Recategorization of Psoriasis Severity
OVERVIEW OF PSORIASIS SEVERITY
Disease severity criteria can significantly impact a psoriasis patient’s eligibility for treatment. While their disease may profoundly affect their quality of life, the current clinical definition of psoriasis severity is narrow. It does not account for the many potential challenges the disease may cause in a patient’s life.
In 2019, IPC began its disease severity reclassification project to redefine the criteria used for assessing disease severity that would better guide clinical decision-making to be more meaningful, practical, and better aligned with the actual severity of a patient’s disease.
This project seeks to challenge using the standard definitions of “mild, moderate, and severe” to determine treatment pathways. Through a robust Delphi process, IPC’s network of experts developed a consensus statement that redefines the criteria for patients who are candidates for systemic therapy. The statement is as follows:
Patients that meet one or more of the following criteria are candidates for systemic therapy:
- Psoriasis lesions on 10% or more of body surface; OR
- Psoriasis lesions on high-impact sites (i.e., hands/feet, face, genitals, scalp); OR
- Topical therapy failed to control symptoms: inability to achieve clear/nearly clear skin (BSA ≤1%, PGA 0 or 1) after two consecutive 4-week topical therapy courses, per guidelines. Strong consideration should be given when a patient self-reports moderate or severe psoriasis, despite a provider’s mild assessment, and experiences significant physical, psychological, or social impact.
Fast Facts
- Typically, patients must have a PASI of 10 or 12 to be eligible for systemic treatments.
- Despite this, patients with a PASI or BSA score below ten can experience significant impairment in their quality of life.
Reclassification allows for more specific clinical severity criteria that guide clinical decision-making to be more practical, meaningful, and better aligned with the severity of a patient’s disease.
Latest Publications
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IPC Resources
PUBLICATIONS AND RESEARCH
Understanding IPC’s Psoriasis Severity Reclassification – Available in 8 Languages
Establishing Consensus on Defining Failure of Topical Therapy in Psoriasis: Recommendations from the International Psoriasis Council
The IPC Disease Severity Reclassification in Clinical Practice
When Topicals Fail: The New IPC Consensus Every Clinician Should Know
Understanding IPC’s Psoriasis Severity Reclassification – Available in 8 Languages
Establishing Consensus on Defining Failure of Topical Therapy in Psoriasis: Recommendations from the International Psoriasis Council
The IPC Disease Severity Reclassification in Clinical Practice
IPC Psoriasis Disease Severity Reclassification: Update on Validity, Acceptance, and Implementation
Recategorization of Psoriasis Severity: A Global Consensus
Investigation of the Applicability of Adult Definitions of Disease Severity for Psoriasis in a Pediatric Cohort: A Prospective Registry Study
Investigation of the Applicability of Adult Definitions of Disease Severity for Psoriasis in a Pediatric Cohort: A Prospective Registry Study
Psoriasis Involving Special Areas is Associated with Worse Quality of Life, Depression, and Limitations in the Ability to Participate in Social Roles and Activities
Psoriasis Severity: Commonly Used Clinical Thresholds May Not Adequately Convey Patient Impact
Recategorization of Psoriasis Severity: Delphi Consensus from the International Psoriasis Council
Additional Resources
Below are resources from other organizations that support IPC’s recategorization of psoriasis severity.
PUBLICATIONS AND RESEARCH
How Rethinking Classification of Psoriasis Severity Can Help Patients Find Their Effective Therapies Sooner. The Dermatologist, HMP Global Learning Network, February 19, 2026.
This article discusses the IPC’s updated psoriasis severity framework and consensus on defining topical therapy failure, emphasizing earlier identification of patients who may benefit from systemic therapy and more proactive psoriasis management.
IPC Brings Clarity to Topical Therapy Failure. Hebebrand M. Dermatology Times. October 7, 2025.
This article highlights the IPC’s consensus on defining topical therapy failure and its role in guiding timely escalation to systemic treatment. It reinforces the adoption of IPC’s reclassification of psoriasis disease severity, distinguishing candidates for topical versus systemic therapy to improve patient outcomes.
Latin American Consensus on Psoriasis Severity Classification. Londoño García AM, Castro-Ayarza JR, Franco MD, et al. Anais Brasileiros de Dermatologia. 2025, ISSN 0365-0596, https://doi.org/10.1016/j.abd.2024.09.010
This expert consensus, developed by Latin American dermatologists using a modified Delphi method, presents 15 statements addressing severity definitions, assessment tools, and practical considerations tailored to the region’s medical context. Based on the International Psoriasis Council’s global reclassification framework, the publication reflects IPC’s growing impact on the standardization of psoriasis severity assessment worldwide.
Criteria for Identifying Candidates for Systemic Psoriasis Treatment in the Real World: Application of the International Psoriasis Council Guidelines in Patients in North America. Strober B, Zhong Y, Sima A, et al. Journal of Psoriasis and Psoriatic Arthritis. 2025;10(1):22-27. doi:10.1177/24755303241302070
This real-world study evaluated the candidacy of psoriasis patients for systemic therapy based on IPC severity criteria. Among 2,739 patients initiating systemic treatment, 82.7% met IPC guidelines, with many having BSA >10%, psoriasis in special areas, or prior topical therapy use. The findings suggest that relying solely on PASI scores and BSA may not fully capture all patients who could benefit from systemic treatment.
Korean Society for Psoriasis Proposes New Severity Criteria to Include Special Areas. Kim J. Korean Biomed Rev. Published October 30, 2024. Accessed November 1, 2024.
The Korean Society for Psoriasis has adopted IPC’s updated approach to recategorizing psoriasis severity to better reflect the disease’s impact on patients. These guidelines incorporate high-impact areas, such as the face, hands, feet, and genitals, to improve treatment eligibility and provide more comprehensive care for individuals affected by psoriasis.
Expert Consensus on Systemic Therapy for Plaque Psoriasis with Limited Skin Involvement in JAPAN: Results from a DELPHI Study. Morita A, Okubo Y, Imafuku S, et al. J Dermatol. 2025 Jan;52(1):56-66. doi: 10.1111/1346-8138.17444. Epub 2024 Sep 4. PMID: 39229687.
A Delphi study involving 45 Japanese dermatology experts established consensus criteria for initiating systemic therapy in patients with plaque psoriasis affecting less than 10% of body surface area. Key indicators include involvement of special or difficult-to-treat areas, significant psychological distress, uncontrolled symptoms impacting social life, presence of psoriatic arthritis, and failure of topical treatments. The panel outlines criteria for identifying psoriasis patients with limited skin involvement who may benefit from systemic therapy and defines topical therapy ‘failure’ to guide treatment decisions.
Australian Consensus: Treatment Goals for Moderate to Severe Psoriasis in the Era of Targeted Therapies – Adult Patients. Foley, P, Gebauer, K, Sullivan, J, et al. Australas J Dermatol. 2023; 00: 1–12. https://doi.org/10.1111/ajd.14138.
A study was conducted to update treatment goals for moderate to severe psoriasis. A modified Delphi approach was used, involving a comprehensive literature review and guideline evaluation. Consensus was reached on expanding the classification of psoriasis severity, incorporating quality of life measures, and widening the scope of high-impact sites. The study aimed to address challenges to timely and equitable access to targeted therapy, aligning with international recommendations and aiming to improve treatment outcomes and patient satisfaction.
Impact of Psoriatic Disease on Quality of Life: Interim Results of a Global Survey. April Armstrong 1, Barbra Bohannan 2, Sicily Mburu 3, Ivette Alarcon 4, Torben Kasparek 4, Jihen Toumi 5, Susan Frade 4, Silvia Fernandez Barrio 6, Matthias Augustin 7 Dermatol Ther (Heidelb). 2022 Apr;12(4):1055-1064. doi: 10.1007/s13555-022-00695-0.Epub 2022 Mar 14.
The IPC disease severity recategorization is not a data-driven but a practice-driven categorization. To a large extent, psoriasis is a systemic disease that requires dermatologists to look more than skin deep. As systemic treatment for psoriasis may be indicated in patients with mild skin involvement suffering from systemic comorbidity, the holistic approach in the IPC definition is crucial.
Evolution of Patient Perceptions of Psoriatic Disease: Results from the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) Survey. Lebwohl M, Langley RG, Paul C, Puíg L, Reich K, van de Kerkhof P, Wu HL, Richter S, Jardon S, Gisondi P.Dermatol Ther (Heidelb). 2022 Jan;12(1):61-78. doi: 10.1007/s13555-021-00635-4. Epub 2021 Oct 25.PMID: 34704231
The proportion of patients with at least a moderate effect of psoriasis on quality of life was greater among patients with involvement in at least one special area versus no special area involvement. In this international population study, the impact of the various special areas on quality of life is reported.
Reassessing Psoriasis Severity
The National Psoriasis Foundation (NPF) addresses limitations in traditional psoriasis severity classifications, emphasizing the significance of “high impact sites” on patients’ lives. The NPF, along with the IPC, advocates for revised treatment criteria. Learn more about redefining psoriasis severity and treatment standards in the full article.
Re-Classification of Psoriasis Severity: Perspectives and Controversy. Danielle Yee, April W Armstrong. J Psoriasis Psoriatic Arthritis. 2022 Jan 18;7(1):7–8. doi: 10.1177/24755303211071033
The IPC psoriasis severity classification redefines disease severity by distinguishing candidates for topical versus systemic therapies. Unlike traditional methods relying solely on BSA, PASI, or PGA scores, the IPC classification considers special area involvement, quality of life impact, and topical treatment failure, addressing gaps in prior severity assessments. This approach not only enhances treatment selection and reduces undertreatment but also has implications for clinical trial design, drug approvals, and insurance coverage, ultimately improving patient outcomes.
Redefining Disease Severity with Special Area Involvement and Reflecting on Treatment Patterns in a Real-World Psoriasis Population. Mary E Horner, Kate K Orroth, Junjie Ma, Yinkang Duan, Myriam Cordey. Dermatol Ther (Heidelb). 2024 Jan 12;14(1):187–199. doi: 10.1007/s13555-023-01065-0
Utilizing IPC’s proposed approach to redefining psoriasis severity, this study quantifies disease burden by analyzing body surface area (BSA) distribution, special area involvement, and treatment patterns in a real-world population. Findings reveal that nearly half of psoriasis patients had two or more special areas affected, yet most received topical rather than targeted therapies. This discrepancy highlights a gap between clinical practice and current guidelines, highlighting an unmet need for systemic treatment
VIDEOS AND PODCASTS
Dialogues in Dermatology: Categorizing Psoriasis Severity (Sponsored by Bristol Myers Squibb)
Listen as IPC Board Member and Vice President/President-Elect Bruce Strober discusses the categorization of psoriasis severity and its part in determining the correct therapy, in this Dialogues in Dermatology podcast.
Listen as IPC Board Member and Vice President/President-Elect Bruce Strober discusses the categorization of psoriasis severity and its part in determining the correct therapy, in this Dialogues in Dermatology podcast.
It’s Time for a Change: IPC Psoriasis Severity Reclassification (CME)
Listen as IPC Board Member Dr. Bruce Strober and IPC Councilor Dr. Andrew Blauvelt discuss the International Psoriasis Council’s rationale for changing psoriasis severity classification for treatment decisions and clinical trials in this NPF podcast.
Listen as IPC Board Member Dr. Bruce Strober and IPC Councilor Dr. Andrew Blauvelt discuss the International Psoriasis Council’s rationale for changing psoriasis severity classification for treatment decisions and clinical trials in this NPF podcast.
Psoriasis is More Than Body Surface Area
IPC Board Member Dr. Andrew Blauvelt discusses when psoriasis should be considered severe and what that means for treatment choices, especially in high-impact areas like the scalp, nails, palms, soles, face, and genitalia.
Page last updated: October 2025