Location Matters: The Outsize Quality of Life Burden of Psoriasis in High-Impact Areas

Abstract

When patients are living with psoriasis in high-impact body areas, defining disease severity by objective measures of body surface extent affected does not provide the full picture. Scalp, palmo-plantar, nail, genital, and flexural involvement can all place a significant burden on quality of life (QoL) in people with psoriasis. In recognition of this, current consensus guidance recommends moving beyond a purely severity-based classification to a more holistic, patient-centred approach that incorporates disease location, symptom burden, and treatment response. The International Psoriasis Council (IPC) consensus recommends classifying patients as candidates for topical or systemic therapy, with systemic therapy candidacy informed by body surface area (BSA) >10%, involvement of special areas, or failure of topical therapy. Here, Maria Politou, senior attending dermatologist/venereologist and medical researcher at the Andreas Syggros Hospital in Athens, Greece, and board member of the Hellenic Dermatological and Venereological Society (EDAE), discusses the outsize QoL impact of psoriasis in high-impact areas, explains why location matters just as much as extent, and shares her own approach to holistic assessment and management of psoriasis, including comorbidity and treatment safety considerations.