Half of people with psoriasis are not satisfied with the
treatment they're receiving for the skin condition, according to a new study.
Marked by recurring patches of scaly, itchy skin, psoriasis
affects about seven million adults in the US and can be treated with topical
creams, light therapy and oral medications. Up to 20% of psoriasis patients
eventually develop a form of arthritis related to the condition called
psoriatic arthritis, according to the US Centers for Disease Control and
Prevention. "Compared to other chronic conditions, patients with psoriasis
and psoriatic arthritis may be at particularly increased risk of not receiving
adequate treatment," lead author Dr April Armstrong, a dermatologist at
the University of California, Davis, said.
Although that's not always a problem for people with mild
psoriasis, those with more severe forms of the condition have an increased risk
of a range of other health problems, researchers said. Between 2003 and 2011,
more than 5 000 psoriasis or psoriatic arthritis patients in the US filled out
surveys about prescription medication use and treatment satisfaction for the
National Psoriasis Foundation.
Depending on the year, between 9 and 30% of the almost 1 900
people with severe psoriasis were not receiving treatment, with higher
percentages for mild and moderate psoriasis. Just over half of psoriasis
patients and 45% of those with psoriatic arthritis reported being dissatisfied
with their treatment, according to results published in JAMA Dermatology.
Most people who stopped taking newer injectable and
intravenous drugs reportedly did so due to side effects or because the
medication wasn't working. Some also reported being unable to secure insurance
coverage for so-called biologic medications, which include etanercept (marketed
as Enbrel) and adalimumab (Humira).
Among patients who discontinued biologic medications in
2008, for example, 25% reported it had not worked, 17% reported a negative side
effect and 5% said their insurance would not pay, or they could not afford the
The fact that so many patients stopped biologic medications,
which are some of the newest and most effective options for severe psoriasis,
indicates that better treatments are still needed, Dr Will Taylor, a
rehabilitation medicine specialist who researches psoriatic arthritis at the
University of Otago in Wellington, New Zealand, said.Taylor, who was not involved in the study, noted to Reuters
Health that it only included members of the National Psoriasis Foundation, a
small percentage of the total number of psoriasis patients in the US, which is
For people with severe psoriasis, inadequate treatment can
be serious because the condition is tied to physical and psychosocial problems,
Armstrong said by email. "Severe psoriasis is associated with increased
risk of heart attack, stroke, and cardiovascular deaths," she said.
Many patients ashamed
"Many patients are ashamed of this skin disease and do
not wish to go to a barber, a public swimming pool, or be involved in intimate
relationships. "Psoriasis patients are also at increased risk of depression
and suicide, Armstrong said. She has received research grants or honoraria from
pharmaceutical companies that make biologic drugs.
Many people may not have access to care or may not
understand the severity of potential side effects of psoriasis, which could
explain the undertreatment rates, Andrew Robertson, chief medical and
scientific officer for the National Psoriasis Foundation in Portland, Oregon,
experienced with psoriasis aren't necessarily available to everyone in every
area, and many insurance plans are hesitant to cover biologic medications,
which may cost up to R256 000 yearly.
Some plans put psoriasis patients in a "specialty
tier", which could require them to pay as much as 25% of the cost of the
That practice puts
medications out of reach for some patients, Robertson told Reuters Health. But
for mild cases of psoriasis, forgoing treatment may not be a big deal, Taylor said.
The researchers agreed that psoriasis varies widely from
patient to patient and treatment should be tailored to individual needs.