How is the severity of psoriasis determined, and which specialist consultations may be indicated in the treatment of psoriasis?

Updated: Mar 17, 2021
  • Author: Jacquiline Habashy, DO, MSc; Chief Editor: William D James, MD  more...
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Answer

Psoriasis is a chronic problem, and consultation for follow-up with a dermatologist or a rheumatologist is appropriate. Close follow-up is necessary to design an optimal treatment plan in accordance with the severity of disease.

Severity of psoriasis can be classified as follows:

  • Mild - Less than 2% of the body is affected

  • Moderate - From 3-10% of the body is affected

  • Severe - More than 10% of the body is affected

Of note, the palm of the patient’s hand is equal to 1% body surface area.

Determining the severity of psoriasis requires combining objective measures, such as body surface area involvement; disease location; symptoms; and presence of psoriatic arthritis with subjective measures such as the physical, financial, and emotional impact of the disease.

Patients with infectious diseases and psoriasis may be using drugs that modify immunologic response and render them immunocompromised. Investigation into the type of therapy is important and, if such an agent is identified, referral and close follow-up is needed.

Many suggest that because of the comorbidities of heart disease and cardiovascular disease that if adult patients have not been recently evaluated and screened for these, they should either be tested or referred back to their primary care provider to consider what is appropriate for any particular patient.

Patients with psoriasis, especially widespread and severe, have a higher incidence of depression, which may require medical intervention. If this cannot be managed by their primary care provider, referral to a mental health specialist might be appropriate.

Autoimmune diseases are generally associated with increased rates of lymphoma and myelodysplastic disease. Whether this is related to the disease itself or to its treatment is not yet determined. Patients who have laboratory abnormalities or physical findings of hematologic disease or malignancy should be evaluated by a hematologist and/or oncologist as appropriate. [51]


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