pasi training for nurses - international psoriasis council · scale = very severe = 4 very rough,...
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PASI Scoring
Barbara Radulski RN
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What is a PASI?
• Psoriasis
• Area
• Severity
• Index
• Objectively quantifies severity of psoriatic lesions and measures body surface area affected by psoriasis
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Why PASI?
• Required to qualify for drug reimbursement scheme
• Required to demonstrate response and qualify for continued drug reimbursement
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The PASI Score
0.1 AH (EH + SH + TH) + 0.2 AA (EA + SA + TA) + 0.3 AT (ET + ST + TT) + 0.4 AL (EL + SL + TL)
PASI total = 0-72
0 72 Cop
yrigh
t
Body Surface Area Affected
HEAD-includes neck
UPPER LIMBS
TRUNK-includes axillae
and groin
LOWER LIMBS-includes
buttocks
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Severity of Psoriatic Lesions in Each Region
Erythema
Thickness
Scaling
0 = None
1 = Mild
2 = Moderate
3 = Severe
4 = Very Severe Copyri
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PASI
Head Upper Limbs Trunk Lower Limbs
Erythema Severity
Thickness 0=None
Scaling 1=Slight
2=Moderate
3=Severe
4=Very Severe
E E E E
T T T T
S S S S
Sub Total 1
Weighting Factor X 0.1 X 0.2 X 0.3 X 0.4
Sub Total 2
Degree of Involvement
0=None
1=1-9% 4=50-69%
2=10-29% 5=70-89%
3=30-49% 6=90-100%
%
%
%
%
Sub Total 2 x Degree of
Involvement
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Erythema
0 = None (including post inflammatory hypo / hyperpigmentation)
1 = Light red
2 = Red but not dark red
3 = Dark red
4 = Very dark red / purple Copyri
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Erythema = Slight =1 Light Red
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Erythema = Moderate = 2 Red / Not Dark Red
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Erythema = Severe = 3 Dark Red
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Erythema = Very Severe -=4 Very Dark Red / Purple
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Thickness
0 = None
1 = Slight elevation, edges indistinct or sloped
2 = Moderate elevation, edges rough or sloped
3 = Marked elevation, edges hard or sharp
4 = Very marked elevation, edges hard or sharp Copyri
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Thickness = Slight = 1 Slight but palpable
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Thickness = Moderate = 2 Palpable sloped edges
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Thickness = Severe = 3
Hard sharp edges
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Thickness = Very Severe = 4 Very hard sharp edges
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Scaling
0 = None
1 = Fine scale covering parts of the lesions
2 = Fine to rough scale covering large parts of the lesions
3 = Rough, thick scale covering large parts of the lesions
4 = Very rough, very thick scale totally covering the lesions
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Scale = Slight = 1 Fine scale partially covering some lesions
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Scale = Moderate = 2 Fine to rough scale covering parts of the
lesions
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Scale = Severe = 3
Rough scale covering large parts of the lesions
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Scale = Very Severe = 4 Very rough, thick scale totally covering
lesions
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Scoring Body Surface Area Affected
0 = absent
1 = 1 - 9 %
2 = 10 - 29%
3 = 30 - 49%
4 = 50 - 69%
5 = 70 - 89%
6 = 90 - 100%
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Case Study
• Male
• 26 yrs
• Biologic naïve
• Previous treatment failures: UVB, MTX, Acitretin
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Baseline PASI – Upper Limbs
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Upper Limbs
• Erythema = 3
• Thickness = 3
• Scale = 4
• Area = 4 (50-69%)
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Baseline PASI – Trunk
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Baseline PASI - Trunk
• Erythema = 3
• Thickness = 3
• Scale = 4
• Area = 5 (70-89%) Copyri
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Baseline PASI – Lower Limbs
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Baseline PASI – Lower Limbs
• Erythema = 3
• Thickness = 4
• Scale = 4
• Area = 4 (50-69%)
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Baseline PASI - Head
• Erythema = 3
• Thickness = 3
• Scale = 4
• Area = 3 (30-49%)
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Baseline PASI Head Upper Limbs Trunk Lower Limbs
Erythema Severity
Thickness 0=None
Scaling 1=Slight
2=Moderate
3=Severe
4=Very Severe
3 3 3 3
3 3 3 4
4 4 4 4
Sub Total 1 10 10 10 11 Weighting Factor X 0.1 X 0.2 X 0.3 X 0.4
Sub Total 2 1.0 2.0 3.0 4.4 Degree of Involvement
0=None
1=1-9% 4=50-69%
2=10-29% 5=70-89%
3=30-49% 6=90-100%
3
4
5
4
Sub Total 2 x Degree of
Involvement 3.0 8.0 15.0 17.6 43.6
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Week 14 PASI – Upper Limbs
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Upper Limbs
Week 0 Week 14
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Upper Limbs
Week 0 Week 14
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Upper Limbs
Week 0 Week 14
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Week 14 PASI Upper Limbs
• Erythema = 1
• Thickness = 1
• Scale = 1
• Area = 3 (30-49%) Copyri
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Week 14 PASI – Trunk
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Trunk
Week 0 Week 14
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Trunk
Week 0 Week 14
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Week 14 PASI - Trunk
• Erythema = 1
• Thickness = 1
• Scale = 1
• Area = 4 (50-69%) Copyri
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Week 14 PASI – Lower Limbs
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Lower Limbs
Week 0 Week 14
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Lower Limbs
Week 0 Week 14
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Lower Limbs
Week 0 Week 14
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Week 14 PASI – Lower Limbs
• Erythema = 2
• Thickness = 2
• Scale = 2
• Area = 3 (30-49%)
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Week 14 PASI - Head
• Erythema = 1
• Thickness = 1
• Scale = 0
• Area = 1 (< 10%)
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Week 14 PASI
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Treatment success?
Week 0 DLQI 28
Week 14 DLQI 5
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Mathematical Success? Week 14 PASI = 12.8
Baseline PASI = 43.6
43.6 x 0.25 = 10.9 Copyri
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Plan?
• Treatment failure and PBS strike
• Delay DOR and add MTX
• Delay DOR and add UVB
• Delay DOR and add day treatments-wet wraps
• Revisit PASI score
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Face Palm Sole Scoring
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Face Palm Sole Scoring
PERCENT OF SURFACE AREA INVOLVEMENT
Face Right
Palm
Left
Palm
Right
Sole
Left
Sole
% Involvement 90 100
SEVERITY OF PSORIATIC LESIONS
0 = None 1 = Slight 2 = Moderate 3 = Severe 4 = Very Severe
Face Right
Palm
Left
Palm
Right
Sole
Left
Sole
Erythema 2 2
Thickness 1 1
Scaling 1 1
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Face Palm Sole Scoring
PERCENT OF SURFACE AREA INVOLVEMENT
Face Right
Palm
Left
Palm
Right
Sole
Left
Sole
% Involvement 80 80
SEVERITY OF PSORIATIC LESIONS
0 = None 1 = Slight 2 = Moderate 3 = Severe 4 = Very Severe
Face Right
Palm
Left
Palm
Right
Sole
Left
Sole
Erythema 2 2
Thickness 4 4
Scaling 4 4
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• Ensure skin cancer checks completed as plaques resolve
• Let common sense prevail
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