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Psoriasis Treatment's Convenience May Be Key for Patients

By Denise Mann
HealthDay Reporter

MONDAY, Nov. 21 (HealthDay News) -- Many people with the skin disease psoriasis put a higher value on a treatment that suits their lifestyle than on out-of-pocket costs and side effects, a new German study finds.

As many as 7.5 million Americans have the chronic skin condition, according to the National Psoriasis Foundation. The most common type is plaque psoriasis, characterized by raised, red patches covered with a silvery white buildup of dead skin cells.

Management of the disease can be frustrating, and many patients object to different facets of treatment, which can involve light-based therapy, creams, pills or systemic medications given by injection or intravenously.

Treatment doesn't work if you don't use it, said Dr. Michele Green, a dermatologist at Lenox Hill Hospital in New York City, who is familiar with the study. "People want to control their own destiny. If someone doesn't want to do light therapy or isn't going to use a cream, we have to talk about other treatments with them."

Green wasn't surprised by the findings. Convenience counts, she said. "We have to meet our patients where they are," she added.

Trying to assess patients' priorities regarding treatment, researchers from the Medical Faculty Mannheim of Heidelberg University in Mannheim surveyed 163 adults who were treated for moderate to severe psoriasis from December 2009 to September 2010. They looked at treatment location -- at home, in the doctor's office or hospital -- frequency, duration, delivery method and cost. They also looked at the chance of benefit, and the severity and likelihood of side effects.

Treatment location was deemed most important, followed by the chance of benefit and the method of delivery, whether by pill, cream or injection. Participants also cared more about whether or not the treatment was going to work than the risk of side effects or how long the benefit would last, the study showed. Out-of-pocket costs were not terribly relevant, the researchers found.

Women and singles cared more about the improvement to their skin than did males and participants in a committed relationship.

The findings are published in the November issue of Archives of Dermatology.

"Although patients with psoriasis attach significant importance to the probability and magnitude of benefit, it appears that process attributes, such as location and method of delivery of treatment, may be even more important," the researchers concluded. "Incorporating preferences in shared decision making may facilitate treatment adherence and optimize outcome."

Dr. Bruce Strober, an assistant professor of dermatology at the University of Connecticut School of Medicine in Farmington, agreed. "All therapies must be tailored to a range of patient-specific parameters, such as age, gender, personality, comorbid conditions, work/life schedule, tolerance for risk and economic status," he said. "Patients should never be shoehorned into a specific modality of treatment that may not fit well with any or all of these parameters."

Psoriasis, which affects both skin and joints, is a debilitating autoimmune disease, meaning the body's immune system attacks its own healthy cells. The condition can vary from mild to severe, with patches affecting more than 10 percent of a person's body in some cases.

The finding that single people care more about their skin's appearance than those in a relationship mirrors what Green sees in her practice. "I have had patients that are single cry, and once they get married, it is not so important," she said.

More information

For more information on psoriasis treatments, visit the National Psoriasis Foundation.

SOURCES: Bruce Strober, M.D., assistant professor, department of dermatology, University of Connecticut School of Medicine, Farmington, Conn.; Michele Green, M.D., dermatologist, Lenox Hill Hospital, New York City; November 2011, Archives of Dermatology

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