Psoriasis Management Challenges Regarding Difficult-to-Treat Areas: Therapeutic Decision and Effectiveness
Alin Codrut Nicolescu,
Marius-Anton Ionescu,
Maria Magdalena Constantin,
Ioan Ancuta,
Sinziana Ionescu,
Elena Niculet,
Alin Laurentiu Tatu,
Henner Zirpel,
Diamant Thaçi
Affiliations
Alin Codrut Nicolescu
Medical Center “Roma” for Diagnosis and Treatment, 011773 Bucharest, Romania
Marius-Anton Ionescu
Dermatology Department, University Hospital “Saint Louis”, University of Paris, 75014 Paris, France
Maria Magdalena Constantin
Department of Dermatology II, “Carol Davila” University of Medicine and Pharmacy, Colentina Clinical Hospital, 020125 Bucharest, Romania
Ioan Ancuta
Department of Rheumatology, “Carol Davila” University of Medicine and Pharmacy, “Dr. I. Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania
Sinziana Ionescu
General Surgery and Surgical Oncology Clinic I of the Bucharest Oncology Institute, “Carol Davila” University of Medicine and Pharmacy, 022328 Bucharest, Romania
Elena Niculet
Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
Alin Laurentiu Tatu
Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
Henner Zirpel
Research Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
Diamant Thaçi
Comprehensive Center for Inflammation Medicine, University of Lübeck, 23538 Lübeck, Germany
Psoriasis is not optimally controlled in spite of newly developed treatments, possibly due to the difficulty of objectively quantifying the disease’s severity, considering the limitations of the clinical scores used in clinical practice. A major challenge addresses difficult-to-treat areas, especially in the absence of significant body surface involvement. It is controversial whether the severity evaluation of patients with several affected areas (having at least one difficult-to-treat area) should be done differently from current methods. Scores used for special areas (PSSI, NAPSI and ESIF) allow an accurate assessment of disease severity in difficult-to-treat areas, but the issue of whether to integrate these scores into PASI, BSA or DLQI remains. The review’s purpose resides in providing an overview of the main current issues in determining psoriasis severity in patients with psoriasis in difficult-to-treat areas and suggesting possible solutions for the optimal integration of the area assessment in current scores: severity can be either established according to the highest calculated score (PASI or PSSI or NAPSI or ESIF) or by adding a correction factor in the calculation of PASI for special areas.
