26 August 2013

Psoriasis treatment often inadequate

A new study indicates that half of people with psoriasis are not satisfied with the treatment they're receiving for their skin condition.


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.

Biologic medications discontinued

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 medication.

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 a limitation.

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, said.

 Dermatologists 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 drug.

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.


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Dr Suretha Kannenberg holds a degree in Medicine and a Masters in Dermatology from the University of Stellenbosch. She is employed as a consultant dermatologist by Stellenbosch University and Tygerberg Academic Hospital, where she is involved in clinical duties and the training of medical students and dermatology residents. Her areas of interest and research include vitiligo, eczema and acne. She also performs limited private practice work in the Northern suburbs of Cape Town in general and cosmetic dermatology.

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