April Armstrong, MD, MPH, Shares Insights on the NPF's Psoriasis Health Indicator Report

Image Credit: © Milan Lipowski - stock.adobe.com

April Armstrong, MD, MPH, professor and chief of dermatology at UCLA and member of the medical board of the National Psoriasis Foundation (NPF), shared pearls with Dermatology Times on the recently released NPF psoriasis health indicator report.¹

The report, a first-of-its-kind presentation on the health impacts of the disease, provides context on the status of psoriasis and its complications in the US. This includes current information and data on the disease, health outcomes, prevention of comorbidities associated with psoriasis, health disparities, and treatment and management of patients with psoriasis.

While no national goals exist to guide improvements in psoriatic disease care, the report does include data connecting psoriasis to existing national goals for related diseases and conditions.²

Q&A

Dermatology Times: What are the most important takeaways from this report?

April Armstrong: The most critical takeaway is the pervasive stigma associated with psoriasis, which may be contributing to significant delays in diagnosis and treatment. Despite psoriasis being a non-contagious inflammatory condition affecting over 7.5 million people in the US, public misconceptions remain widespread. For instance, many people without the disease report feeling uncomfortable in various social situations with individuals who have visible signs of psoriasis, such as shaking hands or sharing a meal. This stigma can lead to embarrassment and isolation for those living with the disease, potentially resulting in delayed care. Delays in care are particularly concerning because they increase the risk of more severe psoriasis and associated comorbidities like psoriatic arthritis, heart disease, obesity, and diabetes. Ultimately, the report underscores the need for greater public awareness, early detection, and consistent treatment to manage this chronic condition effectively.

DT: What are the current gaps in national data on psoriasis, and how can they be addressed to improve understanding of the disease's impact?

Armstrong: A significant gap in national data is the underdiagnosis of psoriasis, with an estimated 600,000 people living with the condition but without a formal diagnosis. This represents a considerable population who may be experiencing symptoms without realizing the potential risks associated with untreated psoriasis. Additionally, many individuals may not seek medical help due to misconceptions that psoriasis is purely a cosmetic issue rather than a systemic inflammatory disease. Addressing these gaps requires targeted outreach and education campaigns that emphasize the importance of recognizing psoriasis symptoms early and seeking professional help. Increased funding for population-based studies and healthcare initiatives aimed at improving access to dermatology services could also contribute to filling these data gaps. Furthermore, integrating psoriasis data collection into broader public health monitoring systems would help improve the overall understanding of the disease's prevalence and impact across different communities.

DT: What are the challenges in implementing national goals for psoriasis care, and how can these challenges be overcome?

Armstrong: One of the biggest challenges in achieving national goals for psoriasis care is ensuring timely diagnosis and access to appropriate treatment for all patients. For many, especially minority populations, accessing specialized care from dermatologists can be difficult due to geographic or financial barriers, leading to delays in treatment. Additionally, public awareness of psoriasis and its potential health risks remains low, which further contributes to underdiagnosis and undertreatment. To overcome these challenges, healthcare systems need to expand their capacity to offer early and effective psoriasis care. This includes training more healthcare professionals to recognize and manage psoriasis, increasing the availability of telemedicine for dermatology consultations, and improving insurance coverage for advanced therapies. Public health campaigns must also be designed to educate the general population and primary care providers about the serious health risks associated with untreated psoriasis. By improving access and awareness, national goals for psoriasis care can become more achievable.

DT: How can public health campaigns be tailored to raise awareness and improve early detection of psoriasis across different demographic groups?

Armstrong: Public health campaigns aimed at raising awareness about psoriasis should focus on reducing the stigma that surrounds the disease and highlighting the importance of early detection. These campaigns must be inclusive and designed to resonate with various demographic groups, ensuring they reach a wide audience. One way to achieve this is by incorporating patient stories into campaigns, as personal accounts can humanize the disease and help break down social barriers. Additionally, public health efforts should leverage multiple media platforms, from traditional television and print to social media, to ensure they reach different age groups and communities. Providing educational materials in multiple languages and partnering with community organizations can also help address the needs of diverse populations. Finally, these campaigns should emphasize that psoriasis is more than a skin condition—it’s a systemic inflammatory disease with serious potential health risks. By making this message clear, public health efforts can encourage earlier diagnosis and prompt individuals to seek treatment.

DT: What are the current gaps in psoriasis treatment accessibility, and how do they vary across regions?

Armstrong: Access to psoriasis treatment can vary widely depending on geographic location and the availability of dermatology services. In rural or underserved areas, individuals may face significant challenges in finding a dermatologist, leading to delays in diagnosis and treatment. Even in more urban areas, treatment accessibility can be hindered by long wait times for specialist appointments or high out-of-pocket costs for advanced therapies. These disparities highlight the need for a more equitable distribution of healthcare resources. One solution is the expansion of telemedicine services, which can help bridge the gap by connecting patients in underserved areas with dermatologists. Additionally, healthcare policies that improve insurance coverage for biologic therapies and other advanced treatments would ensure that more individuals have access to the care they need. By addressing these gaps, healthcare systems can improve the overall quality of care for psoriasis patients, regardless of where they live.

DT: Were there any surprising or unexpected findings in this report?

Armstrong: One of the most surprising findings in the report is the persistence of stigma and social discomfort surrounding psoriasis. Despite widespread knowledge that psoriasis is not contagious, many individuals without the disease still express reluctance to engage in everyday social activities with those who have visible symptoms. For example, a large percentage of respondents indicated discomfort with actions as simple as shaking hands or having someone with psoriasis in their home. This highlights the deep-rooted misconceptions that still exist and suggests that more work needs to be done to educate the public about the realities of living with psoriasis. The report’s findings also suggest that these stigmas are not just social issues but can have real medical consequences, as they may discourage individuals from seeking timely diagnosis and treatment.

DT: What are the implications of this report for future psoriasis research?

Armstrong: The report indicates several areas where future research could have a significant impact. First, there is a clear need for research focused on understanding the social and psychological effects of psoriasis, as stigma continues to play a major role in the patient experience. Additionally, research should aim to better understand the systemic nature of psoriasis, particularly its links to other health conditions like cardiovascular disease, diabetes, and obesity. Identifying the underlying mechanisms that connect psoriasis with these comorbidities could lead to more effective treatment strategies. Lastly, future studies should explore how healthcare access and treatment options can be improved, especially in underserved populations. Expanding the scope of research beyond just the skin manifestations of psoriasis to include its broader health impacts will help guide more comprehensive approaches to care.

DT: Are there any other notable discoveries?

Armstrong: An important point to add is the relationship between psoriasis and other serious health conditions, such as cardiovascular disease and diabetes. These comorbidities highlight the need for a comprehensive approach to treating psoriasis, as it is not just a skin condition but a systemic disease that can have widespread effects on overall health. The report underscores the importance of regular monitoring and multidisciplinary care for psoriasis patients to manage both the skin symptoms and the associated health risks. This conversation should also include discussions about how to better integrate psoriasis management into broader healthcare systems to ensure that patients receive comprehensive care that addresses all aspects of the disease.

References

1. Psoriasis health indicator report. National Psoriasis Foundation. Published January 2024. Accessed September 13, 2024. https://www.psoriasis.org/health-indicator-report/
2. Hebebrand M. New report highlights health disparities in psoriasis care. Dermatology Times. Published August 21, 2024. Accessed September 13, 2024. https://www.dermatologytimes.com/view/new-report-highlights-health-disparities-in-psoriasis-care