Mark Lebwohl, MD, participated in the “Late Breakers in Psoriasis” session at the 2024 Winter Clinical Dermatology Conference, held January 12-17, 2024 in Honolulu. Though not a direct focus of this presentation, Dr. Lebwohl and colleagues had a paper published online in December 2023 in the Journal of Dermatological Treatment.
The authors explored associations between psoriasis severity and special area (scalp, nails, palms, soles, genitals) involvement in health-related QOL (HRQOL), psoriasis symptoms, and work/activity impairment. The impact of plaque psoriasis extends beyond the physical symptoms, significantly affecting patients’ HRQOL and their ability to work effectively.
One of the key treatment goals for plaque psoriasis is to reduce the affected body surface area (BSA), as doing so can lead to substantial improvements in HRQOL and work productivity. However, special areas are often more challenging to treat and may not respond well to standard therapies. Psoriasis involvement in these areas can have a significant impact on patients’ HRQOL, even if the overall BSA involvement is relatively low.
Studies have shown that up to 90% of patients with plaque psoriasis will experience lesions in at least one special area during their lifetime. The presence of psoriasis in these areas can lead to feelings of embarrassment, self-consciousness, and stigmatization, further exacerbating the psychological burden of the disease. As a result, treatment guidelines recommend considering systemic therapies, especially when topical treatments have been ineffective in addressing psoriasis in special areas.
Patient-Reported Outcomes for Assessing Psoriasis Impact
Patient-reported outcomes (PROs) play a crucial role in assessing the impact of plaque psoriasis on patients’ daily lives and treatment effectiveness. PROs provide valuable insights into how patients perceive their disease and its effects, allowing healthcare professionals to tailor treatment plans to individual needs. However, traditional measures of disease severity, such as BSA involvement, may not fully capture the impact of psoriasis on HRQOL, particularly in special areas.
To better understand the relationship between disease severity, special area involvement, and PROs, Dr. Lebwohl and team conducted a study using data from the CorEvitas Psoriasis Registry. This registry collects comprehensive data from adult patients diagnosed with plaque psoriasis who are initiating biologic or non-biologic therapies. The study included patients who had 6-month follow-up data available and assessed disease severity based on BSA involvement and the presence of psoriasis in special areas.
Special Area Involvement a Key Factor in HRQOL
The results of the study showed that increasing disease severity, as measured by BSA involvement, was associated with worsening HRQOL, more severe psoriasis symptoms, and greater work and activity impairment. Patients with psoriasis in special areas reported even greater HRQOL impairment and symptom severity compared with those without special area involvement, despite similar BSA scores.
Furthermore, improvements in BSA were associated with significant improvements in HRQOL and symptom severity, highlighting the importance of achieving skin clearance in the management of plaque psoriasis. Patients who achieved at least 75% improvement in BSA experienced marked improvements in HRQOL and work productivity, underscoring the significance of treatment response in patient outcomes.
Overall, the study emphasized the importance of considering both disease severity and special area involvement when assessing the impact of plaque psoriasis on patients’ lives. Tailored treatment approaches that address the unique challenges posed by psoriasis in special areas are essential for improving patient outcomes and enhancing HRQOL, noted the study authors. By incorporating PROs into clinical practice, healthcare professionals can better understand patients’ perspectives and work collaboratively to optimize treatment outcomes.
