Tackling gaps in psoriasis care: An imperative for the EU

Access to adequate care for psoriasis is inconsistent across Europe and the condition remains misunderstood and undertreated. Only through political will and a shared commitment can we close gaps in psoriasis care. 

Psoriasis is a condition that is more than skin deep. While often recognised by its most common form, plaque psoriasis, which causes scaly, dry patches on the skin, this chronic autoimmune disease is associated with several serious comorbidities, including psoriatic arthritis, cardiovascular disease, type 2 diabetes, obesity, and mental health disorders like depression and anxiety.  

With at least 100 million people affected worldwide, psoriasis remains under-researched, especially compared to other non-communicable diseases. The condition is more prevalent in high-income countries, where the incidence nearly doubles the global average, with 112.6 cases per 100,000 compared to 57.8 per 100,000 globally.  

However, access to adequate care varies across Europe. To address this, efforts must focus on reducing stigma, improving diagnosis, and expanding understanding and management of comorbidities through better awareness and shared decision-making. 

Addressing the undertreatment of psoriasis 

Although new psoriasis treatments, including new biologics, novel topicals and advanced oral treatments, have become available, many psoriasis patients remain undertreated, largely due to a lack of awareness about the condition. Worryingly, around one in four patients with psoriasis symptoms report not receiving any treatment at all. 

A recent report by Economist Impact, “Beyond skin-deep: tackling gaps in psoriasis care”, commissioned and supported by Bristol Myers Squibb, examined the state of psoriasis care across the UK, France, Italy, Spain, Germany, the US, China and Japan. The findings reveal that knowledge of psoriasis is low and this lack of awareness discourages people from seeking treatment and fuels misconceptions and stigma, with many incorrectly believing the disease is contagious. 

Healthcare providers often lack training to recognize psoriasis and its comorbidities. Primary care providers need to be better equipped to recognize its signs, be able to administer first-line treatments for mild to moderate manifestations, and make referrals to specialist care when appropriate. Improving health literacy and provider education is crucial for better patient outcomes. 

Patient organizations like IFPA and EuroPSO can play a key role in driving public awareness and advocating for access to appropriate care pathways and treatment. Additionally, technologies such as telehealth can expand access to specialized care, especially in rural areas, facilitating timely diagnosis and treatment.  

In Sweden, a national registry for psoriasis patients has been introduced, allowing for more precise tracking of treatment outcomes and enabling healthcare providers to tailor interventions more effectively. However, disparities among countries in tracking psoriasis and its economic impact are significant, particularly where reliable data is lacking, making it harder to assess how the disease affects healthcare systems, economies, patients and providers. 

Former Swedish politician and FOKUS Patient founder, Penilla Gunther, emphasizes the importance of equitable access to optimal care: “We must push forward efforts at the EU and member state levels to ensure every person with psoriasis can live a full and healthy life.” 

Enhancing shared decision-making 

Once a patient is in contact with the health system, the referral pathway to specialist care can be convoluted and complex. Often, there is no singular referral pathway, and the patient’s treatment route varies depending on the clinician they see. Many psoriasis patients express dissatisfaction with their treatment options. This highlights an urgent need for better patient-provider communication and a more patient-centric approach to care.  

Promoting shared decision-making can improve outcomes and satisfaction. Healthcare providers can be trained to engage in meaningful dialogue, listen to patient concerns, and incorporate their preferences into care plans. Tools like decision aids and interactive platforms support these conversations, helping patients understand their options and empowering them to take an active role in decisions on their treatment. 

“Shared decision-making between the patient and their doctor is essential for achieving effective, personalized care,” says Antonio Manfredi, psoriasis patient and advocate for ACCIÓN PSORIASIS. “By prioritizing patient voices and aligning treatment goals, we can see significantly better outcomes.” 

Ilse van Ee, psoriasis patient and advocate for Psoriasispatiënten Nederland, emphasizes: "People living with psoriasis need clear, personalized information about their condition and treatment options. Healthcare providers should start the conversation, allowing patients to weigh the pros and cons based on their preferences. This empowers people to make decisions that truly align with their needs." 

Understanding the comorbidity burden 

Any psoriasis treatment plan must consider associated comorbidities like psoriatic arthritis, cardiovascular disease, obesity, diabetes, and mental health issues. Focusing solely on skin symptoms risks neglecting broader systemic implications, leading to gaps in care and poorer outcomes. 

Given the systemic nature of the condition, its varying severity and its many comorbidities, a variety of specialists may be needed to provide integrated, multidisciplinary and patient-centred care, based on an individual’s needs.  This holistic approach may include dermatologists, rheumatologists, physiotherapists, mental health specialists, nurses and primary care providers. 

"Addressing psoriasis goes beyond treating skin symptoms; it requires a comprehensive approach that recognizes the significant burden of comorbidities,” explains Tiago Torres, Professor of Dermatology at University of Porto, Porto, Portugal.  

“Best practices should encompass early diagnosis, multidisciplinary care, and access to the latest treatments to reduce the risk of associated conditions like cardiometabolic disease, psoriatic arthritis and depression. Only by closing these gaps in care, can we enhance the quality of life for those affected.”  

Achieving consistent and equitable psoriasis care across the EU is possible with shared commitment and political will. Many member states, such as Spain, Portugal, Sweden and the Netherlands, are already implementing innovative approaches to address gaps in care, offering valuable lessons that can be shared across borders.  

Policymakers across Europe must take action to address the ongoing challenges of psoriasis. Working closely with patient groups, clinicians, and industry leaders, they must improve public understanding of this chronic condition and improve the treatment journey for those affected. 

To ensure better treatment and outcomes, Europe must lead the way in closing these knowledge gaps and addressing inequalities in psoriasis care. 

Join us on 29 October to continue the discussion on addressing the gaps in psoriasis care. Registration page coming soon.