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Giornale Italiano di Dermatologia e Venereologia 2004 October;139(5):429-38


language: English

Definitions and diagnosis of severe psoriasis: implications for treatment

Pezeshki S., Pearce D. J., Feldman S. R.

Center for Dermatology Research Wake Forest University School of Medicine Winston-Salem, NC, USA


Psoriasis is a chronic, immune mediated, genetic disease of unknown etiology which typically manifests in the skin although the joints are commonly involved. The impact of psoriasis on nearly all aspects of health-related quality of life underscores the importance comprehensive and effective care. With the resurgence of traditional agents and the addition of biologics there has arisen a need to apply and interpret certain definitions of psoriasis. Psoriasis can present as a spectrum of morphologic variants and severities; severe, or generalized, psoriasis is found in approximately 15% of all psoriasis patients and can pose unique challenges to patients and physicians. The varied manifestations of psoriasis create many treatment challenges, further complicated by patient factors including demographics and comorbidities. As a first step to treatment, advocacy groups play a key role in providing patient support and encouraging physician education efforts which will enhance the care of those suffering with psoriasis. The treatment options are manifold, and individualizing a treatment plan is a complex undertaking. Categorization schemes also help physicians and government regulatory agencies determine which treatments are appropriate for which patients. And with new, more costly treatments, categorization schemes are in growing use by insurers in the US. Definitions of the different categories of psoriasis differ between clinical practice and clinical research studies. Moreover, definitions of treatment outcomes obtained from clinical trials, and their relationship to parameters measured in clinical practice, must be critically evaluated. Despite the growth of psoriasis knowledge and the many new therapeutic options, interpreting efficacy of a treatment based on clinical trial data can be difficult. There is great promise for psoriasis treatment as there are many new and exciting treatment approaches under investigation. Physicians need to be aware of many aspects for psoriasis in order to best incorporate new approaches in the care of their patients.

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