Q&A: Expert dives into first-ever national report detailing health impacts of psoriasis

Key takeaways:

• The report included details on social stigma, health disparities and comorbidities associated with patients with psoriasis.
• The report, published by the National Psoriasis Foundation, is the first of its kind.

Earlier this year, the National Psoriasis Foundation published an extensive report on the health impacts of psoriasis, including data on social stigma associated with the disease, health disparities and comorbidities.

This is the first-ever report detailing the health impacts of psoriasis, the foundation shared with Healio via email.

According to the report, approximately 3% of the adult population in the U.S., amounting to more than 7.5 million people, is affected by psoriasis. Additionally, approximately 600,000 adults live with the disease undiagnosed.

To dive deeper into the findings of this National Psoriasis Foundation (NPF) report, Healio spoke with April W. Armstrong, MD, MPH, professor and chief of dermatology at University of California, Los Angeles.

Healio: What are the most common stigmas that people hold against individuals with psoriasis?

Armstrong: Well, the NPF’s findings on this are very disheartening. The most common stigmas against individuals with psoriasis really involve the avoidance by those people who do not have the disease and their discomfort.

For example, over half of the general population are uncomfortable dating a person with psoriasis. About one-third of the general population would be uncomfortable having a person with psoriasis in their home, sharing a meal with a person with psoriasis or carpooling with a person with psoriasis.

In addition to that, about a quarter of people would be uncomfortable being friends with someone with psoriasis.

I would say that these statistics are very disheartening and one thing to note is that even individuals with mild or moderate psoriasis can also feel very isolated or sometimes embarrassed due to the misconception of others.

Healio: Why do you believe many Americans are uncomfortable around individuals with psoriasis?

Armstrong: I think one of the key reasons is that many people lack awareness or have misconceptions about psoriasis.

Despite the fact that psoriasis is not contagious, this latest document points to a widespread misunderstanding of the disease and therefore it is very important to educate the general public about the nature of the disease, and how it is not contagious. It really impacts people who are affected by this disease.

Healio: What can dermatologists do to help fight this stigma?

Armstrong: I think dermatologists play an important role in terms of not only treating psoriasis, but also fighting the stigma surrounding psoriasis in the general society.

It is very important for us to all volunteer our time to educate the general public as well as our patients about the noncontagious nature of psoriasis and the underlying inflammatory process that drives the disease.

We want to also encourage open conversations about psoriasis in different forms, including, for example, getting involved with our local communities, helping reduce the amount of misinformation and bringing our expertise to others.

It is also very important to spread the word about initiatives by the NPF. For example, there is a very important new patient storytelling initiative where patients and the general public can become informed about psoriasis and find stories about the experiences of those living with the disease.

Ultimately, this really gives people a place to learn more about those who live with psoriasis, clear misconceptions about the disease and help patients find effective treatment options.

Healio: Why are diverse groups from various racial and ethnic backgrounds more likely to live with undiagnosed psoriasis?

Armstrong: So, racial and ethnic minorities, based on the data, are more likely to live with undiagnosed psoriasis for a number of reasons.

Many of them have limited access to dermatologists or have longer wait times for diagnosis. Some research data also show that racial and ethnic minorities may have lower rates of ambulatory visits.

Additionally, many patients who either live in geographically remote areas or who may have transportation issues oftentimes will find that they have a difficult time getting to dermatologists.

So, it is very important to recognize these geographical-, financial- and insurance-related barriers that can affect patients from all racial and ethnic groups.

Healio: What can dermatologists do to help patients with psoriasis who struggle with health care barriers?

Armstrong: Dermatologists can play a critical role in terms of helping individuals to have better access to medical care and treatment. It is very important that as dermatologists we are seeking ways to provide quality care to patients who may be living in underserved areas through community outreach as well as tele-dermatology.

It is also very important to educate our primary care colleagues. We should bring our expertise to them so that they can make the proper referral when necessary for patients, especially those with more moderate to severe disease.

We also want to ensure that, as dermatologists, we are screening patients for comorbidities such as psoriatic arthritis, so that we can not only care for their psoriasis, but also play a critical role in the overall management of their comorbidities.

Healio: What comorbidities are most associated with psoriasis and how can dermatologists help treat them?

Armstrong: Psoriasis is associated with an increased risk for various cardiovascular comorbidities including hypertension, obesity and stroke. In fact, patients with psoriasis also have a higher cardiovascular disease-related mortality rate.

The reason for this is because of the chronic inflammation that underlies not only psoriasis, but also many of those cardiovascular risk factors and cardiovascular diseases. So, the link lies in the inflammation which is found in all these diseases.

As a result, it is very important for us to recognize these commodities and make sure that our patients are connected to other specialists who are experts at treating those diseases.

As dermatologists, we also want to recognize the latest data with regard to these comorbidities. For example, there is a 123% increase in the likelihood of obesity among patients with severe psoriasis, an over 50% increase in the risk for stroke and an 80% increased risk for mortality for all patients living with psoriasis.

While some of these data are not necessarily a surprise to dermatologists, because over the last 15 years we have had increased understanding with regard to these comorbidities, I think the next decade or so we will really be focusing on collaborative care between dermatologists and other specialties to ensure that our patients with psoriasis and psoriatic arthritis not only get optimal care for their skin and joints, but also for these cardiovascular and mental health comorbidities.

Healio: What can dermatologists do to limit more comorbidities?

Armstrong: There are several things that dermatologists can do to limit comorbidities, one of which includes promoting early diagnosis. Early recognition of psoriasis is important and part of that includes educating our primary care colleagues of what to look for and who to refer to.

Timely treatment of psoriasis is also important as that can help with decreasing psoriasis severity while also maximizing the chance of patient response. Newer data have shown that psoriasis patients who are treated early actually have a better likelihood at possibly even altering the disease course long-term vs. someone who has had untreated disease for a while.

Dermatologists should also encourage regular screening for comorbidities such as cardiovascular diseases that we mentioned earlier. Of course, regular screening for joint disease for psoriatic arthritis by dermatologists can also hasten the diagnosis of psoriatic arthritis and thereby improve the outlook for patients with early signs of that disease so that they do not progress to having severe joint damage.

In the data, we also learned that patients with even mild psoriasis can oftentimes feel quite isolated and stigmatized as well. I think the population with mild psoriasis is an area that the field has not focused on as much, but we are starting to recognize the impact of mild psoriasis in these patients’ lives, especially when the psoriasis involves certain areas such as the scalp or the genital area.

Healio: What resources would you point your psoriasis patients to for help managing their disease and reducing stigma surrounding psoriasis?

Armstrong: The NPF is the go-to place where patients can learn more about psoriasis as well as get resources on dermatologists and rheumatologists who specialize in the treatment of psoriatic disease. Through the NPF, patients can find a community of people who they can identify with as well as get involved in various helpful initiatives that improves the lives of patients living with psoriasis.

Finally, we need to make sure patients talk to their dermatologist, rheumatologist and other health care providers to ensure that their psoriasis is adequately cared for.

References:

• In Focus: #ThisIsPsoriasis. https://www.psoriasis.org/in-focus/. Accessed Nov. 18, 2024.
• Psoriasis Health Indicator Report. https://npf-website.cdn.prismic.io/npf-website/Zkt5kSol0Zci9SlA_Health_Indicator_Report.pdf. Published January 2024. Accessed Nov. 11, 2024.