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Plaque psoriasis
Psoriasis Academy

Psoriasis Management

Read time: 70 mins
Last updated:7th Aug 2023
Published:7th Aug 2023

Psoriasis management

Burden of psoriasis

Psoriasis is a chronic inflammatory disease that affects approximately 2% of the population. In the majority of cases, people with psoriasis present with disfiguring, scaling, and erythematous plaques of the skin.

It is defined by the World Health Organisation as a chronic, non-communicable, painful, disfiguring, and disabling disease, for which there is no cure and with great negative impact on patients’ quality of life (QoL)1

Moderate-to-severe plaque psoriasis (with or without psoriatic arthritis) places significant social, physical and emotional burden on patients’ lives2,3. Despite treatment, many patients with psoriasis continue to experience clinical symptoms and impaired functioning4

With the significant impact on patient’s QoL, psoriasis impacts use of healthcare resources, associated costs, and work productivity5,6.

The visible disfiguration associated with psoriasis, particularly when on exposed areas of the body, leads to a significant psychological impact and reduction in QoL, which can include:

  • relationship difficulties
  • employment problems
  • low self-esteem
  • avoidance of social situations and isolation7,8

Patients have reported that itching/scratching, flaking/scaling and skin pain, had a significant impact on their social and emotional lives5.

Burden of psoriasis

Psoriasis is a chronic inflammatory disease that affects approximately 2% of the population. In the majority of cases, people with psoriasis present with disfiguring, scaling, and erythematous plaques of the skin.

It is defined by the World Health Organisation as a chronic, non-communicable, painful, disfiguring, and disabling disease, for which there is no cure and with great negative impact on patients’ quality of life (QoL)1

Moderate-to-severe plaque psoriasis (with or without psoriatic arthritis) places significant social, physical and emotional burden on patients’ lives2,3. Despite treatment, many patients with psoriasis continue to experience clinical symptoms and impaired functioning4

With the significant impact on patient’s QoL, psoriasis impacts use of healthcare resources, associated costs, and work productivity5,6.

The visible disfiguration associated with psoriasis, particularly when on exposed areas of the body, leads to a significant psychological impact and reduction in QoL, which can include:

  • relationship difficulties
  • employment problems
  • low self-esteem
  • avoidance of social situations and isolation7,8

Patients have reported that itching/scratching, flaking/scaling and skin pain, had a significant impact on their social and emotional lives5.

Expert-led assessment of relevant clinical guidance

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Unmet patient needs in psoriasis

Join Professor Peter van de Kerkhof from Radbound University Nijmegen, Netherlands, as he explores unmet needs in management of patients with moderate psoriasis.

 

Despite the availability of different treatment options for psoriasis, unmet needs may prevent patients from achieving long-term psoriasis control

Person-centred care requires that therapy is aligned with the patients’ needs/treatment goals. The German Psoriasis registry (PsoBest) has demonstrated that the majority of people with moderate-to-severe psoriasis aspire to a normal everyday life with a low treatment burden18.

Several unmet patient needs have been identified in the field of psoriasis, as summarised in Figure 2.Several unmet needs have been identified in the field of psoriasis

Figure 2. Unmet needs in management of psoriasis19–26.

Psoriasis undertreatment

National surveys by the National Psoriasis Foundation have previously reported that an estimated 24%–36% of people with moderate psoriasis and 9%–30% of people with severe psoriasis were not receiving treatment27

The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey suggests that psoriasis is currently undertreated19. The MAPP survey showed that approximately 30% of people with moderate psoriasis, and approximately 20% of patients with severe psoriasis, were only receiving topical treatment. In addition, it was revealed that many patients are not receiving therapy that addresses the underlying inflammation and/or associated co‐morbidities (i.e., cardiovascular disease, psoriatic arthritis, metabolic syndrome)19.

Efficacy of current psoriasis therapies and long-term control

Dermatologists in the United States, Canada, France, Germany, Italy, Spain, and the United Kingdom, have previously cited concerns around the efficacy of currently available therapies as one of the key contributory factors in the unmet treatment needs for patients with psoriasis20. The following treatment factors have been identified as preventing people with moderate-to-severe psoriasis from achieving long-term control21:

  • Delays in initiating systemic treatment
  • Frequent treatment discontinuation 
  • Frequent dose escalation
  • Frequent dose reduction

In addition, the efficacy from the concomitant use of ≥2 therapies with differing mechanisms of action can fail to achieve desired treatment outcomes21,28.

This highlights the importance of exploring emerging monotherapies, such as IL-17A inhibitors, for achieving improved disease clearance28. Treatment goals that may be achieved through monotherapy, as highlighted by the emergence of new biologic therapies such as IL-17A inhibitors, should not be overlooked28

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Psoriasis diagnosis and identification

Listen to commentary from Professor Peter van de Kerkhof on the use of Psoriasis Area Severity Index (PASI) scores in clinical practice, particularly for objective severity assessment.

 

Psoriasis diagnosis and identification

Listen to commentary from Professor Peter van de Kerkhof on the use of Psoriasis Area Severity Index (PASI) scores in clinical practice, particularly for objective severity assessment.

 

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Patient wellbeing in psoriasis

In this three-way discussion, a dermatologist discusses patient wellbeing in psoriasis with a wellbeing expert and a person living with psoriasis. This is a dynamic and frank discussion, with each speaker offering unique experience and valuable insight on the core clinical issue of mental health and wellbeing in people with psoriasis, concluding that:

  • People with psoriasis often suffer comorbid mental health conditions
  • PASI score does not correlate with overall patient wellbeing
  • The WHO-5 questionnaire can be used to assess patient wellbeing in clinical practice
  • Patients need better mental health support

Watch the highlights and key takeaway messages from the perspectives of Professor Ulrich Mrowietz (dermatologist), Professor Jordi Quoidbach (wellbeing expert) and Jessica Towner (person living with psoriasis). You can also download our infographic on implementing wellbeing consideration into your own clinical practice.

Discussion introduction and highlights

Introduction to the discussion on wellbeing in people with psoriasis
Mental health comorbidities and their impact on people with psoriasis
Effective alternatives to medications to treat stress-induced worsening of psoriasis
Psychological approaches to supporting psoriasis patients
2

Watch the highlights and key takeaway messages from the perspectives of Professor Ulrich Mrowietz (dermatologist), Professor Jordi Quoidbach (wellbeing expert) and Jessica Towner (person living with psoriasis). You can also download our infographic on implementing wellbeing consideration into your own clinical practice.

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COVID-19 and psoriasis

Learn from expert videos and podcasts how to answer your patients’ questions about the COVID-19 pandemic

Join experts Professor Ulrich Mrowietz and Professor Diamant Thaçi as they explore considerations for psoriasis management with systemic and biologic immunosuppressive and immunomodulatory treatment in the age of COVID-19.

General aspects on COVID-19 and patients with psoriasis – with Professor Ulrich Mrowietz

Click here to watch videos with German subtitles

Click on the list icon in the video player (bottom, right-hand side) to directly access the answer to the below questions.

  1. Have many of your patients been in contact with you regarding COVID-19 and treatment for their psoriasis? (00:00 - 01:35)
  2. What additional steps have you taken to support your patients during the current SARS-CoV-2 pandemic? (01:35 - 02:08)
  3. Do you recommend any particular preventive measures for patients with psoriasis during the current SARS-CoV-2 pandemic? (02:08 - 02:47)
  4. What are the risk factors for a severe course of COVID-19? (02:47 - 04:06)
  5. In your opinion, should patients with psoriasis who are taking immunosuppressant drugs stop treatment to reduce their risk of severe COVID-19? (04:06 - 05:08)
  6. In your opinion, are patients with psoriasis taking immunomodulatory rather than pan-immunosuppressant systemic treatment at reduced risk of severe COVID-19? (05:08 - 06:02)
  7. Do you think that immunosuppressant treatments may be beneficial given the ‘cytokine storm’ caused by the virus in severe COVID-19? (06:02 - end).

In this part of our expert interview, we asked Professor Ulrich Mrowietz (Head, Psoriasis Centre, University Medical Centre Schleswig-Holstein, Germany) some key questions around the impact of COVID-19 for patients and their treatment. These included questions about whether patients should start and continue their treatment, and what to do if they are unable to attend scheduled appointments.

We also asked Professor Mrowietz about the risk factors for severe COVID-19, and whether targeted psoriasis treatments could be of use in treating the ‘cytokine storm’ observed in patients with severe COVID-1984.

COVID-19 and psoriasis treatments

COVID-19 and fumaric acid esters in moderate-to-severe psoriasis

Click here to watch videos with German subtitles

Click on the list icon in the video player (bottom, right-hand side) to directly access the answer to the below questions.

  1. Would you recommend starting a patient on dimethyl fumarate (DMF) during the pandemic? (00:00 - 01:53)
  2. In your opinion, is there an elevated risk for infections in patients taking DMF? (01:53 - 03:02)
  3. Do you think there are any patient groups in which DMF treatment requires modification? (03:02 - 04:30)
  4. If DMF treatment has been discontinued for any reason, how should treatment be re-initiated? (04:30 - 05:45)
  5. What should dermatologists do if their patients have missed routine monitoring appointments because of the SARS-CoV-2 pandemic? (05:45 - 06:48)
  6. What would you recommend if a patient on DMF treatment develops symptoms suggestive of a viral respiratory infection, e.g., coughing, sore throat and rhinorrhoea? (06:48 - 07:39)
  7. What would you recommend if a patient on DMF treatment has symptoms of COVID-19, e.g., persistent cough, fever? (07:39 - 08:23)
  8. Are there any treatments for the symptoms of COVID-19 that would interact with DMF treatment? (08:23 - end).

The fumaric acid ester treatment dimethyl fumarate (DMF) is a systemic treatment for moderate-to-severe psoriasis, which is widely used in Northern Europe, particularly in German-speaking countries and the Netherlands85

In this part of our expert interview, we asked Professor Mrowietz some pivotal questions on the impact of COVID-19 for patients and DMF treatment. These included questions about initiating treatment during the pandemic, and how to manage the regular blood count appointments required to monitor leukocyte and lymphocyte counts86.

We also asked Professor Mrowietz about the SARS-CoV-2 infection risk for patients on DMF treatment and any potential drug interactions for patients with confirmed COVID-19.

COVID-19 and biologic treatments for moderate-to-severe psoriasis

Click here to watch videos with German subtitles

Click on the list icon in the video player (bottom, right-hand side) to directly access the answer to the below questions.

  1. Would you recommend starting a patient on a biologic during the SARS-CoV-2 pandemic? (00:00 - 02:05)
  2. Do you think there are any patient groups in which ongoing biologic treatment should be stopped? (02:05 - 03:04)
  3. Would you recommend any additional monitoring for patients with ongoing biologic treatment during the SARS-CoV-2 pandemic? (03:04 - 04:37)
  4. During the SARS-CoV-2 pandemic, which factors are important for dermatologists to consider when selecting a biologic for patients with psoriasis? (04:37 - 06:02)
  5. What is the role of the different biologic treatment targets with regard to the anti-viral immune response? (06:02 - 07:05)
  6. In your opinion, what insights from the safety profile of IL-23 biologics may be helpful during the current pandemic? (07:05 - 08:13)
  7. In your opinion, how does the dosing interval impact the suitability of a biologic treatment during the SARS-CoV-2 pandemic? (08:13 - 09:20)
  8. What would you recommend if a patient on an IL-23 biologic develops symptoms suggestive of a viral respiratory infection, e.g., coughing, sore throat and rhinorrhoea? (09:20 - 10:36)
  9. What would you recommend if a patient on an IL-23 biologic has symptoms of COVID-19, e.g., persistent cough, fever? (10:36 - end).

 

Psoriasis is a systemic inflammatory disease. Discontinuation of biologic treatment could lead to a worsening of symptoms and a lower efficacy in people with psoriasis after treatment interruption87.

We asked Professor Mrowietz several questions on COVID-19 relevant to biologic treatment for psoriasis. These included questions about the SARS-CoV-2 infection risk for patients on biologic treatment and whether to suspend biologic treatment during active infection.

Professor Mrowietz discusses factors to consider when selecting a biologic during the COVID-19 pandemic, with a longer dosing interval, such as that for IL-23 biologics, being advantageous when social distancing is required.

Effectiveness of biologic therapies with reduced dosing schedule during COVID-19


Join our expert, Professor Diamant Thaçi (Director, Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Germany), and find out how the COVID-19 pandemic has impacted physicians and their patients. Learn about the essential need for greater information, education, and continuous treatment during this time as well as the impact of COVID-19 on making treatment decisions.

Risk of COVID-19 in people with psoriasis


Do people with psoriasis face a greater risk of catching or developing severe cases of the disease? Join our expert to stay up to date with the latest literature on managing patients during the COVID-19 pandemic, and find out about the dangers of undertreatment, the need for vaccinations, and the risks of comorbidities.

Podcasts on COVID-19 and psoriasis

Join our moderator, Dr Julia-Tatjana Maul, and listen to our podcasts to hear:

  • Professor Ulrich Mrowietz share guideline updates during the COVID-19 pandemic
  • Dr Christian Greis discuss online patient consultations with the derma2go platform
  • Professor Ricardo Romiti explain his role in the Global Psoriasis Atlas in Latin America

In this series of podcasts moderated by Dr Julia-Tatjana Maul (Senior Dermatologist; Head, Psoriasis Clinic and Clinical Trials Team, University Hospital of Zürich, Switzerland), the impact of the SARS-CoV-2 pandemic is discussed with her guests Professor Ulrich Mrowietz , Dr Christian Greis, (Dermatological Resident, University Hospital of Zürich, Switzerland), and Professor Ricardo Romiti (Clinical Professor of Dermatology; Head, Psoriasis Unit, University Hospital of São Paulo, Brazil).

  • Episode 1: Professor Mrowietz talks about COVID-19 and systemic treatment
  • Episode 2: Dr Greis discusses teledermatology and the derma2go platform
  • Episode 3: Professor Romiti discusses the Global Psoriasis Atlas and COVID-19 in South America

These podcasts were created independently by EPG Health with support from Almirall S.A. This content belongs to EPG Health and is not to be copied. All Rights Reserved.

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