Psoriasis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesPsoriasisSCE Dermatology

A 55-year-old man has chronic plaque psoriasis affecting predominantly his scalp and palms. His PASI is only 4 but his DLQI is 16 due to the high-impact sites. Can he access biologic therapy despite a low PASI?

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Correct answer: E — Yes — BAD guidelines allow biologic access when PASI <10 if there is significant functional or psychological impact at high-impact sites (scalp, face, palms, soles, genitalia, nails)

BAD and NICE guidelines recognise that PASI may underestimate disease severity when high-impact sites (scalp, face, palms, soles, genitalia, nails) are predominantly affected, because these anatomically small areas contribute little to the overall PASI score but cause disproportionate functional and psychological impact. Biologic therapy can be accessed for patients with PASI <10 when there is significant disease at high-impact sites AND high DLQI (≥10), particularly when conventional systemic therapy has failed. This is an important exception to the standard PASI ≥10 eligibility criterion.

Reference: BAD 2020 Biologic Psoriasis Guidelines; NICE CG153