A Personalized Approach to Disease Management in Psoriasis - Episode 3

Disease Burden for Patients With Plaque Psoriasis

Dr Mark Lebwohl explains disease burden for patients with plaque psoriasis and discusses the common comorbidities clinicians see.

Ryan Haumschild, PharmD, MS, MBA: I'm interested, Dr Lebwohl, on really what is the disease burden like for patients with plaque psoriasis when you consider quality of life, depression, these other considerations?

Mark Lebwohl, MD: It's extraordinary. Actually, a study was done a couple of decades ago in which the SF-36 [short form survey – 36], which is a tool that has two components. It has a physical functioning component and has a psychological functioning component. It's called the SF-36, and they looked at different diseases and compared SF-36 results as reported by psoriasis patients compared to patients with diabetes, stroke, cancer, congestive heart failure, severe depression, pulmonary disease. It turned out that on physical functioning, there was a worse outcome to having psoriasis compared to cancer, stroke, diabetes, hypertension, almost every other disease except advanced congestive heart failure, or advanced pulmonary disease. If you look at psychological functioning, the only disease that came out worse than psoriasis was severe depression. And that is easily explained if you think about it. I'll tell you a study that was done by a colleague of mine in Canada. He had first-year medical students painted- First, he asked them what their impression was of psoriasis, and many of them thought it was a trivial disease. He then had them paint on a temporary tattoo of plaques of psoriasis on their elbows and wear short-sleeved shirts. When they came back a couple of days later, I don't remember the duration of the trial, but when they came back, their attitude about psoriasis changed completely because they saw how people treated them. When they walked around in short sleeves and had those tattoos, it looked like psoriasis on their elbows. It impacts every aspect of your life. In fact, there have been many studies on absenteeism and presenteeism. Presenteeism is you're at your job but you're not thinking about it, you're thinking about your psoriasis and distracted from your job because of the symptoms of your psoriasis, or simply thinking about your psoriasis. Psoriasis' impact on absenteeism and presenteeism is extraordinary. If you look at depression, the frequency of depression and suicide is markedly increased in patients who have psoriasis compared to the general public. Thus, it is a disease that impacts all of those aspects of life. But in addition, the secret, the quiet adverse effect that people are developing, is accelerated atherosclerotic vascular disease, and all of the other comorbidities that exist, including psoriatic arthritis.

This transcript has been edited for clarity.