Interview with Dr. AMODE: "Managing Psoriasis."

The diagnosis of psoriasis is made clinically. No additional tests are required.

"Beyond the patient interview, in which we assess the impact of psoriasis on a patient's life and psychological well-being, several severity scales are used:

• the affected cutaneous surface area;

• the DLQI (Dermatology Life Quality Index) which objectively assesses dermatological impact on quality of life;

• the PASI (Psoriasis Area and Severity Index) is a composite score internationally used to objectively assess the severity of involvement.

The choice is made based on severity, lesion type (guttate psoriasis, plaque psoriasis, inverse psoriasis, infantile psoriasis, etc.), patient age, potential pregnancy plans, medical history, possible drug interactions if the patient is already receiving treatments, the dosage form acceptable to the patient (spray, cream, gel, etc.), and the need for systemic therapy.

In practice, a score above 10 on any of the standard scales is considered sufficient to warrant considering systemic treatment—that is, an affected body surface area exceeding 10%, and/or a DLQI above 10, and/or a PASI above 10. The initiation of such treatment is not, however, automatic; it is a decision made jointly."

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

"Cutaneous lesions, which can be quite conspicuous, may have a psychological impact on the patient and social consequences. Rare psoriatic erythrodermas (inflammation affecting 90% of the skin surface) pose risks of dehydration and infection, with potentially life-threatening implications. Mild to moderate psoriasis may not be treated if the patient does not request treatment."

Some medications are contraindicated in pregnant women and women of childbearing potential. One example is acitretin, a retinoid that requires avoiding pregnancy for two years after discontinuing therapy. The cyclosporine and methotrexate are contraindicated during pregnancy. However, certain topical treatments (topical corticosteroids, vitamin D3, etc.) are permitted during pregnancy.

Phototherapy can be considered during pregnancy depending on the patient’s profile (skin phototype, risk factors for skin cancers, melasma). It should be emphasized that phototherapy is a medical treatment that must be prescribed and administered by a dermatologist."

"Drugs known to potentially trigger or worsen psoriasis include primarily beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and lithium, and less commonly nonsteroidal anti-inflammatory drugs. The list is not exhaustive. Therefore, vigilance is required, and any suspected triggering event should be reported."

"Antidepressants are not therapies for psoriasis. However, patient care is holistic and collaborative, meaning that multiple specialists as well as the primary care physician are involved. The treatment of depression in a patient with psoriasis is therefore fundamental and may require the use of antidepressant medication."