From the Guidelines
Screening for psoriasis involves a thorough physical examination and medical history, focusing on characteristic signs such as red, raised patches covered with silvery scales, typically on the elbows, knees, scalp, and lower back, as recommended by the joint AAD-NPF guidelines of care for the management and treatment of psoriasis 1. To screen for psoriasis, healthcare providers should:
- Conduct a thorough physical examination to identify characteristic signs of psoriasis, such as red, raised patches covered with silvery scales
- Take a detailed medical history, asking about symptoms like itching, burning, or pain, as well as family history of psoriasis since it has a genetic component
- Use the Psoriasis Area and Severity Index (PASI) to assess the extent and severity of the condition, although it is rarely used in clinical practice due to its time-consuming nature and limited additional information provided 1
- Be aware of the potential for psoriatic arthritis (PsA) and use screening tools such as the CASPAR criteria to identify patients at risk 1
- Refer patients suspected of having PsA to a rheumatologist for confirmation of diagnosis and treatment, and monitor patients with PsA for risk factors for cardiovascular disease and cancer 1 The goal of screening is to identify psoriasis early, as it is associated with other health conditions, including cardiovascular disease, diabetes, and depression, and treatment options range from topical corticosteroids and vitamin D analogs to systemic medications and biologics, depending on severity.
From the Research
Screening for Psoriasis
To screen for psoriasis, several factors need to be considered, including:
- A detailed patient history and lifestyle assessment, as psoriasis is a complex and heterogeneous disease resulting from interactions between genetic, immunological, and environmental factors 2
- A clinical evaluation, as the diagnosis of psoriasis is primarily clinical and a skin biopsy is seldom required 3
- Assessment of the severity of the disease, as this will determine the appropriate treatment approach 3
Assessment of Psoriasis Severity
The severity of psoriasis can be assessed by considering the following factors:
- The extent of skin involvement and the presence of any comorbidities, such as psoriatic arthritis, cardiovascular disease, or malignancy 4, 3
- The impact of the disease on the patient's quality of life, including social functioning and interpersonal relationships 4, 3
- The patient's treatment history and response to previous therapies 5, 2
Treatment Approaches
Treatment approaches for psoriasis depend on the severity of the disease and may include:
- Topical therapies, such as corticosteroids, vitamin D3 analogues, and combination products, for mild to moderate disease 6, 5, 3
- Systemic therapies, such as biologics or oral medications, for more severe and refractory cases 4, 3
- Light therapy, such as narrowband UV-B phototherapy, as an alternative treatment option 4