showing that patients with mild to moderate disease still report quality of life scores comparable to those seen in phase three trials involving patients with much higher BSA. Dr. Stein Gold further reinforces this point by referencing a study using risankizumab, demonstrating that even when BSA is reduced significantly in moderate patients, the DLQI score barely moves, underscoring that visible disease in any amount continues to affect patients meaningfully.

Dr. Song adds that high impact areas carry a quality of life burden disproportionate to their BSA, and supports aligning with the NPF and IPC recommendations to reframe mild versus moderate and severe around treatment approach rather than BSA thresholds, with mild corresponding to topical-managed patients and moderate to severe corresponding to systemic candidates.

Dr. Crowley offers a practical clinical lens, suggesting the key question is simply whether a patient can adequately control their disease with topicals. If not, they are a systemic therapy candidate regardless of BSA. Dr. Song builds on this by referencing newly published IPC guidelines defining topical failure as two consecutive four-week treatment courses without reaching the treatment goal, providing clinicians and payers a clearer, more actionable standard for escalating care.

The next episode in this series, "Redefining Treatment Success in Psoriasis," features the panelists advancing their conversation on psoriasis and focusing on the evolution of treatment goals toward complete skin clearance, the role of NPF treat-to-target guidelines in combating treatment inertia, and practical strategies for determining when to optimize, modify, or switch therapy based on individual patient response and disease location.