A systematic review of diagnostic criteria for psoriasis in adults and children: evidence from studies with a primary aim to develop or validate diagnostic criteria3. (6th March 2018)

• Record Type: Journal Article
• Authors: Burden‐Teh, E.; Phillips, R.C.; Thomas, K.S.; Ratib, S.; Grindlay, D.; Murphy, R.
• Is Part Of: British journal of dermatology. Volume 178:Number 5(2018)
• Page Start: 1035
• Page End: 1043
• Publication Date: 2018-03-06
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16104
• Languages: English
• ISSNs: 0007-0963

Abstract

Abstract : What's already known about this topic? Diagnostic criteria can aid both clinical diagnosis and support standardization in clinical trials and observational research. In routine dermatology practice, psoriasis is a clinical diagnosis, and the gold (reference) standard is a dermatologist's diagnosis, supported where needed by histology. Diagnostic criteria are currently not widely used in clinical practice or in research about psoriasis. What does this study add? No clinical examination‐based diagnostic criteria have been developed or validated for psoriasis in adults or children. Genetic, molecular, skin imaging, histopathology, questionnaire‐based, computer‐aided and traditional Chinese medicine diagnostic criteria have been developed for psoriasis, but their utility in clinical practice and research needs further exploration. Many of the included diagnostic accuracy studies had unclear or high risk of bias due to weaknesses in study design and study reporting. Plain language summary available online Summary: Background: The diagnosis of psoriasis in adults and children is made clinically, for both patient management and the selection of participants in research. Diagnostic criteria provide a structure for clinical assessment, which in turn helps standardize patient recruitment into clinical trials and case definitions in observational studies. Objectives: The aim of this systematic review was to identify and critically appraise the published studies to date that had a primary research aim to develop or validate diagnostic criteria for psoriasis. Methods: A search of Ovid MEDLINE and Ovid Embase was conducted in October 2016. The primary objective was to record the sensitivity and specificity of diagnostic criteria for psoriasis. Secondary objectives included diagnostic recommendations, applicability to children and study characteristics. Diagnostic accuracy studies were critically appraised for risk of bias using the QUADAS‐2 tool. Results: Twenty‐three studies met the inclusion criteria. None detailed clinical examination‐based diagnostic criteria. The included criteria varied from genetic and molecular diagnostic models to skin imaging, histopathology, and questionnaire‐based, computer‐aided and traditional Chinese medicine criteria. High sensitivity and specificity (> 90%) were reported in many studies. However, the study authors often did not specify how the criteria would be used clinically or in research. This review identified studies with varying risk of bias, and due to each study developing separate criteria meta‐analysis was not possible. Conclusions: Clinical examination‐based diagnostic criteria are currently lacking for psoriasis. Future research could follow an international collaborative approach and employ study designs allowing high‐quality diagnostic accuracy testing. Existing and newly developed criteria require validation.