Psoriasis is a chronic inflammatory disease of the skin, but its effects on a person’s well-being go beyond skin deep. The disease can exact an emotional and mental toll as well.
According to the United Kingdom-based Mental Health Foundation, some clinicians may regard psoriasis as solely a skin condition and may be dismissive of its psychological impact. Individuals with psoriasis can have low self-esteem or experience depression and anxiety, and if unrecognized, these health issues can prevent people from effectively managing their psoriasis.
Scientists at the European Association of Dermatology and Venereology Congress this year addressed the topic in a symposium titled “Are You Wasting Your Time Getting to PASI 100?” The Psoriasis Area Severity Index (PASI) is a widely used instrument in psoriasis to assess and grade the severity of psoriasis. A PASI 100 score indicates complete resolution of all disease.
The symposium presenters questioned whether the PASI, as well as the Dermatology Life Quality Index questionnaire, may be doing enough to capture the full impact of psoriasis on a person’s life. Presenters included Stefano Piaserico, associate professor at the University of Padua, Italy and head of the Regional Centre for Psoriasis; Jordi Quoidbach, a professor at specializing in emotion and decision-making at Esade Ramon Llull University in Barcelona, Spain; and Ulrich Mrowietz, a dermatologist and head of the Psoriasis-Center at the University Medical Center Schleswig-Holstein in Kiel, Germany.
To delve further into the topic, Mrowietz announced that he and his colleagues are launching a new study that will assess the improvement in overall well-being of individuals with psoriasis who are treated with Ilumya (tildrakizumab) — sold as Ilumetri in the European Union. This monoclonal antibody is used to treat moderate to severe plaque psoriasis.
In the study, the investigators plan to assess people using the World Health Organization Well-Being Index — also called the WHO-5, a short, five-question self-reported measure of current mental well-being. The evaluation has been used to gauge psychological health as it relates to a variety of chronic diseases such as diabetes, cardiovascular disease, and cancer.
“For the first time, WHO-5 will be tested as a primary endpoint in patients with psoriasis to capture the effect that tildrakizumab can have on patients' wellbeing in a real-world setting,” read a press release from Almirall, a global biopharmaceutical company focused on skin health that manufactures Ilumetri. “Moreover, the long-term response on physicians' satisfaction and psoriasis patients' partners' lives will also be evaluated.”
A timeline and more details on the study are yet to be announced.
Dr. Justin M. Ko, a dermatologist with Stanford Health Care, recognizes the importance of such research. “My patients’ quality of life and emotional well-being can be negatively impacted by how they perceive the disease, as well as the social stigma that can accompany these conditions,” he told MyPsoriasisTeam.
Sometimes, distress from the illness exacerbates mental health and then worsening emotional health may exacerbate the psoriasis. “We know that stress can negatively affect activity of skin diseases like psoriasis, so it can be a vicious cycle,” said Dr. Ko. “The more stress and impaired emotional well-being, the more activity of the condition, leading to more stress.”
Dr. Ko said that clinicians truly need to see the person “under the plaques and scales of the condition.”
“When I see a patient with psoriasis, my job is to understand how the disease is impacting and affecting their well-being and quality of life, and help craft a treatment plan and approach that will allow us to achieve what is meaningful to them,” said Dr. Ko.
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