Ryan Haumschild, PharmD, MS, MBA, leads a panel discussion highlighting the current prevalence of psoriasis.
Ryan Haumschild, PharmD, MS, MBA: Hello, and welcome to this AJMC® Stakeholder Summit program titled “Treating Psoriasis Across All Skin Phototypes.” My name is Ryan Haumschild. I’m the director of pharmacy services at Emory Healthcare and Winship Cancer Institute in Atlanta, Georgia.
Joining me in this discussion are my valued colleagues: Dr Amy McMichael, a professor in the department of dermatology at Wake Forest School of Medicine [in Winston-Salem, North Carolina]; Dr Bruce Sherman, an adjunct professor in the department of public health education at the University of North Carolina Greensboro [in Greensboro, North Carolina] and a medical adviser for the National Alliance of Healthcare Purchaser Coalitions; and Dr Maria Lopes, a former chief medical officer at Magellan Rx [in Cresskill, New Jersey]. Our panel of experts will explore the burdens associated with psoriasis treatment considerations for all skin prototypes and address disparities in care among patients with psoriasis. Let’s begin.
Let’s first discuss the presentation of psoriasis across all skin types and the different humanistic burdens associated with psoriasis, specifically in those with skin of color. Dr McMichael, I’d like you to address this question to get us started. Explain the prevalence of incidence of psoriasis, and then follow that up with the prevalence of psoriasis and skin of color populations across ethnicities.
Amy McMichael, MD: Thank you very much for that great question. This is a really important topic. We’re great on prevalence in psoriasis but not so great on incidence, so I’m going to lay that as the groundwork. For prevalence, about 3% of the US population has psoriasis. That translates to about 7.5 million people. For African Americans, you’re talking about 2% or thereabouts. It goes down from there, and it’s less clear in terms of the true data because we’re getting data from imperfect sources. But looking at the Asian population, it looks like maybe around 1.2%. For Hispanics and others—we think of Hispanic as an ethnicity and not as a racial category—it’s even less, around 0.5%. This is in adults 20 years and older. That’s where we sit in this country. For incidence data, because they’re talking about how many new cases [there are], we don’t have great measures because we don’t have the databases required for our physicians to put in their information as patients get new cases or present with new cases. We’re not great at that in this country.
Ryan Haumschild, PharmD, MS, MBA: I appreciate you explaining the prevalence of the incidence because not a lot of us have a great understanding of it. There’s a lot of opportunity for us to understand not only the prevalence of the incidence but also the best treatment for patients and patients’ specific considerations, which is what you were hinting at. How does psoriasis present across skin prototypes? Besides skin prototypes, how does psoriasis present within different ethnic backgrounds?
Amy McMichael, MD: You’re right: the incidence or prevalence data are very important. Until very recently, before we had these data, people thought it was quite rare to occur in African American patients. As a matter of fact, years ago I wanted to write a thesis for a program on psoriasis and African Americans, and I was told by an epidemiologist who was an internist that you couldn’t do that because African American people don’t have psoriasis. Of course, as a dermatologist, I knew that to not be true, but there’s still a lot of that sentiment around. We need to get those data out there.
How does that tie into the fact that patients who have skin of color don’t have typical psoriasis lesions? It ties in because if you don’t see typical psoriasis lesions, then you’re not diagnosing the patient correctly. That’s why people think we don’t have patients with psoriasis who are of color because they’re not recognizing it. In people who have darker skin—particularly African Americans, maybe darker people of Hispanic origin, darker Asian patients—you’re not going to see the erythema in those lesions. We’re used to seeing a very erythematous—red and scaly—and prominent lesion. Unfortunately, in brown skin, a lot of times that red is not as visible. It looks purplish or sometimes just looks brown. So then you think, “This must be eczema, contact dermatitis, or something else.” As a result, patients are misdiagnosed for a long time. They’re often not diagnosed until they get something like psoriatic arthritis, and then we’re backtracking diagnostics.
It tends to be a little easier in fair-skinned patients of Asian descent or Hispanic descent. In terms of how the lesions may look a little different in people of African descent, there tends to be a little more calcification around the lesions, a more hypertrophic appearance. There even there tends to be worse disease—thicker disease, more disease. That’s backed up by several studies that have come out in the last 10 years. We’re missing the bulk if we don’t focus on patients of color because when they do have psoriasis, they tend to have a very thick and difficult-to-treat disease, and they also have a larger burden of disease on their bodies in general.
Ryan Haumschild, PharmD, MS, MBA: We’re learning and understanding how to treat patients differently. It seems like such a huge unmet need.
Transcript edited for clarity.