Q&A: Psoriasis, mental health care affected by socioeconomic burdens

In this issue’s cover story, experts discussed how reducing psoriasis in the patient is the best way to curb the negative impact on mental health that stems from disease stigma.

However, not everyone in the United States is offered the same level of care to do so.

Healio Psoriatic Disease spoke to Paul Wallace, MD, MPA, a Los Angeles-based, board-certified dermatologist and researcher, about how socioeconomic status can affect the level of care for patients with psoriasis.

Healio: How does socioeconomic status affect the stigma of psoriasis and the ability to receive care?

Wallace: There has always been a stigma regarding skin disease. It is something you cannot hide. Most patients with moderate to severe psoriasis want to be invisible, or like everyone else in regard to their skin.

People look at psoriasis and think it is contagious. It is red, it is inflamed, sometimes it can be bleeding.

For some with psoriasis it is an inconvenience, but it is something that can be worked through. But, say you are a blue-collar worker – not necessarily someone in the supervisor or corporate level – and you need light therapy. Here in the Los Angeles area, it could take an hour to get there, it is a 30-minute treatment, and then an hour to get back. And you need to do it three times a week. To miss 2.5 hours of work three times a week is unacceptable. As you move from one economic level to another you might not have the luxury to do the treatments.

This is a solvable, controllable problem and we have not been making this accessible to everyone in this country.

Healio: How do insurance companies and different levels of coverage affect psoriasis patients’ ability to get proper treatment?

Wallace: There is clearly a 2-tier, perhaps even a 3-tier, system in this country. If you have commercial or employment insurance and a PPO, you can get all of the FDA-approved biologics at no cost to you. But if you are on a government assisted program, you have to go through a tremendous number of hurdles to get the medication.

That is one of the most frustrating things for me as a physician. This is so far away from the practice of medicine in being dictated by insurance companies.

For example, we know the efficacy of methotrexate is far below the least-effective biologic. And there has been a number of studies that show it is cost effective to get these patients’ disease under control to improve their quality of life and their ability to be productive citizens. But many government programs mandate 3 months of methotrexate before moving on to biologic treatments.

There is a gap in the type of care some individuals get. It is not unusual that those on state insurance plans have as much as a 6 month wait before they can get into our office. They need to get approval by their insurance company and many times a referral from their primary care doctor before they see a specialist.

Healio: In this issue’s cover story we discuss the importance of mental health help for psoriasis patients who are suffering from the effects of stigma from their disease. How is the ability to receive mental health care impacted by socioeconomic status?

Wallace: If it is possible I send all of my patients to a psychologist to have either one-on-one or group sessions to help them understand they are not alone.

The problem is in 90% or more of insurance plans, especially those with government plans, counseling is not included.

Availability and accessibility for all in this country would be the best approach.

• For more information:
• Paul Wallace, MD, MPH, can be reached at the Wallace Skin and Body Institute, 5120 Goldleaf Circle, Suite 20, Ladera Heights, CA 90056; email: paulwallacemd@gmail.com.