According to a National Psoriasis Foundation survey, 25 percent of people living with moderate psoriasis are not receiving treatment, and 30 percent are being undertreated with only topical medications. These patients face an uphill battle in getting a proper diagnosis and accessing treatment options that could improve their lives.
Psoriasis is an inflammatory disease that causes red, scaly patches on the skin, most commonly on the elbows, knees or scalp. Dermatologists classify a patient’s disease as mild, moderate or severe based on how much of the body is affected. If less than 3 percent of a patient’s body is covered with psoriasis, it is considered mild, and if more than 10 percent is affected, it is considered severe. Those cases that fall in between are called moderate.
“Unfortunately, it’s an imperfect diagnostic tool that fails us often,” said Dr. Abby Van Voorhees, the chair of dermatology at the Eastern Virginia Medical School and chair of the National Psoriasis Foundation medical board. “It doesn’t take into account the impact of the location or the severity of inflammation on a patient’s life.”
For instance, a patient with psoriasis on the palm of his or her hands would technically have a mild case based on the small area affected, but the location could be debilitating. That impact on the patient’s life might justify classifying this case as more severe, according to Van Voorhees.
Traditionally, dermatologists have prescribed topical medications for mild psoriasis and systemic therapies for those with severe psoriasis. But for the 40 percent of psoriasis patients who identify their disease as moderate, few treatments really addressed their unique needs. As a result, doctors had little choice but to prescribe topical treatments for most moderate psoriasis patients.
To improve the lives of patients stuck in between mild and severe psoriasis, we need to educate doctors and insurers about the impact of moderate psoriasis on patients’ lives and about the potential of these new treatments.
However, new treatment options for moderate psoriasis have recently become available and are continuing to be explored. “New data is continuing to come out that shows these new therapies can improve patients’ lives and lower their risk for other diseases with minimal risk,” Van Voorhees said. “Dermatologists need to stay informed and encourage patients to explore these treatment options for moderate psoriasis.”
Even if a dermatologist prescribes a new therapy, insurance companies could still deny coverage. Insurers often only cover systemic therapies if 10 percent or more of a patient’s body is affected by psoriasis, meaning only severe psoriasis patients would have access to these therapies. According to a 2014 study, insurance problems were one of the top reasons psoriasis patients stopped taking their treatment.
“It’s very distressing but not surprising,” Van Voorhees said. “To improve the lives of patients stuck in between mild and severe psoriasis, we need to educate doctors and insurers about the impact of moderate psoriasis on patients’ lives and about the potential of these new treatments.”