Transcript
Announcer:
This is DermConsult on ReachMD. On this episode, we’ll explore how to assess psoriasis severity beyond body surface area with Dr. Amylynne Frankel. She’s a board-certified dermatologist at Advanced Dermatology and Cosmetic Surgery in Spartanburg, South Carolina. Here’s Dr. Frankel now.
Dr. Frankel:
The first thing, when you have a patient who's in front of you who has psoriasis—whether it's biopsy-proven or just slap-you-in-the-face psoriasis—is to see how much body surface area they have, because that's the first way we determine how severe it is. So typically, if you have up to three percent, it's mild disease. If you have up to 10 percent, they consider that moderate, and then anything above 10 percent is usually considered severe.
However, in the last decade or so, we've been coming up with more ways than just body surface area to determine severity of disease, and that includes quality-of-life issues and where the psoriasis is located. So, in addition to how much disease they actually have in their body, it's important to ask them how the disease is affecting them, what therapies they may or may not have tried already in the past, and what have they heard about. It really matters—is it on their genitals, and is it affecting the quality of their life, dating, and marriage? Is it on their face? Can they not put their best face forward? Things like that.
Additionally, if people have disease in their scalp, it's harder to get topicals in there, and there's a higher risk of joint disease, so it's important as a dermatologist to ask patients about their joints. Do they have morning stiffness? That's not going to be treated with a topical medicine, and then you're going to direct your therapy more towards a systemic medication that might also help their joints.
So it’s really important to not just take into account what you see, but take into account how the patient's feeling, what they've tried in the past, what their goals are, and if their joints are involved.
I have patients who have 80 percent of their body surface area affected and they don't really care, and then I have patients who have one percent of their body surface area, but it happens to be on their face or their genitals, and that really matters and can affect their quality of life. So I think just ask the patients and have open and honest dialogues with them. That patient-doctor relationship is really important. If they don't trust you, you're not going to be able to help them.
Announcer:
That was Dr. Amylynne Frankel sharing her insights on evaluating psoriasis severity. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
