Using the upgrade criteria of the European Psoriasis Consensus is best practice care according to the people-centred healthcare concept of the World Health Organization

Psoriatic disease is a chronic condition for which there is no cure and people live with the illness 24 h a day, 7 days a week. Great progress has been made to approve new drugs, with about 80% of people achieving complete or almost complete skin clearance with a very low rate of adverse events. These developments have created the perception of ‘freedom of disease’1 and led to major improvements in health‐related quality of life and wellbeing. Access to optimal care that includes drug treatment is dependent on the definition of severity. For this purpose, tools such as the Psoriasis Area and Severity Index (PASI) are used. In addition, patient‐reported outcomes (PROs) provide the patient’s perspective; the most frequently used tool is the Dermatology Life Quality Index (DLQI). According to common definitions, psoriasis severity was previously divided into mild and moderate‐to‐severe. This was subsequently transformed into a numerical definition by using the ‘rule of tens’ or the definition of the European Consensus on Treatment Goals.2 Both of these approaches require that PASI and/or the body surface area (BSA) should be greater than 10 for a definition of moderate‐to‐severe psoriasis. Although most severity definitions also use PROs such as the DLQI, they do not fully incorporate the patient’s point of view. Many studies have shown that the location of skin involvement determines perceived severity and burden from the perspective of affected people,3 and there is poor agreement between the patient’s and the physician’s perception of burden.4