Importance of Complete Skin Clearance in Psoriasis as a Treatment Goal: Implications for Patient-Reported Outcomes

Psoriasis is associated with physical, psychological, social, and economic burdens that lead to substantial impairment over a patient's lifetime. It is important to understand how different skin clearance levels may relate to patient perceptions of psoriasis symptoms and health-related quality of life. Here, we highlight notable advantages to complete skin clearance relative to high levels of efficacy without complete skin clearance, including meaningful improvements in patient-reported signs and symptoms of psoriasis, a higher mean proportion of symptom-free days, and significant improvements in quality of life. We also review biologic therapies associated with high percentages of complete skin clearance and significant improvements in signs and symptoms of psoriasis, notably brodalumab. These therapies are likely to play important roles in the future treatment of moderate-to-severe psoriasis, given that improvement in quality of life is of significant value relative to biologics or other systemic therapies associated with lower rates of complete skin clearance.