CHALLENGES

  • The past decade has seen many new medications approved for psoriasis, and several are currently in Phase II and III with anticipated approval in the next few years. This has led to an ongoing need for education on pathophysiologic advances that underscore the development of novel treatments.
  • Epidemiological data suggest that in psoriasis, like in rheumatoid arthritis, screening for CV risk factors and management of CVD are suboptimal.1,2
  • There is a need for collaboration by rheumatologists, cardiologists, gastroenterologists, endocrinologists and primary care physicians with dermatologists to better screen and manage patients with psoriasis and more adequately control comorbid conditions.3
  • Patients with psoriasis experience a variety of psychological symptoms related to their condition.4-11
    • Presence of plaques has been associated with touch avoidance, affecting quality of life and intimacy.
    • Psoriasis patients have a higher risk of sexual dysfunction as compared to the general population, which can cause significant changes in quality of life.
    • Depression, anxiety and suicidal tendencies are prevalent in psoriasis. Psychological symptoms can contribute to disability of patient with psoriasis.
    • Several psoriasis treatments have shown that improvement in clinical outcome is associated with improved HRQoL.
    • Results from clinical trials of biologics for psoriasis indicate improvements in work productivity are associated with clinical outcomes.

 

psoriasis impact

  • Each therapy’s benefit can be compromised by poor tolerability, adverse events, and route of administration (particularly injection/infusion reactions). Proper individualization of treatment is key.12
  • While use of psoriasis treatments can limit the physical manifestations of psoriasis and help improve quality of life, non-adherence is common with both topical and systemic therapies.13-15
    • Only 22-67% of psoriasis patients have been reported as adherent, underscoring an important unmet need for strategies to improve adherence.
  • For most patients, pruritus is the most bothersome symptom of psoriasis and, not surprisingly, patients with pruritus showed more reduced QoL compared to those without pruritus, with the pruritus intensity correlating with the degree of quality of life impairment.16-18
  • Up to one third of patients with psoriasis may develop psoriatic arthritis, which can involve painful swelling and stiffness of joints that can lead to permanent damage.19

REFERENCES

  1. Ahlehoff O, Skov L, Gislason G, et al. PLoS One. 2012;7(4):e36342.
  2. Alamdari HS, Gustafson CJ, Davis SA, Huang W, Feldman SR. J Drugs Dermatol. 2013;12:e14-9.
  3. Armstrong AW et al. PLoS One. 2012;7:e52935.
  4. Choi J, Koo,J. J Amer Acad of Dermatology 2003;49(2)Suppl:57-61.
  5. Gupta MA, Gupta AK, Watteel GN. Cutis 1998; 61:339–342.
  6. Molina-Leyva A, Jiménez-Moleón JJ. J Eur Acad Dermatol Venereol. 2015 Apr;29(4):649-55.
  7. McDonough E, Ayearst R, Eder L, Chandran V, et al. J Rheumatol. 2014;41(5):887-96.
  8. Richards HL, Fortune DG, Griffiths CE, Main CJ. J Psychosom Res. 2001;50(1):11-5.
  9. Krueger GG, Langley RG, Finlay AY, et al. Br J Dermatol 2005;153:1192–1199.
  10. Revicki DA, Willian MK, Menter A, et al. 2008;216:260-27.
  11. Lebwohl M, Papp K, Han C, Schenkel B, Yeilding N, Wang Y, Krueger GG. Br J Dermatol 2010, 162:137–146.
  12. Ravindran V, Scott DL, Choy EH. Ann Rheum Dis 2008, 67:855–859.
  13. Richards HL, Fortune DG, O’Sullivan TM, Main CJ, Griffiths CE. J Am Acad Dermatol. 1999;41(4):581–583.
  14. Devaux S, Castela A, Archier E et al. J Eur Acad Dermatol Venereol 2012; 26:61–7.
  15. Thorneloe R, Bundy C, Griffiths C, Ashcroft, M, et al. The British Journal of Dermatology. 2013;168:20-31.
  16. Reich A. and Szepietowski J. Clinical Aspects of Itch- Psoriasis. Chapter 4. Itch: Mechanisms and Treatment. Carstens E, Akiyama T, editors. Boca Raton (FL): CRC Press; 2014.
  17. Zhu B, Edson-Heredia E, Guo J, et al. Br J Dermatol. 2014 Nov;171(5):1215-9.
  18. Mrowietz U, Chouela EN, et al. J Eur Acad Dermatol Venereol. 2015 Jun;29(6):1114-20.
  19. National Psoriasis Foundation. Available at: https://www.psoriasis.org/psoriatic-arthritis.

Epidemiology

Challenges

Diagnosis

Cardiovascular Disease

Treatments

Additional Reading