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Video Transcript

Uncovering Patient Perspectives

Welcome! This 3-part video series will delve into the impact of moderate psoriasis.
Psoriasis is a systemic immune disorder which can affect each patient differently. To understand a patient’s unique experience with psoriasis, healthcare professionals, or HCPs, should consider:1-4
  • The impact of systemic inflammation
  • Special areas and symptoms, and
  • Individual patient perspectives
Each chapter of this series will focus on 1 of these components of a comprehensive disease assessment.
In chapter 3 of this video series, we will discuss the importance of considering patient perspectives in moderate psoriasis.
From a patient’s perspective, psoriasis can have a large impact despite more moderate skin involvement, when they are affected by special areas such as the scalp, or symptoms such as itch..1-3
However, these patients’ disease severities may be underestimated by commonly used clinical measures such as body surface areas, or BSA, or psoriasis area severity index, or PASI.5-6
For example, a population-based survey of patients in North America and Europe found that 39% of patients with moderate skin involvement by BSA perceived their psoriasis to be severe at its worst.6
One reason for this discrepancy may be that conventional clinical measures do not capture the full impact of psoriasis.1-3
Measures such as BSA only assess the area of skin affected by psoriasis while PASI and sPGA account for the severity of psoriatic lesions. 1-3,5-9
However, none of these measures account for the impact of special areas and symptoms, nor do they consider patient-reported outcomes or patient perspectives.1,3,4,7,8
Additionally, patient-HCP misalignment on what aspects of disease contribute most to disease severity potentially contributes to the underestimation of patients’ psoriasis experience..10
For example, itch has been reported by patients as the most important factor contributing to disease severity. And drivers of disease severity, such as itch, may be underappreciated by HCPs.10
HCPs who see patients with psoriasis have an opportunity to probe deeper.1
Although psoriasis severity is often defined by the extent of BSA affected by disease….1
such conventional clinical measures can miss key factors and drivers of patient-perceived severity.1
Recent treatment guidelines recommend looking beyond skin involvement when assessing disease severity and considering psoriasis in special areas, treatment history, patient perspectives, and impact of disease on quality of life.1-4
HCPs can probe for patient perspectives to better understand the patient’s unique experience with their psoriasis.1,4
A comprehensive assessment of all aspects of psoriatic disease is an important step towards optimizing patient-centered care.1,4
Uncovering each patient's perception of disease and unique unmet needs can help ensure patient-provider alignment and a personalized approach to patient care.1-3

References

  1. Van Voorhees AS, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options. 6th ed. https://www.psoriasis.org/physician-member-benefits-portal/ Accessed March 9, 2021.
  2. Menter A, et al. J Am Acad Dermatol. 2019;80;1029-2072.
  3. Strober B, et al. J Am Acad Dermatol. 2020;82:117-122.
  4. Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
  5. Menter A, et al. J Am Acad Dermatol. 2019;80;1029-1072.
  6. Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
  7. Knuckles MLF, et al. J Dermatolog Treat. 2018;29:658-663.
  8. Lebwohl MG, et al. J Am Acad Dermatol. 2014;70:871-881.e1-e30.
  9. Cohen JM et al. J Rheumatol. 2015;42:1032–1033.
  10. Gottlieb AB, et al. J Am Acad Dermatol. 2015;72:345-348.
  11. Feldman SR, et al. Ann Rheum Dis. 2005;64(suppl 2):ii65-ii68.
  12. Lebwohl MG, et al. Am J Clin Dermatol. 2016;17:87-97.

Video Transcript

Systemic Inflammation

Welcome! This 3-part video series will delve into the impact of moderate psoriasis.
Psoriasis is a systemic immune disorder which can affect each patient differently. To understand a patient’s unique experience with psoriasis, healthcare professionals, or HCPs, should consider:1-4
  • The impact of systemic inflammation
  • Special areas and symptoms, and
  • Individual patient perspectives
Each chapter of this series will focus on 1 of these components of a comprehensive disease assessment.
In chapter 1 of this video series, we will take a closer look at the impact of systemic inflammation in psoriasis.
Although psoriasis commonly presents with skin manifestations such as well-demarcated red plaques with silvery scales the underlying cause of these plaques is more than skin deep.1,2
It is important to recognize that psoriasis is a chronic systemic inflammatory disease...1,2
...which can have a large impact on patients, even those with more moderate skin involvement.1-3
For example, a population-based survey of patients in North America and Europe...5
...found that 39% of patients with moderate skin involvement perceived their psoriasis to be severe at its worst.5
To understand the systemic nature of psoriasis, let’s look deeper.
At a cellular level, psoriasis is the result of a sustained proinflammatory response caused by dysregulation of a complex signaling pathway involving dendritic cells, T-cell activation, and production of proinflammatory cytokines.6-9
The sustained inflammatory response results in keratinocyte hyperproliferation and skin plaques which are hallmark features of psoriasis.2,7
These inflammatory cytokines may diffuse away from psoriasis skin lesions into the circulation....7,10,11
...causing patients with psoriasis to have elevated systemic levels of proinflammatory cytokines, driving systemic inflammation.6,7,10,11
Several such mediators of psoriasis are also implicated in psoriatic arthritis, or PsA, a chronic inflammatory disease impacting the joints.6,12-15
PsA is a common comorbidity, even in patients with moderate psoriasis. These patients may also have other serious comorbidities, such as cardiometabolic disorders.4,16
Consequently, appropriate management of these patients calls for multidisciplinary care.1,4
HCPs who see patients with psoriasis have a unique opportunity in the management of this systemic disease.4
HCPs can regularly assess patients with psoriasis for potential signs and symptoms associated with this systemic disease and facilitate multidisciplinary care for appropriate patients.1,4
HCPs can also proactively educate patients on the systemic nature of psoriasis.1,4
Involving patients in such discussions may encourage more comprehensive, personalized, patient-centered care.1,4
Help your patients with moderate psoriasis by looking beyond skin involvement and recognizing that psoriasis is a systemic disease.1,4

References

  1. Van Voorhees AS, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options. 6th ed. https://www.psoriasis.org/physician-member-benefits-portal/ Accessed March 9, 2021.
  2. Menter A, et al. J Am Acad Dermatol. 2019;80;1029-2072.
  3. Strober B, et al. J Am Acad Dermatol. 2020;82:117-122.
  4. Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
  5. Lebwohl MG, et al. J Am Acad Dermatol. 2014;70:871-881.e1-e30.
  6. Korman NJ. Br J Dermatol. 2020;182:840-848.
  7. Lowes MA, et al. Annu Rev Immunol. 2014;32:227-255.
  8. Benezeder T, et al. Semin Immunopathol. 2019;41:633-644.
  9. Suárez-Fariñas M, et al. J Invest Dermatol. 2012;132:2552-2564.
  10. Arican O, et al. Mediators Inflamm. 2005; 2005:273–279.
  11. Nestle FO, et al. N Engl J Med. 2009;361:496-509
  12. Chimenti MS, et al. Autoimmun Rev. 2013;12:599-606.
  13. Gladman DD. Epidemiology. In: Mease PJ, Helliwell PS, ed. Atlas of Psoriatic Arthritis. Springer-Verlag London Limited; 2008:1-14.
  14. Conigliaro P, et al. Autoimmun Rev. 2011;10:577-581.
  15. Barnas JL, et al. Rheum Dis Clin North Am. 2015;41:643-663.
  16. Strober B, et al. BMJ Open. 2019;9:e027535.
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Video Transcript

Special Areas in Psoriasis

Welcome! This 3-part video series will delve into the impact of moderate psoriasis.
Psoriasis is a systemic immune disorder which can affect each patient differently. To understand a patient’s unique experience with psoriasis, healthcare professionals, or HCPs, should consider:1-4
  • The impact of systemic inflammation
  • Special areas and symptoms, and
  • Individual patient perspectives
Each chapter of this series will focus on 1 of these components of a comprehensive disease assessment.
In chapter 2 of this video series, we will take a closer look at the impact of special areas and symptoms of psoriasis.
Psoriasis is a heterogenous disease that can manifest with different degrees of skin involvement across many areas of the body.1,5
However, psoriasis manifestations in certain locations, termed special areas, can have a disproportionately large impact on patients.1-3,6
The International Psoriasis Council defines these special areas as the face, palms, soles, genitalia, scalp, or nails.3
These special areas are commonly affected among patients with psoriasis, even those with more moderate skin involvement.7,8
For example, among patients with moderate disease based on body surface area, or BSA, up to 58% may have manifestations on the scalp and up to 31% may have nail disease.7,8
When psoriasis occurs in one of these special areas, such as the scalp, it can feel severe irrespective of the amount of BSA involved.1-3
Scalp psoriasis can have a substantial impact on patients and contribute to disease severity.2,3
It is one of the most commonly impacted locations and is often considered difficult to treat.9-11
Additionally, the scalp is one of the most common locations impacted by itch, although itch can affect the entire body.12,13
In fact, itch is another important factor that can contribute to disease severity.14,15
Even patients with lower levels of skin involvement, such as those with moderate psoriasis, commonly experience itching, with 60% of patients with moderate skin involvement reporting itch.15
Psoriasis may feel severe regardless of BSA involved, when it causes intractable itch.2
When assessing patients with psoriasis, it is important to consider special areas and/or symptoms that may drive increased disease severity in patients with more moderate skin involvement.1-3
Checking for psoriasis manifestations in special areas, including the scalp and nails, and…1,3
…inquiring about the patient’s experience with itch can help provide a more complete picture of the patient’s disease experience.1,3
Help address your patients’ unique needs by screening for special areas and symptoms of psoriasis.1,3

References

  1. Van Voorhees AS, et al. The Psoriasis and Psoriatic Arthritis Pocket Guide: Treatment Algorithms and Management Options. 6th ed. https://www.psoriasis.org/physician-member-benefits-portal/ Accessed March 9, 2021.
  2. Menter A, et al. J Am Acad Dermatol. 2019;80;1029-2072.
  3. Strober B, et al. J Am Acad Dermatol. 2020;82:117-122.
  4. Elmets CA, et al. J Am Acad Dermatol. 2019;80:1073-1113.
  5. Menter A, et al. J Am Acad Dermatol. 2020;82:1445-1486.
  6. Augustin M, Br J Dermatol. 2019;181:358-365.
  7. Egeberg A, et al. BMC Dermatol. 2020;20:3.
  8. Callis Duffin K, et al. Dermatology. 2021;237:46-55.
  9. Merola JF, et al. Dermatol Ther. 2018;31:e12589; 2.
  10. Sampogna F, et al. Acta Derm Venereol. 2014;94:411-41.
  11. Elmets CA, et al. J Am Acad Dermatol. 2021;84:432-470
  12. Elewski B, et al. J Eur Acad Dermatol Venereol. 2019;33:1465-1476.
  13. O’Neill JL, et al. Acta Derm Venereol. 2011;91:537-540.
  14. Lebwohl MG, et al. J Am Acad Dermatol. 2014;70:871-881.e1-e30.
  15. Griffiths CEM, et al. Br J Dermatol. 2018;179:173-181.
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