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Effective diagnosis & management

Effective diagnosis and management of psoriasis

This chapter highlights the need for early and accurate diagnosis in psoriasis and discusses optimal management strategies

Hafsah Sazali MB BCh BAO, LRCPI&SI James Connolly Hospital, Dublin, Ireland Gillian Murphy MD FRCPI FRCP Edin Department of Dermatology, Beaumont Hospital, Dublin, Ireland

Having identified psoriasis as an immune-mediated disease and considered the impact of the disease, from both the patient and economic perspectives, the discussion now turns to its effective diagnosis and management.


Even though there are overviews or sets of recommendations for the treatment of psoriasis by the dermatology associations in respective countries, due to a lack of clear guidelines, decisions in the management of psoriasis are usually based on clinicians’ preferences or experience. The introduction of new treatment options, especially the biologics therapy, in the management of psoriasis has led to differences in clinical practice across Europe.1

The problem with lack of 8

evidence-based guidelines was addressed in The European S3-guidelines on the systemic treatment of psoriasis vulgaris.1 In the UK, the National Institute for Health and Care Excellence produced a clinical guideline and pathway for the assessment and management of psoriasis, aiming to improve the area of practice, with less variation where clear guidance was lacking.2

DLQI is a subjective assessment based on the patient’s opinion of his or her condition in terms of its symptoms, psychological impact and effects on daily activities.4

These scores are also used to

evaluate the patient’s response to treatment. A systematic review of the studies involving patients treated with biological therapies

Measuring psoriasis severity The most common methods used to measure disease severity are the Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA). The Dermatology Life Quality Index (DLQI) can be used to measure the impact of psoriasis on a patient’s quality of life. The PASI score is an objective assessment of the condition determined by the percentage of body surface area affected by psoriasis, and severity of the redness, thickness and scaling of the psoriasis on the head, arms, trunk and legs.3

shows that a reduction of PASI of at least 75% results in a significant improvement in the patient’s quality of life.5

When to refer to specialist care Referral to a dermatologist should be considered if: ● there is diagnostic uncertainty, ● extensive disease (more than 10% of body surface area),

● psoriasis that is not controlled with topical treatment used over a reasonable time (2–3 months),

● adverse reactions to topical treatment, or

● a patient whose DLQI score is six or above or if the condition is having a major effect on a patient physically, psychologically or socially or causing excessive time lost from work or school.2,6,7

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