Addressing Treatment Challenges and Advancing Care in Psoriasis

Over the last 20 years that I’ve been practicing medicine as both a clinician and as a researcher, I’ve treated countless patients with psoriasis. An estimated 7.5 million Americans are affected by psoriasis,¹ of whom 80 to 90 percent suffer from plaque psoriasis, the most common form.² What many patients, clinicians and even dermatologists fail to recognize is that psoriasis isn’t just a skin condition. It’s a chronic immune-mediated disease that has an impact on patients and their families far beyond the skin. Living with plaque psoriasis can affect patients physically, emotionally and socially, causing severe psychosocial distress that adversely impacts their quality of life. More recently, it has been identified that more severe psoriasis — when over 10 percent of the body is affected³ — can increase the incidence of depression, cardiovascular disease and even increase mortality in those who suffer.^4,5

When I began practicing, we had limited options to offer psoriasis patients who had more extensive disease. Many patients didn’t respond to the therapies available or achieve the results they desired. Moreover, due to perceived side effects, some clinicians were very hesitant to use available systemic treatments. In recent years, the number of, U.S. Food and Drug Administration (FDA)-approved treatments has grown substantially. Advances in our understanding of the immune system and the role of proteins, such as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-17, IL-12 and IL-23,⁶ have made the discovery and development of biologics that target the underlying cause of psoriasis possible. With a more targeted approach, many patients demonstrate meaningful improvements in their condition.

Yet, even with advances in therapy, challenges remain, in part because psoriasis is a complex condition and patients can have a variable response to different treatments. Therefore, a continued need exists for research that will lead to new options that offer high rates of lasting skin response for patients.

Acknowledging the Psychosocial Burden of Psoriasis

Dermatologists who treat patients with psoriasis often focus on treating the physical symptoms of the disease — addressing the inflamed, scaly and erythematous patches – but the impact of psoriasis goes well beyond clinical severity. For many patients, psoriasis interferes significantly with daily life, negatively impacting relationships at home, school or work.⁷ Nearly 90 percent of psoriasis patients indicate that the disease impacts their overall emotional well-being and report feeling helpless and embarrassed.⁸ Additionally, nearly 80 percent of patients report symptoms of depression and anxiety, and more than half experience significant stress.⁹

While patients living with psoriasis may feel self-conscious, ashamed and depressed, they often do not discuss these emotions with their dermatologist. Likewise, dermatologists may only superficially ask their patients about the impact psoriasis may be having on their quality of life. As the clinical severity of psoriasis may not accurately reflect the degree of its emotional impact, it’s critical that dermatologists assess the psychosocial aspects of the disease when meeting with their patients.ⁱⁱ

Partnering Closely with Patients

Dermatologists must deeply understand their patients’ treatment goals. More recently, treatment advances have led to greater numbers of patients achieving high levels of clinical response and even completely clear skin, as measured by a Psoriasis Area and Severity Index (PASI) of 100. Unfortunately, psoriasis is unpredictable. Not all patients achieve high levels of skin clearance, and if they do, it sometimes doesn’t last. Today, patients still cycle through various treatment modalities, including topical and oral treatments, experiencing response followed by flare-ups, which can be frustrating for both the patient and their dermatologist.

Each year, the global dermatology community comes together at the American Academy of Dermatology (AAD) Annual Meeting to share new research that can lead to improved care and management of psoriasis as well as other serious dermatologic conditions. While attending this year’s meeting in Washington, DC, I was pleased to see new data, including long-term results, from clinical trials in psoriasis that demonstrated high rates of skin clearance. Additionally, there were several sessions focused on helping physicians select the appropriate course of care for psoriasis patients in an era of multiple treatment options — a critical topic as the treatment landscape continues to grow and evolve. I left the meeting feeling optimistic about the available information and potential research advances on the horizon that may help dermatologists meet the treatment expectations of their patients.

As the psoriasis treatment landscape continues to change, it’s important we keep abreast of scientific developments. We also must maintain an open dialogue with patients about the full impact of this chronic disease on their quality of life and ensure an accurate understanding of their treatment goals. By establishing a solid partnership with our patients and gaining a better understanding of their individual challenges, we can determine the most appropriate course of care and help them achieve their goals, ultimately improving outcomes.

Sponsored by AbbVie.

DISCLOSURE: Gordon reports financial ties to AbbVie, Almirall, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene Corporation, Demira, Dermavant Sciences, Eli Lilly and Company, Genzyme, Janssen Pharmaceuticals, Kyowa Hakko Kirin Pharma, Leo Pharma, Merck & Co, Novartis Pharmaceuticals, Ortho Dermatologics, Pfizer, Sun Pharmaceuticals and UCB.

¹ American Academy of Dermatology. Skin conditions by the numbers. https://www.aad.org/media/stats/conditions/skin-conditions-by-the-numbers. Accessed February 12, 2019.

² Menter A, et al. J Am Acad Dermatol. 2008;58(5):826-850.

³ National Psoriasis Foundation. About Psoriasis. https://www.psoriasis.org/about-psoriasis. Accessed Feb 20. 2019

⁴ American Academy of Dermatology Association. Psoriasis is more than skin deep. https://www.aad.org/media/news-releases/psoriasis-is-more-than-skin-deep. Accessed Feb. 20.2019

⁵ National Psoriasis Foundation. Comorbidities associated with psoriatic disease. https://www.psoriasis.org/about-psoriasis/related-conditions. Accessed February 20, 2019.

⁶ National Psoriasis Foundation. Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs. https://www.psoriasis.org/about-psoriasis/treatments/biologics. Accessed Feb. 20. 2019

⁷ Global Report On Psoriasis. World Health Organization. 2016. Available at: http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf. Accessed February 12, 2019.

⁸ Armstrong AW, et al. PLoS One. 2012;7(12):e52935.

⁹ Lakshmy S, et al. Indian J Psychol Med. 2015;37(4):434-440.