Burden of disease

Psoriasis continues to have a significant impact on QoL, health-care resource utilisation, costs and productivity. A US study suggested that despite treatment, a large number of psoriasis patients continue to experience clinical symptoms and impaired functioning. These results point towards the need for new and effective treatment options (Schaefer et al., 2015).

In fact, in a French national survey comparing people with and without psoriasis using an online questionnaire, patients with psoriasis being treated with systemic therapies (PsoST) had greater sickness and absenteeism rates than those with psoriasis only (PsO) (48% vs. 31% in the last 12 months, 22.6 hours vs. 10.7 hours in the last 12 months due to a medical follow-up, respectively). However, sick leave from work within the previous 12 months was highest in patients with psoriasis and psoriatic arthritis (PsO + PsA) (66%), but sickness in both the PsO + PsA group and the PsoST group was significantly higher than the control group (35%) (p<0.05). Absenteeism due to a medical follow-up within the last 12 months was significantly higher for all patients with psoriasis in comparison to the control group (PsO 10.7 hours, PsoST 22.6 hours, PsO + PsA 35.6 hours, controls 7.1 hours). The impact on work productivity, measured by an estimated mean decrease in productivity over the previous 7 days in those with active psoriasis, was significantly higher for those in the PsoST group (43.3%, p<0.05) and the PsO + PsA group (57.6%, p<0.05) compared to the controls (27.9%). Perhaps surprisingly, those in the PsO group had a significantly lower decrease in work productivity than the control group (22.2% vs. 27.9%, p<0.05) (figure 8) (Claudepierre et al., 2018).

Impact on absenteeism and work productivity over the past 7 days.

Figure 8: Impact on absenteeism and work productivity over the past 7 days (Claudepierre et al., 2018).
a, active psoriasis skin lesions; b, active psoriasis skin lesions and/or psoriatic arthritis; * signficanly higher compared to controls (p<0.05); ** significantly lower compared to controls (p<0.05).

Psoriasis places a significant burden on patient’s QoL and patients with more severe psoriasis experience more severe symptoms and have a greater reduction in QoL and work productivity (Korman et al., 2016). A study evaluating real-life experiences revealed that patients suffer in many aspects of their lives and often in ways not recorded by typical severity measures (Pariser et al., 2015). The symptoms most ‘bothersome’ to patients were itching/scratching, flaking/scaling and skin pain, and patients report that these have a significant impact on their social and emotional lives (Pariser et al., 2015). Data from 3,821 patients with moderate-to-severe psoriasis in the multinational Growth from Knowledge Disease Atlas Global Real-World Evidence programme revealed that patients with additional comorbidities were significantly more likely to experience skin pain, have a lower QoL and greater work impairment, as well as increased use of medical resources (except patients with comorbid obesity and type 2 diabetes). The study also highlighted that those patients suffering from itch and those whose disease affects visible and sensitive areas of the body had greater impairment of their QoL than those without these aspects of psoriasis (Griffiths et al., 2018).

The visible disfiguration associated with psoriasis, particularly when on exposed areas of the body such as the hands, lower arms, face or scalp, leads to a significant psychological impact and reduction in quality of life (Boehncke & Boehncke, 2014). This can include relationship difficulties, employment problems and low self-esteem as well as avoidance of social situations and isolation (Cohen, 2012). A multi-centre study confirmed that psoriasis is strongly associated with depression and anxiety (Dalgard, 2015). This is supported by a primary care cohort study in the UK that assessed psychiatric morbidity and suicidal behaviour among 56,961 patients with psoriasis and 876,919 patients without psoriasis. At baseline, patients with psoriasis had higher prevalence ratios (PR) for a history of alcohol misuse (PR 1.30, 95% CI, 1.23–1.37), bipolar disorder (PR 1.23, 95% CI, 1.10–1.37), depression (PR 1.17, 95% CI, 1.15–1.20), anxiety disorders (PR 1.15, 95% CI, 1.13–1.18), self-harm (PR 1.10, 95% CI, 1.06–1.15), and psychotropic medication prescription (PR 1.13, 95% CI, 1.12–1.14). Interestingly, while patients with psoriasis had an increased risk of self-harm versus the general population, they had a reduced risk of suicide (Parisi et al., 2018).

Many cases of psoriasis begin in adolescence and affected adolescents face combined physical and psychosocial challenges (Gonzalez et al., 2016). A recent systematic review of HRQoL in adolescent psoriasis patients confirms that in addition to the challenges seen in adult psoriasis patients, adolescents also have to cope with additional and complex issues inherent to adolescence. It is therefore imperative that, in addition to treating the visible lesions and disease comorbidities, dermatologists and primary care physicians should assess the psychosocial impact of psoriasis in adolescent patients allowing them to better identify the impact of the disease (Gonzalez et al., 2016).