Body surface area and PASI can look low while disease on the palms, soles, nails or scalp is disabling. These sites often decide whether a patient can work or walk, so assess function and quality of life, not only extent.
- Look at palms, soles, nails and scalp at every visit.
- Ask what the disease stops the patient doing, such as gripping or walking.
- Distinguish plaque disease from pustular disease, which behaves differently.
- Treat disabling site-specific disease as severe even when the body score is low.
Why it matters
A low PASI can hide disease that is disabling, delaying systemic treatment.
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