Dermatologists underestimate treatment needs in psoriasis patients

[Fred]

This study aims to describe from diagnosis, the patient demographics, disease characteristics, treatment patterns and disease progression in a cohort of patients diagnosed with psoriasis to understand real-world clinical practice for managing these patients.

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Background:
Categorisation of psoriasis (PsO) disease severity in patients varies, although body surface area (BSA) affected is commonly used (< 3% ‘mild’, 3%–10% ‘moderate’ and > 10% ‘severe’). While moderate-severe PsO has been well-studied, more limited information regarding mild-to-moderate PsO is available.

Objectives:
To assess diagnosis, treatment patterns and disease progression for patients diagnosed with mild-to-moderate PsO.

Methods:
Data were drawn from the Adelphi Real World PsO Disease Specific Programme, a cross-sectional survey with retrospective data collection from dermatologists and their consulting adult PsO patients in France, Germany, Italy, Spain and the United Kingdom, conducted December 2021 to March 2022. Dermatologists reported on patient demographics and clinical characteristics at survey, diagnosis and treatment initiation. Patients self-reported the impact of PsO on their quality of life.

Results:
Overall, 209 dermatologists provided data for 875 patients, with 356 (40.7%) providing self-reported data. At initial presentation, 35.3% of patients were diagnosed with mild PsO, despite 79.7% of these patients having a BSA of 3%–10%. Further, 64.7% of patients were diagnosed with moderate PsO, although 62.8% had a BSA > 10%. Between diagnosis and current treatment initiation, patients diagnosed with mild PsO showed greater deterioration than those diagnosed with moderate PsO (mean relative BSA increase of 113.2 ± 307.2% compared to 17.7 ± 93.6%; p < 0.001).
Most patients received topical therapy and/or phototherapy at diagnosis (mild: 94.9%, moderate: 85.5%; p < 0.001). Those diagnosed with moderate PsO were more likely to receive systemic treatments at diagnosis (p < 0.001) and biologics at diagnosis and time of survey (p = 0.029 and p < 0.001, respectively).
Patients diagnosed with moderate PsO showed greater quality-of-life impact in the DLQI (p = 0.006) and WPAI (p = 0.002 and p = 0.006, respectively).

Conclusions:
Dermatologists may underestimate severity and treatment requirements in patients diagnosed with mild-moderate PsO. Further research into PsO underdiagnosis and advanced treatment use in cases of mild PsO may provide better optimised treatment strategies.

Source: onlinelibrary.wiley.com

*Funding: Johnson & Johnson

[Caroline]

Question:
Has this been published recently? It seems a bit old 2021-2022 piece of research.

It is sad to see that dermatologists seem to be less professional then you would expect them to be.

It also shows that BSA is apparently not a good way to measure psoriasis. … Indeed I think PASI is better. And I can imagine that there are even better ways of measuring, although maybe not “validated” and therefore “copyrighted”
Did you know that by the way? That all those measuring question lists are copyrighted? Utter senseless copyrighting a question list…..

It does seem logical that if you are considered too low, that you deteriorate.
And it is logical that the heavier patients get “better” treatments, systemics and biologics.

The risk that mild cases with to low treatment in the sense of comorbidities have, I consider as very serious.

[Fred]

Question:
Has this been published recently? It seems a bit old 2021-2022 piece of research.

It is sad to see that dermatologists seem to be less professional then you would expect them to be.

It also shows that BSA is apparently not a good way to measure psoriasis. … Indeed I think PASI is better. And I can imagine that there are even better ways of measuring, although maybe not “validated” and therefore “copyrighted”
Did you know that by the way? That all those measuring question lists are copyrighted?  Utter senseless copyrighting a question list…..

It does seem logical that if you are considered too low, that you deteriorate.
And it is logical that the heavier patients get “better” treatments, systemics and biologics.

The risk that mild cases with to low treatment in the sense of comorbidities have, I consider as very serious.

It was published 07 this month on Wiley before inclusion in "Journal of the European Academy of Dermatology and Venereology" next edition.

The Psoriasis Club Pscore is copyright but free to use