Framing Severity by Quality of Life Impact

Quality of life (QOL) can heavily influence how patients with psoriasis perceive their disease. In this video, Elizabeth B. Wallace, MD, FAAD, shares how dermatologists can incorporate QOL into their definitions of severity and into the patient's care plan.

Dr Wallace is an assistant professor of dermatology in the department of dermatology at University of Colorado School of Medicine and Anschutz Medical Campus in Aurora. She is also the co-director of the Connective Tissue Disease Program, co-founder of the Rheumatology-Dermatology clinic, and assistant director of Clinical Trials.

Transcript
Dr Wallace: We know that psoriasis Is no longer just a skin condition. It goes beyond the skin. That inflammation is impacting other organ systems, not only the joints. We know that psoriatic arthritis is very much a component of psoriatic disease: the cardiovascular system, as you mentioned, the gut, with inflammatory bowel disease, mental health as well.

Selecting therapies to treat patients really needs to take into account these other comorbidities, first to make sure that you're picking one that's safe but then also picking one that's going to be effective and compatible with those other conditions. For example, not all of our psoriasis medications also treat psoriatic arthritis. We really have to be aware of the different domains of disease that patients have so that we can pick not only one that matches their severity but also, again, takes into account the whole person, thinks about the skin and the joints and the overall health.

The National Psoriasis Foundation has conducted a number of surveys. We know that psoriasis impacts the emotional well-being of nearly 90% of the psoriasis population. Just keeping that in the back of our mind and letting patients know that they're not alone, normalizing these feelings. Patients can have diminished quality of life for many reasons, feeling like they're frustrated with their disease. They haven't received a diagnosis for a while. They have fears of outbreaks. They have social embarrassment and feel the need to cover up.

Just understanding where a patient's coming from in terms of what is preventing them from going about their day-to-day life, functioning optimally at work, maintaining really strong, healthy relationships with those around them. Taking that into consideration along with their disease severity to come up with a personalized and tailored treatment plan and really setting expectations for what you hope to accomplish with that treatment plan.

A couple different things I can think about with regards to visibility. Nail psoriasis. If psoriasis is on the trunk or on the extremities, we can throw on a long sleeve shirt. When it's on your fingernails and you have to interact with people at work or you're out with a group of friends, it's really hard, especially maybe men who don't use nail polish to hide that. I know a number of patients who have come to me just so distressed about maybe having mild or maybe no disease elsewhere, but they're just so impacted by having nail psoriasis.

Other areas that might be more visible include the ears or the scalp, having it along the scalp hairline, another area that can be really hard to cover up. I know my patients with ear psoriasis, it's very itchy. It can be very flaky.

Again, having the urge to scratch in a public setting or having flaking on the clothing, that can also...Again, the ear is a very small body surface area. The scalp, even if just the hairline is affected, can be a very small body surface area.

Those areas can really have major impacts on patient quality of life and is definitely an area where we consider the severity to be out of proportion to what the BSA would show.