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PubMed This is a summary of 20 peer-reviewed journal articles Updated
Dermatology

Tracking Your Progress: Monitoring and Long-Term Care

At a Glance

Tracking psoriasis progress involves measuring skin clearance with PASI scores, assessing quality of life with DLQI, and screening for joint pain and metabolic issues. If a treatment stops working due to anti-drug antibodies, your dermatologist can adjust or switch your medication.

Successfully managing psoriasis over the long term is a marathon, not a sprint. To keep you on the right track, your medical team uses specific tools to measure how well your skin is healing and how much the disease is affecting your life. Understanding these metrics empowers you to advocate for the best possible care and stay ahead of potential complications [1][2].

Measuring Your Success: PASI and DLQI

Doctors use two main scoring systems to determine if your treatment is working or if it’s time to try something new.

  • PASI (Psoriasis Area and Severity Index): This is the clinical “ruler” for your skin. Your doctor looks at how much of your body is covered and how red, thick, and scaly the patches are [3].
    • The Target: Most modern treatments aim for PASI 90 (90% improvement) or PASI 100 (completely clear skin) [4][5].
  • DLQI (Dermatology Life Quality Index): This is a 10-question survey that measures the emotional and social impact of your psoriasis [6].
    • The Target: A score of 0 or 1 means the disease has no impact on your quality of life [7].

Long-Term Health: The Monitoring Timeline

Because psoriasis is a systemic disease, monitoring involves more than just looking at your skin. Your care should include regular check-ins for related conditions [8][9].

Every Visit

  • Joint Screening: Your dermatologist should ask about joint pain or stiffness at every appointment to catch psoriatic arthritis early [10]. They may use tools like the PEST questionnaire to screen for risk [11].

Annually (or as recommended by your Primary Care Physician)

  • Cardiovascular Health: Regular checks of your blood pressure and cholesterol levels are vital because systemic inflammation increases heart risk [12][13].
  • Metabolic Health: Monitoring your BMI and blood sugar helps manage the increased risk of diabetes and metabolic syndrome [9].

Managing Expectations: When Treatments Change

It is common for a treatment that worked well for years to slowly become less effective. This is often referred to as drug survival—the length of time a medication remains “active” in your body [14].

  • Secondary Loss of Response: This happens when your skin begins to flare again after a period of being clear [15].
  • Anti-Drug Antibodies (ADAs): In some cases, your immune system recognizes a biologic medication as “foreign” and creates antibodies to clear it out of your system too quickly [16][17].
  • The Solution: If a drug stops working, your doctor may increase the dose, add a supporting medication like methotrexate, or switch you to a different class of biologic [18][19].
Metric What it measures The Goal
PASI Physical skin severity [3]. 90% to 100% improvement [4].
DLQI Quality of life impact [6]. Score of 0 or 1 [7].
Joint Screen Early signs of arthritis [10]. No new pain or stiffness [20].
Metabolic Screen Heart and diabetes risk [9]. Normal blood pressure and sugar [12].

Remember, if your skin isn’t meeting these targets, it isn’t your fault—it’s a sign that your treatment plan needs an adjustment to better manage the underlying inflammation [2].

Common questions in this guide

What is a good PASI score for psoriasis treatment?
Most modern treatments aim for a PASI 90 or PASI 100 score, which means a 90% to 100% improvement in your skin's clearance. If you aren't reaching this goal, your doctor may need to adjust your treatment plan.
What does the DLQI score mean?
The Dermatology Life Quality Index (DLQI) is a brief survey used to measure the emotional and social impact of your psoriasis. A score of 0 or 1 means the condition is having almost no negative impact on your daily life.
Why did my psoriasis medication stop working?
Over time, a treatment can lose its effectiveness, known as a secondary loss of response. This frequently happens because your immune system creates anti-drug antibodies that clear the medication from your body too quickly.
Why does my dermatologist always ask about my joints?
Because psoriasis causes systemic inflammation, it increases your risk for psoriatic arthritis. Dermatologists ask about joint pain and morning stiffness to catch and treat any early signs of joint damage.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is my current absolute PASI score, and what is our target score for the next six months?
  2. 2.Can we use a tool like PEST or PURE-4 during this visit to check for early signs of psoriatic arthritis?
  3. 3.How are we coordinating with my primary care doctor to monitor my cardiovascular and metabolic health?
  4. 4.If my current biologic starts to lose effectiveness, what is our 'Plan B' for switching treatments?
  5. 5.Are there specific laboratory tests, like trough levels or anti-drug antibody tests, we should run if my skin starts to flare again?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
  1. 1

    Treat-to-Target Approach for the Management of Patients with Moderate-to-Severe Plaque Psoriasis: Consensus Recommendations.

    Gisondi P, Talamonti M, Chiricozzi A, et al.

    Dermatology and therapy 2021; (11(1)):235-252 doi:10.1007/s13555-020-00475-8.

    PMID: 33426634
  2. 2

    Effect of baseline disease severity on achievement of treatment target with apremilast: results from a pooled analysis.

    Reich K, Mrowietz U, Menter A, et al.

    Journal of the European Academy of Dermatology and Venereology : JEADV 2021; (35(12)):2409-2414 doi:10.1111/jdv.17520.

    PMID: 34255891
  3. 3

    The skin in psoriasis: assessment and challenges.

    Oji V, Luger TA

    Clinical and experimental rheumatology 2015; (33(5 Suppl 93)):S14-9.

    PMID: 26472560
  4. 4

    Complete Skin Clearance is Associated with the Greatest Benefits to Health-Related Quality of Life and Perceived Symptoms for Patients with Psoriasis.

    Augustin M, Gottlieb AB, Lebwohl M, et al.

    Dermatology and therapy 2024; (14(10)):2841-2857 doi:10.1007/s13555-024-01261-6.

    PMID: 39285121
  5. 5

    Clinical meaningfulness of complete skin clearance in psoriasis.

    Strober B, Papp KA, Lebwohl M, et al.

    Journal of the American Academy of Dermatology 2016; (75(1)):77-82.e7.

    PMID: 27206759
  6. 6

    Relationship Between Family History and Quality of Life in Patients with Psoriasis: A Cross-Sectional Study from China.

    Jiang F, Lu L, Wang S, et al.

    Clinical, cosmetic and investigational dermatology 2024; (17()):891-900 doi:10.2147/CCID.S453078.

    PMID: 38660588
  7. 7

    Long-term, durable, absolute Psoriasis Area and Severity Index and health-related quality of life improvements with risankizumab treatment: a post hoc integrated analysis of patients with moderate-to-severe plaque psoriasis.

    Gooderham M, Pinter A, Ferris LK, et al.

    Journal of the European Academy of Dermatology and Venereology : JEADV 2022; (36(6)):855-865 doi:10.1111/jdv.18010.

    PMID: 35174556
  8. 8

    Palmoplantar Plaque Psoriasis is Associated with Diabetes, Hypertension, Obesity, and Metabolic Syndrome-A Case-Control Study.

    Rathod A, Neema S, Radhakrishnan S, et al.

    Indian dermatology online journal 2022; (13(5)):606-610 doi:10.4103/idoj.idoj_59_22.

    PMID: 36304648
  9. 9

    [Moderate-severe psoriasis and associated comorbidity in patients on biologic therapy: implications for primary care].

    González Fernández J, Ara-Martín M, Ruiz-Cortegoso AP, Prieto-Torres L

    Semergen 2026; (52(3)):102720 doi:10.1016/j.semerg.2026.102720.

    PMID: 41707582
  10. 10

    Psoriatic arthritis screening by the dermatologist: development and first validation of the 'PURE-4 scale'.

    Audureau E, Roux F, Lons Danic D, et al.

    Journal of the European Academy of Dermatology and Venereology : JEADV 2018; (32(11)):1950-1953 doi:10.1111/jdv.14861.

    PMID: 29430720
  11. 11

    Management of psoriatic arthritis: Early diagnosis, monitoring of disease severity and cutting edge therapies.

    Raychaudhuri SP, Wilken R, Sukhov AC, et al.

    Journal of autoimmunity 2017; (76()):21-37 doi:10.1016/j.jaut.2016.10.009.

    PMID: 27836567
  12. 12

    Laboratory monitoring in patients with moderate to severe plaque psoriasis.

    Fenkel JM, Osborne JA, Armstrong AW, et al.

    The Journal of dermatological treatment 2025; (36(1)):2583227 doi:10.1080/09546634.2025.2583227.

    PMID: 41346021
  13. 13

    The Heart of Psoriasis: Cardiovascular Alterations and Common Inflammatory Mechanisms.

    Santillo E, Marini L, Cardinali L

    Current cardiology reviews 2026; (22(4)):e1573403X412277 doi:10.2174/011573403X412277250911072530.

    PMID: 41017089
  14. 14

    Effectiveness End Points in Real-World Studies on Biological Therapies in Psoriasis: Systematic Review with Focus on Drug Survival.

    Costanzo A, Malara G, Pelucchi C, et al.

    Dermatology (Basel, Switzerland) 2018; (234(1-2)):1-12 doi:10.1159/000488586.

    PMID: 30300876
  15. 15

    Mechanisms and management of loss of response to anti-TNF therapy for patients with Crohn's disease: 3-year data from the prospective, multicentre PANTS cohort study.

    Chanchlani N, Lin S, Bewshea C, et al.

    The lancet. Gastroenterology & hepatology 2024; (9(6)):521-538 doi:10.1016/S2468-1253(24)00044-X.

    PMID: 38640937
  16. 16

    Immunogenicity of infliximab and adalimumab: what is its role in hypersensitivity and modulation of therapeutic efficacy and safety?

    Murdaca G, Spanò F, Contatore M, et al.

    Expert opinion on drug safety 2016; (15(1)):43-52 doi:10.1517/14740338.2016.1112375.

    PMID: 26559805
  17. 17

    Time Course and Clinical Implications of Development of Antibodies Against Adalimumab in Patients With Inflammatory Bowel Disease.

    Steenholdt C, Frederiksen MT, Bendtzen K, et al.

    Journal of clinical gastroenterology 2016; (50(6)):483-9 doi:10.1097/MCG.0000000000000375.

    PMID: 26166141
  18. 18

    Association of early therapeutic drug monitoring of adalimumab with biologic remission and drug survival in Crohn's Disease.

    Rueda García JL, Suárez-Ferrer C, Amiama Roig C, et al.

    Therapeutic advances in gastroenterology 2025; (18()):17562848251324226 doi:10.1177/17562848251324226.

    PMID: 40110342
  19. 19

    Adalimumab and Infliximab in Crohn's disease - real life data from a national retrospective cohort study.

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    Current health sciences journal 2016; (42(2)):115-124 doi:10.12865/CHSJ.42.02.01.

    PMID: 30568821
  20. 20

    Nail psoriasis as a predictor of the development of psoriatic arthritis.

    Raposo I, Torres T

    Actas dermo-sifiliograficas 2015; (106(6)):452-7.

    PMID: 26026773

This page provides educational information about tracking psoriasis treatment progress and is not a substitute for professional medical advice. Always consult your dermatologist to discuss your specific medication and care plan.

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