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Video Transcript

Uncovering Patient Perspectives

Welcome! This 3-part video series will delve into the impact of moderate psoriasis.

Psoriasis is a systemic immune disorder which can affect each patient differently. To understand a patient’s unique experience with psoriasis, healthcare professionals, or HCPs, should consider:^1-4

The impact of systemic inflammation
Special areas and symptoms, and
Individual patient perspectives

Each chapter of this series will focus on 1 of these components of a comprehensive disease assessment.

In chapter 3 of this video series, we will discuss the importance of considering patient perspectives in moderate psoriasis.

From a patient’s perspective, psoriasis can have a large impact despite more moderate skin involvement, when they are affected by special areas such as the scalp, or symptoms such as itch..^1-3

However, these patients’ disease severities may be underestimated by commonly used clinical measures such as body surface areas, or BSA, or psoriasis area severity index, or PASI.^5-6

For example, a population-based survey of patients in North America and Europe found that 39% of patients with moderate skin involvement by BSA perceived their psoriasis to be severe at its worst.⁶

One reason for this discrepancy may be that conventional clinical measures do not capture the full impact of psoriasis.^1-3

Measures such as BSA only assess the area of skin affected by psoriasis while PASI and sPGA account for the severity of psoriatic lesions. ^1-3,5-9

However, none of these measures account for the impact of special areas and symptoms, nor do they consider patient-reported outcomes or patient perspectives.^1,3,4,7,8

Additionally, patient-HCP misalignment on what aspects of disease contribute most to disease severity potentially contributes to the underestimation of patients’ psoriasis experience..¹⁰

For example, itch has been reported by patients as the most important factor contributing to disease severity. And drivers of disease severity, such as itch, may be underappreciated by HCPs.¹⁰

HCPs who see patients with psoriasis have an opportunity to probe deeper.¹

Although psoriasis severity is often defined by the extent of BSA affected by disease….¹

such conventional clinical measures can miss key factors and drivers of patient-perceived severity.¹

Recent treatment guidelines recommend looking beyond skin involvement when assessing disease severity and considering psoriasis in special areas, treatment history, patient perspectives, and impact of disease on quality of life.^1-4

HCPs can probe for patient perspectives to better understand the patient’s unique experience with their psoriasis.^1,4

A comprehensive assessment of all aspects of psoriatic disease is an important step towards optimizing patient-centered care.^1,4

Uncovering each patient's perception of disease and unique unmet needs can help ensure patient-provider alignment and a personalized approach to patient care.^1-3

References

Van Voorhees AS, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options. 6th ed. https://www.psoriasis.org/physician-member-benefits-portal/ Accessed March 9, 2021.
Menter A, et al. J Am Acad Dermatol. 2019;80;1029-2072.
Strober B, et al. J Am Acad Dermatol. 2020;82:117-122.
Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
Menter A, et al. J Am Acad Dermatol. 2019;80;1029-1072.
Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
Knuckles MLF, et al. J Dermatolog Treat. 2018;29:658-663.
Lebwohl MG, et al. J Am Acad Dermatol. 2014;70:871-881.e1-e30.
Cohen JM et al. J Rheumatol. 2015;42:1032–1033.
Gottlieb AB, et al. J Am Acad Dermatol. 2015;72:345-348.
Feldman SR, et al. Ann Rheum Dis. 2005;64(suppl 2):ii65-ii68.
Lebwohl MG, et al. Am J Clin Dermatol. 2016;17:87-97.

Video Transcript

Systemic Inflammation

Welcome! This 3-part video series will delve into the impact of moderate psoriasis.

Psoriasis is a systemic immune disorder which can affect each patient differently. To understand a patient’s unique experience with psoriasis, healthcare professionals, or HCPs, should consider:^1-4

The impact of systemic inflammation
Special areas and symptoms, and
Individual patient perspectives

Each chapter of this series will focus on 1 of these components of a comprehensive disease assessment.

In chapter 1 of this video series, we will take a closer look at the impact of systemic inflammation in psoriasis.

Although psoriasis commonly presents with skin manifestations such as well-demarcated red plaques with silvery scales the underlying cause of these plaques is more than skin deep.^1,2

It is important to recognize that psoriasis is a chronic systemic inflammatory disease...^1,2

...which can have a large impact on patients, even those with more moderate skin involvement.^1-3

For example, a population-based survey of patients in North America and Europe...⁵

...found that 39% of patients with moderate skin involvement perceived their psoriasis to be severe at its worst.⁵

To understand the systemic nature of psoriasis, let’s look deeper.

At a cellular level, psoriasis is the result of a sustained proinflammatory response caused by dysregulation of a complex signaling pathway involving dendritic cells, T-cell activation, and production of proinflammatory cytokines.^6-9

The sustained inflammatory response results in keratinocyte hyperproliferation and skin plaques which are hallmark features of psoriasis.^2,7

These inflammatory cytokines may diffuse away from psoriasis skin lesions into the circulation....^7,10,11

...causing patients with psoriasis to have elevated systemic levels of proinflammatory cytokines, driving systemic inflammation.^6,7,10,11

Several such mediators of psoriasis are also implicated in psoriatic arthritis, or PsA, a chronic inflammatory disease impacting the joints.^6,12-15

PsA is a common comorbidity, even in patients with moderate psoriasis. These patients may also have other serious comorbidities, such as cardiometabolic disorders.^4,16

Consequently, appropriate management of these patients calls for multidisciplinary care.^1,4

HCPs who see patients with psoriasis have a unique opportunity in the management of this systemic disease.⁴

HCPs can regularly assess patients with psoriasis for potential signs and symptoms associated with this systemic disease and facilitate multidisciplinary care for appropriate patients.^1,4

HCPs can also proactively educate patients on the systemic nature of psoriasis.^1,4

Involving patients in such discussions may encourage more comprehensive, personalized, patient-centered care.^1,4

Help your patients with moderate psoriasis by looking beyond skin involvement and recognizing that psoriasis is a systemic disease.^1,4

References

Van Voorhees AS, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options. 6th ed. https://www.psoriasis.org/physician-member-benefits-portal/ Accessed March 9, 2021.
Menter A, et al. J Am Acad Dermatol. 2019;80;1029-2072.
Strober B, et al. J Am Acad Dermatol. 2020;82:117-122.
Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
Lebwohl MG, et al. J Am Acad Dermatol. 2014;70:871-881.e1-e30.
Korman NJ. Br J Dermatol. 2020;182:840-848.
Lowes MA, et al. Annu Rev Immunol. 2014;32:227-255.
Benezeder T, et al. Semin Immunopathol. 2019;41:633-644.
Suárez-Fariñas M, et al. J Invest Dermatol. 2012;132:2552-2564.
Arican O, et al. Mediators Inflamm. 2005; 2005:273–279.
Nestle FO, et al. N Engl J Med. 2009;361:496-509
Chimenti MS, et al. Autoimmun Rev. 2013;12:599-606.
Gladman DD. Epidemiology. In: Mease PJ, Helliwell PS, ed. Atlas of Psoriatic Arthritis. Springer-Verlag London Limited; 2008:1-14.
Conigliaro P, et al. Autoimmun Rev. 2011;10:577-581.
Barnas JL, et al. Rheum Dis Clin North Am. 2015;41:643-663.
Strober B, et al. BMJ Open. 2019;9:e027535.

Video Transcript

Special Areas in Psoriasis

Welcome! This 3-part video series will delve into the impact of moderate psoriasis.

Psoriasis is a systemic immune disorder which can affect each patient differently. To understand a patient’s unique experience with psoriasis, healthcare professionals, or HCPs, should consider:^1-4

The impact of systemic inflammation
Special areas and symptoms, and
Individual patient perspectives

Each chapter of this series will focus on 1 of these components of a comprehensive disease assessment.

In chapter 2 of this video series, we will take a closer look at the impact of special areas and symptoms of psoriasis.

Psoriasis is a heterogenous disease that can manifest with different degrees of skin involvement across many areas of the body.^1,5

However, psoriasis manifestations in certain locations, termed special areas, can have a disproportionately large impact on patients.^1-3,6

The International Psoriasis Council defines these special areas as the face, palms, soles, genitalia, scalp, or nails.³

These special areas are commonly affected among patients with psoriasis, even those with more moderate skin involvement.^7,8

For example, among patients with moderate disease based on body surface area, or BSA, up to 58% may have manifestations on the scalp and up to 31% may have nail disease.^7,8

When psoriasis occurs in one of these special areas, such as the scalp, it can feel severe irrespective of the amount of BSA involved.^1-3

Scalp psoriasis can have a substantial impact on patients and contribute to disease severity.^2,3

It is one of the most commonly impacted locations and is often considered difficult to treat.^9-11

Additionally, the scalp is one of the most common locations impacted by itch, although itch can affect the entire body.^12,13

In fact, itch is another important factor that can contribute to disease severity.^14,15

Even patients with lower levels of skin involvement, such as those with moderate psoriasis, commonly experience itching, with 60% of patients with moderate skin involvement reporting itch.¹⁵

Psoriasis may feel severe regardless of BSA involved, when it causes intractable itch.²

When assessing patients with psoriasis, it is important to consider special areas and/or symptoms that may drive increased disease severity in patients with more moderate skin involvement.^1-3

Checking for psoriasis manifestations in special areas, including the scalp and nails, and…^1,3

…inquiring about the patient’s experience with itch can help provide a more complete picture of the patient’s disease experience.^1,3

Help address your patients’ unique needs by screening for special areas and symptoms of psoriasis.^1,3

References

Van Voorhees AS, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options. 6th ed. https://www.psoriasis.org/physician-member-benefits-portal/ Accessed March 9, 2021.
Menter A, et al. J Am Acad Dermatol. 2019;80;1029-2072.
Strober B, et al. J Am Acad Dermatol. 2020;82:117-122.
Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
Menter A, et al. J Am Acad Dermatol. 2020;82:1445-1486.
Augustin M, Br J Dermatol. 2019;181:358-365.
Egeberg A, et al. BMC Dermatol. 2020;20:3.
Callis Duffin K, et al. Dermatology. 2021;237:46-55.
Merola JF, et al. Dermatol Ther. 2018;31:e12589; 2.
Sampogna F, et al. Acta Derm Venereol. 2014;94:411-41.
Elmets CA, et al. J Am Acad Dermatol. 2021;84:432-470
Elewski B, et al. J Eur Acad Dermatol Venereol. 2019;33:1465-1476.
O’Neill JL, et al. Acta Derm Venereol. 2011;91:537-540.
Lebwohl MG, et al. J Am Acad Dermatol. 2014;70:871-881.e1-e30.
Griffiths CEM, et al. Br J Dermatol. 2018;179:173-181.