Mean values on the highest ever documented psoriasis area and severity index (PASI) – the PeakPASI – were twice as high as the mean PASI in patients with psoriasis, suggesting that the cumulative burden of this dermatologic disease is much higher than what is captured with a single measurement on the standard PASI, according to findings from a cross-sectional study published in the Journal of the American Academy of Dermatology.

The PeakPASI was developed to assess a patient’s lifetime highest PASI, compared with the standard PASI which offers only a snapshot of disease burden at a single visit. In this study, researchers from Germany and Sweden investigated the PeakPASI in patients presenting to a dermatology practice.

A total of 398 patients aged 18 years or older (mean age, 49.1 ± 14.5 years) from 36 dermatologic settings in Germany were included in this study. Patients were recruited consecutively by dermatologists. In addition to reporting the PeakPASI in the patients’ files, clinicians were asked to administer the Dermatological Life Quality Index (DLQI) to patients and to assess happiness. There were 2 PeakPASI classifications created for this study: PeakPASI <10 (n=92)/≥10 (n=306) and PeakPASI <13.6 (n=197)/≥13.6 (n=201).

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At the time of study examination, there were 302 patients with a higher PeakPASI than PASI. According to the investigators of this study, the mean PeakPASI value was approximately twice as high as the mean PASI.

In both PeakPASI classifications, patients with a higher PeakPASI were more often men (≥10: 62.2% vs 37.8%, P =.001; ≥13.6: 63.7% vs 36.3%, P <.001), had a higher mean PASI (≥10: 8.5 ± 8.3 vs 0.0 – 53.8, P <.001; ≥13: 9.9 ± 9.5 vs 0.0 – 53.8, P <.001), were more likely to receive systemic treatment (≥10: 69.0% vs 32.4%, P =.002; ≥13.6: 70.7% vs 29.4%, P =.030), and had previously received ultraviolet therapy (≥10 vs <10: 19.0% vs 3.3%, P <.001; 19.9% vs 10.7%, P =.011).

Patients with PeakPASI ≥13.6 had higher DLQI (7.9 ± 7.3 vs 6.1 ± 6.2; P =.010) and lower happiness (6.6 ± 2.0 vs 7.2 ± 1.9; P =.005) scores compared with patients with PeakPASI <13.6.

Limitations of this study were the lack of data on treatment status of patients, the time span between PASI and PeakPASI measurements, and the duration of patients’ current treatments.

The researchers wrote that additional study “should examine factors like after which length of time a change of therapy was initiated and whether the PeakPASI is helpful in determining the need for more comprehensive therapies.”

Disclosure: This clinical trial was supported by the Novartis. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Tizek L, Schielein MC, Zink A. PeakPASI: A new measurement tool in psoriasis care. Published online August 27, 2020. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.08.096