Palmoplantar Psoriasis Area and Severity Index (PPASI)

DESCRIPTION:

The Palmoplantar Psoriasis Area and Severity Index scale is used to assess the severity of localized non-pustular psoriasis on the palms and soles of patients. A clinician assesses the palms and soles for induration, desquamation, and erythema, and surface area of palms and soles covered by plaque psoriasis.1

DISEASE STATES: 
Psoriasis

VALIDATED USES: 
Treatment monitoring

ADMINISTRATION METHOD:
Clinician

COMMONLY USED IN:
Clinical trials, research

DETAILED DESCRIPTION:
Similar to Psoriasis Area and Severity Index (PASI), except in PPASI, the physician assesses erythema (E), induration (I), and desquamation (D) on the patient’s palms and soles, and then multiplies the total by a score that represents percent area of involvement.1,2

The PPASI provides a static, numeric scoring for psoriasis affecting the hands and feet with scores ranging from 0 to 72 (the most severe disease). Similar to PASI, clinical trials often compare baseline PPASI scores at predetermined points in time to monitor change. This is often represented as a proportion of patients who achieve a predetermined reduction in PPASI score, or disease severity:1-3

  • PPASI 100: Proportion of subjects achieving 100% reduction in PPASI score
  • PPASI 75: Proportion of subjects achieving ≥75% reduction in PPASI score
  • PPASI 50: Proportion of subjects achieving ≥50% reduction in PPASI score

PPASI is calculated as follows:1-3

(sum of scores for E + I + D) * Area * 0.2(location: right palm) + (sum of scores for E + I +D) * Area * 0.2(location: left palm) + (sum of scores for E + I + D) * Area * 0.3(location: right sole) + (sum of scores for E + I + D) * Area *0.3(location: left sole).

PPASI SCORING

Severity Score
0 None
1 Slight
2 Moderate
3 Severe
4 Very severe
Area of Involvement Score
0 None
1 1%–9%
2 10%–29%
3 30%–49%
4 50%–69%
5 70%–89%
6 90%–100%
Plaque Characteristic Left Palm Right Palm Left Sole Right Sole
Erythema (E) 0–4 0–4 0–4 0–4
Induration (I)+ 0–4 0–4 0–4 0–4
Desquamation (D)+ 0–4 0–4 0–4 0–4
Severity Score=        
Weighting Factor*x 10% (0.1) 20% (0.2) 30% (0.3) 30% (0.3)
Severity Subtotal=        
Area Scorex 0–6 0–6 0–6 0–6
Region Score=        
PPASI SCORE (Sum of Region Scores)=       0–72

VALIDITY:
PPASI has similar features to the PASI scale, which has demonstrated acceptable interrater and intrarater reliability, sensitivity, and the ability to detect change in clinical trials.5,6

LIMITATIONS:
The PPASI is resource-intensive and complex, therefore often reserved solely for clinical trials and research. Clinicians’ unfamiliarity with PPASI tool can lead to large intrarater and interrater variability in scores, leading to subjective measures and low accuracy.5,7

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.

References: 1. Wechter T, Heath MS, Aung-Din D, Sahni DR, Cline A, Feldman SR. Current psoriasis efficacy outcome measures in clinical trials. Curr Dermatol Rep. 2018;7(2):261-268. doi:10.1007/s13671-018-0237-6 2. Tsiogkas SG, Grammatikopoulou MG, Kontouli KM, et al. Efficacy of biologic agents for palmoplantar psoriasis: a systematic review and network meta-analysis. Expert Rev Clin Immunol. 2023;19(12):1485-1498. doi:10.1080/1744666X.2023.2272049 3. Gottlieb A, Sullivan J, van Doorn M, et al. Secukinumab shows significant efficacy in palmoplantar psoriasis: Results from GESTURE, a randomized controlled trial. J Am Acad Dermatol. 2017;76(1):70-80. doi:10.1016/j.jaad.2016.07.058 4. Menter A, Warren RB, Langley RG, et al. Efficacy of ixekizumab compared to etanercept and placebo in patients with moderate-to-severe plaque psoriasis and non-pustular palmoplantar involvement: results from three phase 3 trials (UNCOVER-1, UNCOVER-2 and UNCOVER-3). J Eur Acad Dermatol Venereol. 2017;31(10):1686-1692. doi:10.1111/jdv.14237 5. Bożek A, Reich A. The reliability of three psoriasis assessment tools: psoriasis area and severity index, body surface area and physician global assessment. Adv Clin Exp Med. 2017;26(5):851-856. doi:10.17219/acem/69804 6. Langley RG, Ellis CN. Evaluating psoriasis with Psoriasis Area and Severity Index, Psoriasis Global Assessment, and Lattice System Physician’s Global Assessment. J Am Acad Dermatol. 2004;51:563-569. doi:10.1016/j.jaad.2004.04.012 7. Leonardi C, See K, Gallo G, et al. Psoriasis severity assessment combining physician and patient reported outcomes: the optimal psoriasis assessment tool. Dermatol Ther (Heidelb). 2021;11(4):1249-1263. doi:10.1007/s13555-021-00544-6

Explore more clinical tools to improve dermatologic care for your patients.