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Interactive Introduction to PASI Scoring 1.1

Interactive introduction to PASI scoring
Created 2019.
 
This exercise will teach you the basics of PASI scoring and give you a few examples to get you started. 

This introduction should take you about 10 minutes.
 
Learning objectives
  • To become familiar with PASI scoring.
  • To understand the concepts behind scoring the area affected by psoriasis in a body region.
  • To understand the concepts behind scoring the severity of psoriasis.
  • To understand how to calculate a PASI score.
Contents
Section 1: area scoring
Section 2: severity scoring
Section 3: calculations
 
Disclaimer
This online exercise is intended to familiarise health professionals with PASI scoring. DermNet NZ does not offer any guarantee of accuracy, but if you see any errors or omissions, please let us know at http://dermnetnz.org/contactus/ so that we can correct them. 
 
Author: Sam MacGill, Medical Student, University of Otago, New Zealand
Editor: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand
Images: Waikato District Health Board, New Zealand
Thank you to Prof Richard Langley for scoring advice.
Abbvie provided an educational grant towards the costs of providing this course.
Interactive introduction to PASI scoring
Created 2019.
 
This exercise will teach you the basics of PASI scoring and give you a few examples to get you started. 

This introduction should take you about 10 minutes.
 
Learning objectives
  • To become familiar with PASI scoring.
  • To understand the concepts behind scoring the area affected by psoriasis in a body region.
  • To understand the concepts behind scoring the severity of psoriasis.
  • To understand how to calculate a PASI score.
Contents
Section 1: area scoring
Section 2: severity scoring
Section 3: calculations
 
Disclaimer
This online exercise is intended to familiarise health professionals with PASI scoring. DermNet NZ does not offer any guarantee of accuracy, but if you see any errors or omissions, please let us know at http://dermnetnz.org/contactus/ so that we can correct them. 
 
Author: Sam MacGill, Medical Student, University of Otago, New Zealand
Editor: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand
Images: Waikato District Health Board, New Zealand
Thank you to Prof Richard Langley for scoring advice.
Abbvie provided an educational grant towards the costs of providing this course.
PASI scoring
The Psoriasis Area and Severity Index is used to objectively grade the extent and severity of chronic plaque psoriasis. PASI scores are used by dermatologists, nurses, doctors and clinical trial coordinators.
 
PASI is used in several situations:
  • Screening.
  • Tracking a patient's progress.
  • To determine how well a given treatment is working.
  • For data collection in clinical trials.
  • To get funding for certain treatments.
PASI is not used for:
We will describe how to determine the area affected by psoriasis in each of the four body regions, and the relative redness, thickness and scaliness of typical plaques in each region. When you have completed the quiz you will receive a certificate with your name and results.
PASI scoring
The Psoriasis Area and Severity Index is used to objectively grade the extent and severity of chronic plaque psoriasis. PASI scores are used by dermatologists, nurses, doctors and clinical trial coordinators.
 
PASI is used in several situations:
  • Screening.
  • Tracking a patient's progress.
  • To determine how well a given treatment is working.
  • For data collection in clinical trials.
  • To get funding for certain treatments.
PASI is not used for:
We will describe how to determine the area affected by psoriasis in each of the four body regions, and the relative redness, thickness and scaliness of typical plaques in each region. When you have completed the quiz you will receive a certificate with your name and results.
Scoring area
Area diagram table
The body is split into four regions.
  1. Head and neck
  2. Upper limbs
  3. Trunk
  4. Lower limbs
In each of these regions, you need to estimate the area of the region affected by psoriasis and grade it using the Area Score. Refer to Table 1.
Scoring area
Area diagram table
The body is split into four regions.
  1. Head and neck
  2. Upper limbs
  3. Trunk
  4. Lower limbs
In each of these regions, you need to estimate the area of the region affected by psoriasis and grade it using the Area Score. Refer to Table 1.
What is the area score for the arms?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the legs?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the head?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the arms?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the legs?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the trunk?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the legs?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
What is the area score for the trunk?
Area score 0: none
Area score 1: < 10%
Area score 2: 10–29%
Area score 3: 30–49%
Area score 4: 50–69%
Area score 5: 70–89%
Area score 6: 90–100%
Scoring Severity

PASI-severity-scoring-table
 
For each body region, you need to score the severity of typical plaques based on:
  • Erythema (redness)
  • Induration (thickness)
  • Desquamation (scaling)
These scores are is graded on a scale from 0–4 as shown above.
 
Please note that induration is difficult to assess from photographs. Our scores are approximate.
Scoring Severity

PASI-severity-scoring-table
 
For each body region, you need to score the severity of typical plaques based on:
  • Erythema (redness)
  • Induration (thickness)
  • Desquamation (scaling)
These scores are is graded on a scale from 0–4 as shown above.
 
Please note that induration is difficult to assess from photographs. Our scores are approximate.
What is the erythema (redness) score for these lesions?
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
What is the erythema (redness) score for these lesions?
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
What is the erythema (redness) score for this lesion?
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
Postinflammatory hyperpigmentation
 
Postinflammatory hyperpigmentation may occur. Some before-and-after examples will be shown in the next few slides.
 
Postinflammatory hyperpigmentation has a PASI erythema score of zero.
Postinflammatory hyperpigmentation
 
Postinflammatory hyperpigmentation may occur. Some before-and-after examples will be shown in the next few slides.
 
Postinflammatory hyperpigmentation has a PASI erythema score of zero.
What is the erythema (redness) score for these lesions?
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
What is the erythema (redness) score for these lesions?
 
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
What is the erythema (redness) score for these lesions?
 
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
What is the erythema (redness) score for these lesions?
 
Erythema score 0: absent
Erythema score 1: mild
Erythema score 2: moderate
Erythema score 3: severe
Erythema score 4: very severe
What is the induration (thickness) score for this lesion?
Induration score 0: absent
Induration score 1: mild
Induration score 2: moderate
Induration score 3: severe
Induration score 4: very severe
What is the induration (thickness) score for this lesion?
 
Induration score 0: absent
Induration score 1: mild
Induration score 2: moderate
Induration score 3: severe
Induration score 4: very severe
What is the induration (thickness) score for this lesion?
 
Induration score 0: absent
Induration score 1: mild
Induration score 2: moderate
Induration score 3: severe
Induration score 4: very severe
What is the desquamation (scaling) score for this lesion?
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
What is the desquamation (scaling) score for this lesion?
 
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
What is the desquamation (scaling) score for these lesions?
Desquamation score 0: no scale
Desquamation score 1: mainly fine scale, some of lesion covered
Desquamation score 2: coarser, thin scale, most of lesion covered
Desquamation score 3: coarser, thick scale, most of lesion covered, rough
Desquamation score 4: very thick scale, all of lesion covered, very rough
Region weighting
The surface area of each region varies, so the area scores for different regions are given different weightings before they're added together to provide the total PASI score.
 
Body region Body surface area % Weighting
Head 10 0.1
Arms 20 0.2
Trunk 30 0.3
Legs 40 0.4
 
Calculations
Today, with easy access to online calculators, it is not necessary to memorise these equations, although it is useful to understand where the numbers come from and what the score means.
 
1. You score each body region individually, so pick a region to start with.
2. Add together the three Severity Scores for erythema, induration and desquamation.
3. Multiply this by the body region's Area Score.
4. Multiply that by the body region's weighting.
5. Repeat for the other three body regions.
6. The sum of these four numbers is the PASI score. It will be a number from 072.
 
Fortunately, it's not necessary to do these calculations manually. Click the link below to download a PASI calculator you may find useful: 
 
 (If the link doesn't work, copy and paste it into your browser)
 
For a summary of your results and a free certificate, enter some more information about yourself on the next page.
Region weighting
The surface area of each region varies, so the area scores for different regions are given different weightings before they're added together to provide the total PASI score.
 
Body region Body surface area % Weighting
Head 10 0.1
Arms 20 0.2
Trunk 30 0.3
Legs 40 0.4
 
Calculations
Today, with easy access to online calculators, it is not necessary to memorise these equations, although it is useful to understand where the numbers come from and what the score means.
 
1. You score each body region individually, so pick a region to start with.
2. Add together the three Severity Scores for erythema, induration and desquamation.
3. Multiply this by the body region's Area Score.
4. Multiply that by the body region's weighting.
5. Repeat for the other three body regions.
6. The sum of these four numbers is the PASI score. It will be a number from 072.
 
Fortunately, it's not necessary to do these calculations manually. Click the link below to download a PASI calculator you may find useful: 
 
 (If the link doesn't work, copy and paste it into your browser)
 
For a summary of your results and a free certificate, enter some more information about yourself on the next page.
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