The International Psoriasis Council recently announced a new system for classifying psoriasis. Currently, doctors classify cases of the skin condition based on severity, which can be subjective. The IPC Psoriasis Severity Reclassification Project recommends a more consistent and standardized approach, classifying cases of psoriasis based on the type of treatment they warrant: topical or systemic.
Under the IPC’s proposed classification, people with psoriasis affecting more than 10 percent of their body surface area (BSA) would qualify for systemic treatments, which include biologics and oral treatments. People who have not had success with topical therapies — such as corticosteroid cream — would also qualify for systemic treatments. Additionally, those whose psoriasis affects certain special areas of high impact — including the scalp, genitals, nails, palms, or soles of the feet — would also qualify as candidates.
“Traditionally, psoriasis severity has been categorized into mild, moderate, and severe categories,” said project chair Dr. Bruce Strober in a statement to Dermatology Times. The Psoriasis Area and Severity Index (PASI), for instance, takes into account the severity of symptoms such as erythema (skin discoloration), induration (hardening of the skin), and scaling. The PASI is just one of several tools used to assess a person’s psoriasis, and there is currently no universal consensus on their implementation. “These categories are not of significant benefit to clinicians,” Dr. Strober continued, “because they’re defined differently by different entities and organizations.”
The classification of a person’s psoriasis can impact many facets of their treatment and quality of life — including whether they qualify to participate in clinical trials and the type of treatment their insurance will cover. American insurance companies, for instance, commonly require that more than 10 percent of a person’s BSA be affected by psoriasis before authorizing systemic medications. Moreover, as Dr. Strober noted, insurance companies in the United States and other countries do not accept patient-reported outcomes to justify the use of systemic therapies.
The IPC seeks to address the disparities between existing clinical assessments and the people’s real-life experiences with psoriasis with its comprehensive system. Advocates of the revised classification system hope it will broaden access to systemic therapies to those who could benefit from them.