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Scalp Psoriasis — SCE Dermatology MCQ

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ModerateInflammatory DermatosesScalp PsoriasisSCE Dermatology

A 55-year-old man with scalp psoriasis has failed topical therapy and NB-UVB (which is difficult to deliver to the scalp). His PSSI is 25 and his DLQI is 14. He has no body psoriasis. Can he access biologic therapy for predominantly scalp psoriasis?

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Correct answer: C — Yes — scalp is a high-impact site and biologics can be accessed when standard systemic therapy fails, even with predominantly scalp disease

The scalp is a designated high-impact site per BAD guidelines. Patients with predominantly scalp psoriasis (even with low PASI) who have high DLQI (≥10) and have failed conventional systemic therapy can access biologic therapy. NICE commissioning recognises that PASI may significantly underestimate disease severity in patients with predominant scalp, face, genital, palmoplantar, or nail psoriasis. The PSSI (Psoriasis Scalp Severity Index) and patient-reported scalp-specific quality of life measures support the case for biologic access. IL-17 inhibitors and IL-23 inhibitors have demonstrated high scalp-specific efficacy.

Reference: BAD 2020 Biologic Guidelines; NICE