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Valuable Quality of Life Assessments in Psoriasis


Amy McMichael, MD, explores why psoriasis can substantially affect quality of life more severely in some ethnicities more than others.

Ryan Haumschild, PharmD, MS, MBA: There was a study that found patients with psoriasis who are Black, Hispanic, Latino, or Asian report a greater impact from psoriasis on quality of life than White patients with psoriasis. Dr McMichael, I think about this a lot because these patients are valued employees, family members, and citizens. When they have impacts on their quality of life, it impairs their ability to live their best life. When you’re meeting with your patients, what are some of the quality-of-life assessments that are valuable in psoriasis? How are you using these assessments in your clinical practice to guide treatment selection?

Amy McMichael, MD: The majority of tools we use are used in clinical trials. There’s the Dermatology Life Quality Index. There are some specific psoriasis questionnaires that you can use for quality of life in real practice situations. Unfortunately, we don’t have time to use those tools. We have access to them from many of the clinical trials that have been done lately because the FDA requires them. However, the data we get from those trials are very limited because there aren’t enough people of color in those trials. A couple of companies, fortunately, are doing trials looking at African American patients or skin-of-color patients for psoriasis treatment only. I’m very excited about that. But these are just starting to come on board.

In my practice setting, I’ll speak with a patient about what’s going on. Many times they’ll have a family member in the room with them who will answer those questions when I ask. I’m talking to the patient, but the spouse or the daughter or the son or the parent or whoever will say, “This person isn’t able to go to work every day because they’re feeling this way.” At times I’ll have a patient tell me, “I’m not sure I can go on with this.” I’ve had to stop and say, “Do we need to get you referred to somebody to talk to you about your overall emotional and psychiatric health?” I’ve done that. It becomes a relationship in that room [based on] how comfortable that patient feels. They need to feel they can talk to you about that side of things, not just about, “When’s my next dose? What labs do I need to get?” [You also want them to say], “I’m not feeling the way I should, and I might hurt myself,” or “I might not be able to go on in this journey.”

You have to have an open heart with your patients. Let them know that you’re interested in their emotional health too. “I know your psoriasis is doing better, but how are you feeling? How’s everything going? Are things OK at home?” I always start that questioning when I walk in the room. I try to place where people are and meet them wherever they’re sitting. The short and long of it is that we’ll have more specific answers about the overall quality of health as trials with more patients of color come on board. But we still have to get that interaction in the room going.

Part of the problem is the access issue. Sometimes we don’t have dermatologists in the neighborhoods where people of color live. That’s an overall dermatologic problem that we need to address. But we don’t have a lot of people of color in dermatology. We’re the second-worst specialty in the country after orthopedics, in terms of patients with African American or people of underrepresented minorities in medicine in our specialty. We have work to do there. That’s not to say that every interaction needs to be race concordant, because I don’t think that’s the goal. But the goal has to be that people of color in dermatology are in the communities. We know that that happens more often for people with skin of color going to those communities to work. We need to balance the access for patients, and we need to have the doors open for them to talk to us when they get there.

Ryan Haumschild, PharmD, MS, MBA: Yeah, [we have to] insert ourselves in the communities, go to where they are, meet them where they’re at. What an opportunity for us across the board, but specifically in dermatology for psoriasis.

Transcript edited for clarity.

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