Psoriasis, a complex, chronic autoimmune disease, affects approximately 125 million people worldwide. But it’s far more than just a skin condition. The associated comorbidities and emotional toll can significantly impact every aspect of a person’s life. In addition to the visible plaques that can be unsightly and cause physical discomfort, people with psoriasis may also experience feelings of extreme self-consciousness and social isolation—hidden symptoms that can oftentimes be overlooked. This is why, as our understanding of this condition and its underlying mechanisms evolve, it is crucial that our approach to its management and treatment advances alongside it.
Incorporating a patient-centered approach to care and including the patient in the entire decision-making process is seen as a critical strategy. Not only does it make the patient an active participant in their own health care, but it also fosters a sense of empowerment and collaboration. In this blog post, we’ll explore how adopting such a patient-centered approach can enhance psoriasis care and treatment and help improve patient satisfaction.
Understanding Psoriasis Beyond the Skin
To fully understand and optimize psoriasis treatment, it is essential to recognize psoriasis as the chronic inflammatory disease it truly is.
“Psoriasis, an immune-mediated, chronic inflammatory disease primarily affecting the skin and causing scaling, pain, itching and burning, is now widely accepted to be systemic in nature with manifestations beyond the skin. Patients with psoriasis can experience serious comorbidities including psoriatic arthritis (PsA), cardiometabolic syndrome, inflammatory bowel disease and psychological disorders.”
As healthcare providers, knowing and understanding the existing comorbidities and those potentially associated with psoriasis can help guide treatment pathways. By doing so, the visible symptoms of psoriasis can be treated alongside other arising symptoms and health issues, thereby optimizing treatment outcomes.
With respect to many of the comorbidities associated with psoriasis, taking a patient-centered approach to treatment is especially important. According to Mark Lebwohl, MD, a dermatologist with Mt. Sinai Health System, has stated, “People always ask which psoriasis drug is my favorite or which is best. The truth is, it’s a different drug for different patients because there are a whole range of conditions that we should look for and ask the patient about.” He adds that certain drugs may be risky for certain individuals depending on other underlying conditions, such as hypertension or diabetes. In the same way, people with, for example, congestive heart failure and latent tuberculosis (TB) could affect the type of drug required for psoriasis treatment. Dr. Lebwohl adds that, “I hope dermatologists will talk with patients about their symptoms and their comorbidities and apply a greater understanding of which drugs might work best in which circumstances. If they don’t, they’ll be relegated to trial-and-error in trying to find the right treatment, and they won’t necessarily be giving the best drug to the patient.”
Psoriasis and Quality of Life
In addition to the many comorbidities often associated with psoriasis, the physical symptoms can cause much more than itching, burning, and pain. These symptoms can significantly impact a person’s quality of life as they interfere with sleep, work, and other daily activities. Furthermore, the visible nature of this condition can often lead to feelings of distress as people feel embarrassed and stigmatized, which can result in low self-esteem, and even depression.
During a study of 300 patients with psoriatic disease, authors found that the overall prevalence of mild depressive symptoms was 54% for those with psoriasis and 69% for those with PsA. Furthermore, a total of 19.8% of patients with psoriasis and 30.1% of those with PsA had moderate to severe depressive symptoms.
Moreover, flare-ups are unpredictable, leading to increased anxiety for many patients, not to mention the cost and time required to treat and manage psoriasis. All of this takes a toll on the overall well-being of individuals.
A study published in 2023 by Armstrong et al. which examined patients’ understanding of psoriatic disease, associated comorbidities, disease burden, and relationships with healthcare professionals revealed that 48% of patients reported that their disease had a very large to extremely large effect on their quality of life (QoL). Only 13% of the 4,978 patients reported no impact of the disease on QoL. Furthermore, most of the patients in the study stated they had experienced stigma and discrimination (82%) and a negative impact on relationships (81%) in their lives.
Educating Patients on Psoriasis and Comorbidities
The study conducted by Armstrong et al. also evaluated how patients understood their disease and its relationship to other common comorbidities.
They found that 69% of the patients had heard that their disease was part of a systemic disease and 60% had previously heard of the term “psoriatic disease”. However, only 29% were aware that PsA was related to their psoriasis and less than one-third were aware of the relationship between psoriasis/PsA and common comorbidities including depression, anxiety, CVD (cardiovascular diseases), and diabetes.
A cornerstone of patient-centered care in the management of psoriasis is comprehensive education. However, effective care goes beyond merely explaining the basics of the disease. It means providing patients with in-depth information, helping them to understand the chronic nature of the disease, its potential impacts on overall health, and the importance of consistent management. With this detailed information, patients will have the tools they need to recognize the signs of flare-ups, adhere to their treatment plans, and make informed lifestyle decisions where appropriate.
Additionally, it is crucial for patients to learn about any potential comorbidities associated with psoriasis so that they can recognize these early on and seek the appropriate treatment. An increased understanding of their health can lead to improved outcomes and overall well-being.
A Multi-Disciplinary Approach: Involving Experts Across Specialties
Because psoriasis often involves multiple aspects of a patient’s overall health, bringing in other specialists in their care and treatment is essential.
“Psoriasis management encompasses a multidisciplinary team that includes other medical specialists, nurses, psychologists and social workers who also contribute to increasing patients' health-related QoL and well-being.”
Given the complex nature of the disease, collaboration with rheumatologists, cardiovascular specialists, and psychologists is sometimes necessary. By adopting this multidisciplinary approach, healthcare providers can ensure that all aspects of a patient’s health are addressed comprehensively. This, in turn, optimizes psoriasis treatment and enhances the overall quality of life.
Sommer et al. conducted an expert review on the importance of implementing well-being in the management of psoriasis. The experts suggest that current psoriasis management may not adequately address all relevant health domains, adding that as the main aim of healthcare is to restore or maintain health, the health outcomes should include all areas of the patient’s overall health. Their review looked to include the concept of well-being as an entity within the holistic therapeutic approach for patients with psoriasis. They conclude that “advanced healthcare in dermatology today requires an extended perspective related to the WHO (World Health Organization) concept of people-centered healthcare (PCHC).” This places the patient at the center of care delivery and means that “healthcare providers must understand the patient’s needs, preferences and values.”
In their study’s conclusion, Armstrong et al. reiterate the importance of assessing psoriasis severity from different viewpoints. This should include the physical impact, the impact on the patient’s everyday life, and QoL since the physical impact alone is not a sufficient indicator of the burden of disease.
Improving Patient-Provider Communication with Shared Decision-Making
Effective communication between patient and provider is key in a patient-centered approach to psoriasis management. When patients feel heard and understood by their providers, they are more likely to adhere to their treatment plans, share their concerns, and engage in self-care. These simple steps can go a long way in achieving better outcomes.
To enhance this level of care, it is crucial for providers to take the necessary time to listen and allocate adequate time to their patients for consultations and follow-ups. Addressing concerns, providing education, and offering support allows the patient to feel valued and empowered, which in turn builds trust and strengthens the patient-provider relationship.
As the one living with psoriasis, they know better than anyone how the disease affects them, what they can and cannot do, and what their priorities are. As providers, recognizing the patients’ needs and perspectives can enhance the treatment process.
In a population-based study conducted by Yee et al. it was found that “approximately 42% of patients with psoriasis reported high levels of shared decision–making (SDM).” Moreover, those with a high SDM score had, on average, 85% higher satisfaction with care. As such, researchers concluded by stressing the importance of constructing a framework for carrying out SDM efficiently to enhance physician-patient communication and improve patient outcomes.
By incorporating this collaborative approach to treatment, both patient and provider can set realistic goals and look ahead to improved outcomes.
Armstrong et al. echo these findings by stating “Increasing patients’ participation in their care can facilitate shared decision-making between patients and healthcare providers, which may result in better treatment adherence and patient outcomes.”
Conclusion
By providing comprehensive education, engaging in collaborative decision-making, fostering open communication, and involving a multidisciplinary team of experts, it is possible to offer patients with psoriasis more personalized and effective care. Doing so not only leads to better outcomes but also helps to empower patients to take an active role in their health.
Echoing Dr. Lebwohl’s earlier statement, each person’s experience with psoriasis is unique, so what works for one patient may not work for another. This is why tailoring psoriasis treatment plans to each patient is an essential part of effective care. It is important to recognize that psoriasis should not be treated as just a skin disease but as a complex systemic condition.
Sources:
- Psoriasis statistics. (n.d.). https://www.psoriasis.org/psoriasis-statistics/#:~:text=Prevalence&text=125%20million%20people%20worldwide%20%E2%80%94%202,the%20World%20Psoriasis%20Day%20consortium.
- Frede, N., Hiestand, S., Schauer, F. et al. Psoriasis and Psoriatic Arthritis Have a Major Impact on Quality of Life and Depressive Symptoms: A Cross-Sectional Study of 300 Patients. Rheumatol Ther 10, 1655–1668 (2023). https://doi.org/10.1007/s40744-023-00602-9
- A patient-centered approach to psoriasis treatment
- Armstrong AW, Bohannan B, Mburu S, Coates LC, Ogdie A, Alarcon I, Kasparek T, Frade S, Barrio SF, Augustin M. Patient Perspectives on Psoriatic Disease Burden: Results from the Global Psoriasis and Beyond Survey. Dermatology. 2023;239(4):621-634. doi: 10.1159/000528945. Epub 2023 Apr 19. PMID: 37075723; PMCID: PMC10357389.
- Sommer R, Mrowietz U, Gaarn Du Jardin K, Kasujee I, Martini E, Daudén E, et al. Implementing well-being in the management of psoriasis: An expert recommendation. J Eur Acad Dermatol Venereol. 2024; 38: 302–310. https://doi.org/10.1111/jdv.19567
- Shared decision-making and satisfaction with care in patients with psoriasis: A population-based study in the United States
