Stratified psoriasis treatment plans: why is patient preference information needed?

Abstract

CMN', 'colour of CMN', 'texture of CMN' and 'satellite naevi number'; (ii) quality of life: 'emotional distress'; (iii) neoplasm: 'presence of melanoma'; (iv) neurology: 'neurological symptoms and signs'; (v) adverse events: 'wound problems of the CMN' and 'scar problems'; and, for research only, (vi) pathology: 'molecular characteristics'. Nine of ten outcomes were redundant for both patient care and research.This raises the question of whether two distinct COS are needed for this condition. In contrast, outcomes for other clinically relevant domains such as neuroimaging to rule out neurocutaneous melanocytosis and psychological functioning were not included in the final set of outcomes.The past two steps of the OCOMEN project are undoubtedly important milestones in the journey towards a uniform approach to CMN as a condition with high variability in its clinical features and a paucity of data. However, the most difficult step is still looming ahead: to define a core outcome measurement set based on specific measurement instruments. This endeavour is not entirely novel as several classification schemes have been proposed for CMN in the past. 4 Within the OCOMEN initiative, Fledderus et al. 3 agreed on size of the lesion, number of satellite naevi, colour and texture as outcomes for the domain 'skin appearance'. These parameters were also part of a consensus-based scheme for the categorization of CMN published previously by an interdisciplinary panel of experts. 5 In the next step, we will see how the COS of the OCOMEN initiative will differ from existing recommendations, and what additional value it will generate for physicians and patients. In particular, measuring the domains and outcomes relating to extracutaneous findings such as emotional distress or neurological symptoms and signs can add significant novelty and fill existing gaps as they are not sufficiently considered in current categorization schemes.