Dermatol Ther (Heidelb). 2026 Nov 12. doi: 10.1007/s13555-026-01933-5. Online ahead of print.
ABSTRACT
INTRODUCTION: Plaque psoriasis is a chronic, immune-mediated skin disorder with significant physical and psychosocial burden. Although classification of disease severity guides treatment decisions in clinical guidelines, the absence of a standardized "moderate" psoriasis definition complicates management.
METHODS: A targeted literature review was conducted using a prespecified protocol, searching MEDLINE, Embase, clinical trial registries, and guideline repositories for English-language studies and guidelines (2014-2024) that defined "moderate" plaque psoriasis in adults, using objective measures. Eligible records underwent screening, independent data extraction, and quality assessment.
RESULTS: Of 341 full-text records screened, 102 publications (97 unique studies) were included; most were observational studies with a wide geographic distribution. Definitions of "moderate" psoriasis varied widely. The most used tools were the Psoriasis Area and Severity Index (PASI), body surface area (BSA), and the Physician Global Assessment (PGA), with typical thresholds of PASI 10-20, BSA 3-10%, and PGA score 3. Some studies and guidelines employed composite definitions combining BSA, PASI, and/or quality-of-life measures. Very few guidelines defined "moderate" psoriasis as a standalone category, instead including it in a "moderate-to-severe" category. Patient-reported outcomes were rarely included.
CONCLUSIONS: No universal "moderate" psoriasis definition was identified. This review supports adoption of the International Psoriasis Council's dichotomous, pragmatic, treatment-focused definition, which considers BSA, special area involvement, and response to topical therapy to identify candidates for systemic versus topical treatment, informing patient management and ensuring appropriate access to systemic therapies. Incorporating patient perspectives and quality-of-life impact into disease classification is also essential to improving outcomes.
PMID:43018917 | DOI:10.1007/s13555-026-01933-5