Localization of treatment‐resistant areas in patients with psoriasis on biologics

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Abstract
Background Traditionally, psoriasis in certain body sites such as the scalp, nails, palms, soles, and the intertriginous areas has been acknowledged as difficult‐to‐treat. Objective To investigate the body location of treatment‐resistant psoriasis in patients treated with biologic agents in real‐world clinical practice, and to study the association between localisation and the quality of life. Methods In this observational study we investigated the skin and/or nail location of treatment‐resistant psoriasis in patients with moderate‐to‐severe psoriasis treated for > 6 months with biologic agents with a partial or good response to treatment defined as having a PASI ≥ 1 and ≤ 5. Experienced PASI assessors used a uniform data collection form in which the body area was divided into 26 regions and 20 nails. Results We included 146 patients with chronic plaque‐type psoriasis (74·7% men, mean [SD] age 49·8 [13·7] years, with a median PASI score of 2·4 (IQR 1·2‐3·2). The median PASI reduction from treatment initiation was 86·1% (IQR 78·1‐91·3). The most common site of recalcitrant psoriasis was the anterior lower leg (49·3%; 95% confidence interval (CI): 41·2–57·4). Further common sites of recalcitrant psoriasis were the posterior lower leg (24·7%; 95% CI: 17·7‐31·6), the elbow (35·6%; 95% CI: 27·8‐43·4), and the scalp (19·2%; 95% CI: 12·8‐25·6%). No association between DLQI and specific areas of recalcitrant psoriasis were observed. Conclusion In real‐world clinical practice, the most common sites of recalcitrant psoriasis in patients treated with biologic agents are the anterior lower leg, the posterior lower leg, and the elbows. Recalcitrant psoriasis in no specific area caused a greater impact on quality of life than any other area.

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