Italian Dermatologists Propose Practical Criteria to Define Moderate Psoriasis

A panel of Italian dermatologists proposed practical criteria for defining moderate psoriasis, emphasizing the importance of combining objective severity measures with patient-reported outcomes to improve treatment selection and reduce undertreatment.

The panel conducted a comprehensive literature review of publications from 2016 through 2024, examining established psoriasis severity assessments, including the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), Dermatology Life Quality Index (DLQI), and Physician's Global Assessment (PGA).

The review also considered involvement of special anatomical areas and patient-reported symptoms, recognizing that traditional severity measures may not fully capture the clinical and psychosocial burden of psoriasis.

Despite variability across studies and the absence of universally accepted thresholds, the panel proposed defining moderate psoriasis using the following criteria:

•    BSA involvement of 5% to 10%
•    DLQI score of 5 to 10
•    PGA score of 3
•    Involvement of at least 2 special areas, including the scalp, face, genitals, nails, hands, or feet

The panel also identified distressing itch and psychosocial impact as important factors influencing patients' perceptions of disease severity.

According to the authors, “the clinical definition of moderate psoriasis is debated,” creating challenges for determining treatment eligibility and ensuring patients receive appropriate care.

To address these limitations, the panel proposed a composite PGA-based approach that integrates objective clinical assessments with patient-centered measures. This framework may help identify patients with moderate psoriasis who could benefit from systemic therapy despite not meeting traditional severity thresholds.

The authors emphasized that disease burden should be assessed beyond the extent of skin involvement, particularly when symptoms affect sensitive anatomical areas or substantially impair quality of life.

“This pragmatic approach may help bridge the gap between guidelines and real-world clinical practice,” the authors concluded.

Reference
Costanzo A, Bardazzi F, Burlando M, et al. Toward the definition of moderate psoriasis: an expert opinion. J Dermatolog Treat. 2026;37(1):2626219. doi:10.1080/09546634.2026.2626219