Psoriasis is more than a skin disease. Approximately 3% of adults in the United States have psoriasis, which translates to more than 7.5 million people. Patients with psoriasis have a greater risk of developing metabolic syndrome, cardiovascular disease, stroke, diabetes, and even certain cancers. Additionally, the disease itself can adversely impacts one’s day-to-day quality of life, including one’s psychological state. Many patients with psoriasis have depression, lack self-esteem, and have a negative body image. Alcohol consumption is a known environmental trigger of psoriasis; at the same time, it is possible that the psychosocial burden of severe psoriasis may be a factor in an individual’s alcohol consumption. Work productivity is also reduced, so individuals with psoriasis are not as likely as those without psoriasis to be employed.

Psoriasis can cause a profound deterioration in a patient’s life, just as skin clearance can lead to improvements and restoration in someone’s life that go well beyond the skin. I recall one patient who really illustrates this point. This person was enrolled in one of our clinical studies of a newer, highly effective psoriasis drug. At intake, approximately 90% of their body surface area was affected. Part of the burden or stigma of psoriasis is that the lesions can drop scales in the person’s living environment, and, with so much of the body involved, an individual can also develop an odor. In this case, the patient’s psoriasis was so severe that the family did not want the individual living in the house, which led to homelessness. Once on therapy, the psoriasis was almost all clear within 1 month, and it eventually cleared completely. It is very heartwarming to see how much improvement can occur in a person’s life with treatment. They can regain employment, their life can normalize, and their relationships with friends and family can flourish.

So, what do patients want? The answer is that they want to be clear. I think that the National Psoriasis Foundation treat-to-target is less than 1% of the body involved, and that is okay, but patients want to be clear, and the quicker they clear, the happier they are. However, once someone is totally cleared, they often are not satisfied if they do not remain 100% disease free. The newer psoriasis drugs provide high Psoriasis Area Severity Index (PASI) 100 rates, which may be maintained for years. These are perfect options for patients who are concerned about disease recurrence.

A final thought on addressing the burden is the need for collaborative care. Because psoriasis is a multisystem disease with significant burden, optimal care involves a multidisciplinary team that includes a dermatologist, a primary care provider, and possibly a dietician, a psychiatrist, and/or a rheumatologist.