Scalp Involvement May Drive QOL Impact in Psoriasis

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Research presented at the 2025 AAD Annual Meeting showed that moderate to severe scalp psoriasis was associated with a substantial impact on quality of life.

Patients with scalp psoriasis experienced significant impacts on quality of life (QOL), even when they had less extensive psoriasis across the rest of their bodies, according to a poster presented at the 2025 American Academy of Dermatology Annual Meeting.

Steven R. Feldman, MD, PhD, and colleagues conducted an analysis of patients enrolled in PSORIATYK SCALP, a phase 3b/4 trial testing  the safety and efficacy of deucravacitinib. The trial recruited adults with moderate to severe scalp psoriasis and total body surface area (BSA) involvement of 3% or more.

The analysis included 154 patients with psoriasis who had an average BSA involvement of 10.3%.

Patient-Reported Outcome Measures

The researchers compared QOL outcomes in 2 subgroups: BSA 3% to 10% (n=108) and BSA greater than 10% (n=46). To determine QOL impact, the researchers used the following patient-reported outcome (PRO) measures:

• Dermatology Life Quality Index (DLQI)
• Four numeric rating scale (NRS) measures: for scalp-specific itch, pain, and flaking, and whole-body itch
• Global Assessment Psoriasis Symptoms-Scalp (GAPS-S)
• Scalpdex

“No severity bands have been determined for Scalpdex to aid score interpretation,” the authors noted. “Skindex severity thresholds suggest that symptoms score ≥52, emotions score ≥39, function score ≥37, and total score ≥44 indicate severe impact on QoL.”

Scalp Psoriasis Linked to Significant QOL Impact

The researchers found that average DLQI scores were similar between the subgroups and demonstrated a very large effect on QOL. The average scalp-specific NRS scores were also similar between groups and indicated that patients had moderate to severe symptoms.

Participants in the subgroup with BSA involvement of more than 10% had worse whole-body itch scores on average. In addition, more patients in the higher BSA involvement group reported severe scalp symptoms.

“Mean Scalpdex subscale and total scores were numerically worse for patients with BSA 3%-10% than for those with BSA >10%,” the authors added.

The researchers concluded that scalp symptoms may drive psoriasis’s QOL impact on patients with moderate to severe disease.

“QoL across multiple PROs was greatly impacted in patients with moderate to severe scalp psoriasis, including those with less extensive overall body psoriasis,” Dr. Feldman and colleagues concluded. “Scalp disease may disproportionately affect QoL relative to total BSA involvement in patients with psoriasis.”