Interview with Dr. AMODE: "The management of psoriasis."

Question No. 1: "How is psoriasis diagnosed?"

The diagnosis of psoriasis is clinical. No further diagnostic tests are required.

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Question No. 2: "How is the severity of psoriasis measured?"

"Beyond the patient interview, in which the impact of psoriasis on the patient's life and its psychological repercussions is assessed, several severity scales are used:

the affected skin surface area;
the DLQI (Dermatology Life Quality Index) which objectively assesses the dermatological impact on quality of life;
The PASI (Psoriasis Area and Severity Index) which is an internationally used composite score to objectively quantify disease severity."

Question No. 3: "How is the treatment choice made? On what basis does the physician make their prescription?"

The choice is based on severity, the type of lesion (guttate psoriasis, plaque psoriasis, inverse psoriasis, infantile psoriasis, etc.), patient age, any potential pregnancy plans, the patient’s medical history, possible drug interactions if the patient is already on treatment, the formulation acceptable to the patient (spray, cream, gel, etc.), and the need for systemic therapy.

In practice, a score > 10 on any of the common scales warrants considering systemic therapy—that is, skin surface involvement exceeding 10%, and/or a DLQI above 10, and/or a PASI above 10. However, initiating such treatment is not automatic. It is a collaborative decision."

The treatment will depend on the severity of the condition and how it manifests. Treatment options include steroidal anti-inflammatory creams, medications, as well as phototherapy which is a light-based treatment.

Question No. 4: "If psoriasis is left untreated, what are the consequences?"

"Skin lesions, which can be highly visible, may have a psychological impact on the patient and social consequences. Rare psoriatic erythrodermas (inflammation affecting 90% of the skin surface) expose patients to the risk of dehydration and infection, with potentially life-threatening outcomes. Mild-to-moderate psoriasis may not be treated if the patient does not request it."

Question No. 5: "How is psoriasis treated in a pregnant woman and in a child?"

There are medications contraindicated in pregnant women and women of childbearing age. These include acitretin, a retinoid that contraindicates pregnancy for two years after treatment discontinuation. The cyclosporine and the methotrexate are contraindicated during pregnancy. However, some topical treatments (topical corticosteroids, vitamin D3, etc.) are permitted during pregnancy.

Phototherapy may be considered during pregnancy depending on individual factors (skin phototype, skin cancer risk factors, melasma). It should be emphasized that phototherapy is a medical treatment that must be prescribed and administered by a dermatologist.

Question No. 6: "Which medications can trigger a psoriasis flare-up?"

"The drugs known to potentially trigger or worsen psoriasis are primarily beta-blockers, angiotensin-converting enzyme inhibitors (ACE inhibitors), and lithium, and less commonly nonsteroidal anti-inflammatory drugs. This list is not exhaustive. Therefore, it is essential to remain vigilant and report any suspected triggering event."

Question No. 7: "Do antidepressants have a positive impact on psoriasis?"

"Antidepressants are not treatments for psoriasis. However, patient care is holistic and collaborative, meaning that multiple specialists as well as the primary care physician are involved. Consequently, treating depression in a patient with psoriasis appears fundamental and may necessitate the use of an antidepressant."