Anthony Bewley, FRCP

A recent summary was conducted on the ‘Tailoring topical psoriasis treatments to patients' needs and expectations’ symposium which was held at the 2021 EADV Congress.

The summary included a description of the psychological aspects of psoriasis, psoriasis comorbidities, physician and patients’ shared decision-making responsibilities, and the overall adherence of patients to topical treatments.

The review was led by Anthony Bewley, FRCP, from Barts Health NHS Trust’s Department of Dermatology, and Peter Van De Kerkhof, MD, PhD, from the Radboud University Medical Center in the Netherlands.

“During this session, the factors affecting adherence and outcomes to topical treatments were presented, with a particular focus on the patients' point of view. Psoriasis is not just a skin condition,” Bewley and Van De Kerkhof wrote. “Psoriasis can cause negative psychosocial effects, such as depression and anxiety.”

Psychological Aspects

The investigators first summarized some of the key points about the psychological aspects of psoriasis, including the fact that the skin condition and its appearance heavily affect many patients’ self-esteem and their emotional well-being.

They also noted that psoriasis patients often live with some form of depression or anxiety, adding that it can also be related to their symptom severity.

The team advised clinicians to keep these effects in mind when determining treatment, interacting with patients, providing patient education, and recommending self-help groups for patients.

“The European Society for Dermatology and Psychiatry (ESDaP) is trying to promote the availability of a psychologist in dermatological units across Europe to facilitate the psychodermatological support of patients who are living with psoriasis,” they wrote.

The research team wrote that a key component of treatment is a collaborative effort on the part of the patient, the dermatologist, and a psychologist or psychiatrist.

They also wrote that the effects of psoriasis can be “treated with any combination of the following: psychological counseling, oral and topical psychotropic medications, relaxation/stress management therapy, cognitive behavioral therapy, hypnosis and/or guided imagery training and involvement in patient support groups.”

What Affects Treatment Adherence?

The investigators referenced the importance of clinicians explaining to patients the cost versus benefits for one particular kind of treatment for their psoriasis. They pointed out the fact that past treatments' failures may negatively affect patients’ adherence to treatments.

“Delivering comprehensive treatment information to the patient will help develop realistic objectives and expectations, which may encourage undertreated patients to seek care,” they wrote. “In the majority of cases, patients’ expectations are influenced by the clinician, although some misalignments may exist (e.g. patients could express a higher treatment goal than physicians).”

Overall, the team concluded that patients’ adherence to treatment regimens depend the establishment of positive communication with their clinician about how they are feeling, about cost versus benefits, and about their own expertise in the management of their own skin conditions.

The study, “Engaging psoriasis patients in adherence and outcomes to topical treatments: A summary from the Symposium ‘Tailoring topical psoriasis treatments to patients' needs and expectations’ of the 30th EADV Congress 2021,” was published online by The Journal of the European Academy of Dermatology and Venereology.