Psoriasis is a chronic skin condition. Its clinical assessment involves four measures: erythema, scales, induration, and area. In this paper, we introduce a scale severity scoring framework for two-dimensional psoriasis skin images. Specifically, we leverage the bag-of-visual words (BoVWs) model for lesion feature extraction using superpixels as key points. BoVWs model is based on building a vocabulary with specific number of words (i.e., codebook size) by using a clustering algorithm with some local features extracted from a constructed set of key points. This is followed by three-class machine learning classifiers for scale scoring using support vector machine (SVM) and random forest. Besides, we examine eight different local color and texture descriptors, namely color histogram, local binary patterns, edge histogram descriptor, color layout descriptor, scalable color descriptor, color and edge directivity descriptor (CEDD), fuzzy color and texture histogram, and brightness and texture directionality histogram. Further, the selection of codebook and superpixel sizes are studied intensively. A psoriasis image set, consisting of 96 images, is used in this study. The conducted experiments show that color descriptors have the highest performance measures for scale severity scoring. This is followed by the combined color and texture descriptors, whereas texture-based descriptors come last. Moreover, K-means algorithm shows better results in vocabulary building than Gaussian mixed model, in terms of accuracy and computations time. Finally, the proposed method yields a scale severity scoring accuracy of 80.81% using the following setup: a superpixel of size 15× 15 × 3, a combined color and texture descriptor (i.e., CEDD), a constructed codebook of size 128 using K-means, and SVM for scale scoring.