Mild, moderate or severe?
How can my psoriasis be assessed in terms of severity?
In order to objectively assess the severity of psoriasis, doctors primarily use morphological criteria such as the Psoriasis Area and Severity Index (PASI). This tool allows the extent of lesions to be assessed as well as the degree of erythema and scale. A high score corresponds to an assessment of “severe psoriasis”. "
This scoring system has the advantage of being reproducible, but it gives no indication of the objective or subjective severity of the condition," says Professor Grob.
Many specialists believe that numerous factors contribute to the severity of psoriasis, such as its impact on quality of life and resistance to treatment, and not just morphological criteria and the extent of lesions.
Essentially, the severity of psoriasis relates to how well a patient copes with the condition. The notion of perceived stress is key as psoriasis affects patients very differently. For example, two people who have similar lesions as regards extent and location may cope with their condition differently, with the first believing she has a "serious" skin condition, and the second considering his condition "mild".
Extensive psoriasis can sometimes have a lower impact on quality of life than very localised lesions. For example, lesions on the palms and soles of the feet can lead to significant functional handicap.
Profound psychological stress can result from facial or genital involvement.
This does not mean that the extent of lesions does not have a psychological impact. Certain studies have found that patients experiencing lesions on more than 30% of the surface of their skin would be ready to sacrifice a quarter of their life expectancy to live without psoriasis.
It is therefore clear that the notion of severity cannot be reduced to a single dimension, and although the extent and topography of lesions are important, the crucial factor remains how patients deal with psoriasis within their own cultural and professional environment.
It is essential to assess the impact of psoriasis on quality of life as the risks and benefits of any medication must be weighed according to its impact on patient quality of life.
As with any condition that affects quality of life, psoriasis should be treated in a holistic manner, with the patient, not the condition, as the focus.