Cutaneous and Systemic Psoriasis: Classifications and Classification for the Distinction

Abstract

Psoriasis is a chronic multisystem inflammatory disease that affects ~0.1-1.5% of the world population. The classic cutaneous manifestation of psoriasis is scaly erythematous plaques, limited or widely distributed. Moreover, psoriasis could be associated with comorbidities like psoriatic arthritis, metabolic syndrome, diabetes, cardiovascular disease, nephropathy, bowel disease, and brain diseases. In this review, we suggest that psoriasis should be classified as cutaneous psoriasis or systemic psoriasis and propose the classification for distinction. This would help to better understand and manage psoriasis.

Keywords: biologics; classification criteria; cutaneous and systemic; diagnosis; psoriasis; therapy.

Figure 1

Therapies for cutaneous psoriasis. Different treatments for mild, moderate, and severe patients with cutaneous psoriasis. For mild cutaneous psoriasis, follow-up and topical therapies are advised choice. For moderate to severe cutaneous psoriasis, topical therapies, phototherapy, traditional agents, and biologics can be selected one by one. BSA, body surface area; PASI, psoriasis area and severity index; IGA, investigator's global assessment; UVB, ultraviolet radiation b; NB, narrow bound; BB, broad bound; PUVA, psoralen plus ultraviolet radiation a.

Figure 2

Therapies for systemic psoriasis. Selection of treatments for different types of systemic psoriasis includes psoriatic arthritis, psoriasis with diabetes, psoriasis with pulmonary disease, psoriasis with brain diseases, psoriasis with uveitis, psoriasis with cardiovascular disease, psoriasis with bowel disease, psoriasis with nephropathy, psoriasis with metabolic syndrome, psoriasis with liver disease, psoriasis with malignancy, psoriasis with lupus erythematosus.

Figure 3

Therapies for pediatric psoriasis. Treatment of moderate to severe pediatric psoriasis. Non-biologics include cyclosporin, acitretin and methotrexate. Biologics include adalimumab, etanercept, ustekinumab, and ixekizumab. NB-UVB, narrow bound ultra violet B light.