Psoriasis Clinical Classification

Morphological, Clinical & Life Style Classifications of Psoriasis

© Hanish Babu

Dec 22, 2008

Different systems of classification help the dermatologists to plan the most appropriate mode of management in psoriasis patients.

1. Morphological Classification of Psoriasis
   • Depending upon the appearance of skin lesions:
     • Guttate Psoriasis Rain drop like lesion, sudden onset, seen usually in children.
     • Plaque Psoriasis (Psoriasis Vulgaris) The common raised patch (plaque) variety
     • Inverse Psoriasis (Flexural Psoriasis) Involves the body folds like axilla, groin, below the breasts and in between the buttocks
2. Life Style Impact
   1. Mild
      • Disease does not alter the patient's quality of life.
      • Patients can minimize the impact of disease and may not require treatment.
      • Treatments have no known serious risks (eg, class 5 topical steroids).
      • Generally less than 5% of body surface area is involved with disease.
   2. Moderate
      • Disease does alter the patient's quality of life.
      • The patient expects therapy will improve quality of life.
      • Therapies used for moderate disease have minimal risks (i.e. although these therapies may be inconvenient,expensive, time-consuming, and less than totally effective,they are not recognized as having the potential for altering short- or long-term health).
      • Generally between 2% and 20% of body surface area is involved with disease.
   3. Severe
      • Disease alters the patient's quality of life.
      • Disease does not have a satisfactory response to treatments that have minimal risks.
      • Patients are willing to accept life-altering side effects to achieve less disease or no disease.
      • Generally more than 10% of body surface area is involved with disease.
      Other factors that may affect the severity classifications are:
      • Patient's attitude about disease
      • Location of disease (e.g. face, hands, fingernails, feet, genitals)
      • Symptoms (e.g. pain, tightness, bleeding, or severe itching)
      • Joint pains/Joint inflammation
3. Clinical Stage of Psoriasis
   1. Acute eruptive psoriasis: This is the guttate variety which erupts all over the body
   2. Chronic progressive psoriasis: The common plaque psoriasis, also known as psoriasis vulgaris
   3. Chronic stationary psoriasis: When the psoriasis lesions remain stationery without increasing in size and with a dull red colour and minimal scaling, this is a stationary stage. This stage usually precedes the regressive stage
   4. Chronic regressive psoriasis: With and even sometimes without treatment, psoriasis lesions gradually become thin, scaling reduces, the red color changes from dull red to violaceous and gradually fade. In those who have used steroids or ultraviolet radiation, a hypopigmented (whitish) ring known as Woronoff's ring may be seen surrounding the lesion.
4. Other classifications

Several other methods exist for measuring the severity of psoriasis. These scales are generally based on the following factors:

• The proportion of body surface area affected.
• Disease activity (degree of plaque redness, thickness and scaling)
• Response to previous therapies
• Impact of the disease on the person.

The Psoriasis Area Severity Index (PASI)is the most widely used measurement tool for psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease).

Next: Psoriasis Triggers.

Reference

Psoriasis, in Rook’s Textbook of Dermatology, 7th Edition, 2004

Chronic Stationary Psoriasis

Print Article

View All Articles

How to subscribe to feeds