From the Guidelines
The 11% BSA in the patient's record indicates that psoriasis covers approximately 11% of the patient's total skin surface, categorizing it as moderate-to-severe disease, which necessitates aggressive treatment approaches like Skyrizi due to its significant impact on the patient's quality of life, particularly with involvement of highly visible areas such as the face and scalp. This measurement is a standard way to quantify the extent of psoriasis involvement and helps determine disease severity, as outlined in the joint AAD-NPF guidelines of care for the management and treatment of psoriasis 1. According to these guidelines, psoriasis affecting more than 10% BSA is considered severe disease, which aligns with the decision to prescribe Skyrizi, a biologic medication typically used for moderate-to-severe psoriasis. Key points to consider include:
- The total body surface area (BSA) involved is a critical factor in determining psoriasis severity, with less than 3% BSA considered mild, 3% to 10% BSA considered moderate, and greater than 10% considered severe disease 1.
- The location of psoriasis plaques, such as the face and scalp, can significantly impact the patient's quality of life and may warrant more aggressive treatment approaches, regardless of the overall percentage of affected skin 1.
- The Psoriasis Area Severity Index (PASI) is a more specific means of quantifying the extent and severity of psoriasis, taking into account not only BSA but also the intensity of redness, scaling, and plaque thickness, but it is rarely used in clinical practice to guide management 1.
From the FDA Drug Label
Overall, subjects had a median baseline PASI score of 17. 8 and a median BSA of 20%. The 11% refers to the Body Surface Area (BSA) involvement of the patient's psoriasis, meaning that 11% of the patient's body surface area is affected by psoriasis. 2
From the Research
Psoriasis and Body Surface Area (BSA)
- The 11% in the given statement refers to the percentage of Body Surface Area (BSA) affected by psoriasis in the patient 3.
- BSA is a measure used to assess the extent of skin involvement in patients with psoriasis.
- In clinical trials, BSA is often used as a primary endpoint to evaluate the efficacy of treatments for psoriasis, with higher percentages indicating more severe disease.
Assessment of Psoriasis Severity
- The Psoriasis Area and Severity Index (PASI) score is a commonly used measure to assess the severity of psoriasis, taking into account the extent of skin involvement, as well as the severity of erythema, induration, and scaling 3.
- A PASI score of 75 (PASI 75) or higher indicates a significant improvement in psoriasis symptoms, while a score of 100 (PASI 100) indicates complete skin clearance.
Treatment Options for Psoriasis
- Various treatment options are available for psoriasis, including topical agents, biologics, and oral therapies 4, 5, 6, 7.
- The choice of treatment depends on the severity of the disease, patient preferences, comorbidities, and cost.
- Biologics, such as interleukin (IL)-17 inhibitors, have been shown to be effective in achieving significant improvements in psoriasis symptoms, including complete skin clearance 3, 6.