Study, Doctors Report Undertreatment of Psoriasis is a Common Problem

Many psoriasis patients are undertreated and unhappy with their current treatment options, according to a new study published in JAMA Dermatology.

The study, which analyzed 5,604 patient survey results from 2003-2011, found that as many as 50% of patients with mild psoriasis receive no treatment for their condition, and more than 52% of patients are dissatisfied with their current treatment. A co-author of the study concluded, “Nontreatment and undertreatment of patients with psoriasis and psoriatic arthritis remain a significant problem in the United States. Efforts in advocacy and education are necessary to ensure that effective treatments are accessible to this patient population.”

These findings come as no surprise to Dr. John Koo, MD, Professor and Vice Chairman, UCSF Department of Dermatology, Director, UCSF Psoriasis Treatment Center Phototherapy Unit, “The tragedy is, a lot of dermatologists are not very aggressive. One of the problems for people with chronic skin diseases like psoriasis is they often have a hard time finding dermatologists willing to use aggressive treatments to clear their skin,” says Dr. Koo, “We have many great treatments available, but not every dermatologist is willing to offer them.”

He asserts that the problem isn’t limited to psoriasis patients; some dermatologists are also reluctant to take on patients suffering from severe and generalized chronic skin conditions like eczema because such cases tend to require more time. Instead, many dermatologists choose less time-consuming and less severe cases, or more lucrative cases, like cosmetic procedures.

Considering the advances that have been made in dermatological medicine, and the advances in psoriasis research specifically, Dr. Koo believes no patient should go untreated, “There are so many treatment options available – not just topical treatments but also injectable biologic therapies, oral medications, laser treatments, and phototherapy. If you consider all the options it’s pretty rare I have somebody that I cannot improve.”

As a part of a broader outreach initiative Dr. Koo spoke at the AAD Summer Conference held in New York, where he urged doctors to be more mindful of the toll a chronic skin condition takes on a person’s quality of life, “Skin is visible. When people have skin conditions they look and feel ugly, so their self-esteem is devastated,” says Dr. Koo, reminding doctors, “Don’t dismiss a skin condition as something minor. Totally take into consideration the amount of stress it is causing.”

Dr. Koo finds that doctors, and people in general, tend to dismiss skin conditions, “It’s unfortunate that many people – most general public, the government, insurance companies – do not understand the importance and huge impact of skin conditions. People with skin conditions often encounter people who poo poo it. They say, ‘Well, no big deal. You’re lucky you don’t have something worse, like high blood pressure.’”

Dr. Koo advises patients to be assertive about their needs: Don’t allow a doctor to dismiss your skin condition, he says, If your current dermatologist won’t treat your condition adequately, find a dermatologist who will. The National Psoriasis Foundation can be a great resource for finding a dermatologist who will provide sufficient treatment.

Through his work as Director of the UCSF Psoriasis and Skin Treatment Center, where patients take part in therapeutic treatment in addition to medical treatments, Dr. Koo has found that patients thrive when given a sense of community, “If patients feel isolated or feel like they’re the only one with this disease, or they’re the only one who isn’t responding well to treatments, they are typically depressed and anxious. When patients with skin conditions get to know each other, it’s one of the best ways to help fight the stress. They feel like they’re all in the same boat.” So as not to dilute his larger message Dr. Koo reminds us, “That said, the best treatment of all is getting rid of the disease by offering appropriately aggressive therapies.”