Psoriasis is one of the most prevalent skin diseases. In fact, it is a chronic and disabling systemic inflammatory disease with a predominance of the skin that affects more than a million Spaniards throughout their lives.
Despite the fact that not a few readers will have their own or close experience of psoriasis, there are still many unknown aspects of this disease. One of the most relevant is the existence of many clinical variants of this disease, with their own singularities in terms of manifestations, severity and impact.
Some of these distinct clinical entities are not only rare, but can also have serious health consequences for those who suffer from them.
An example is generalized pustular psoriasis (PPG), an entity that, in some cases, usually requires the patient to be hospitalized and can even cause death.
The diagnosis of psoriasis includes patients with limited forms, involving a few skin areas, to very extensive forms, which will require systemic treatments, sometimes for life, with complications –comorbidities– in the form of joint lesions or metabolic diseases. .
Meanwhile, there is a clear trivialization of the reality of a disease that not only impacts the physical sphere of the person and their families or caregivers, but also notoriously affects the psychological and work spheres. By way of example, patients with psoriasis lose an average of 4.9 working days per year due to their disease. A figure that can increase in more serious cases of the pathology.
In the “NEXT Psoriasis” survey – prepared by the Acción Psoriasis patients association – it was verified that four out of ten people affected with psoriasis consider that the disease has a significant impact on their quality of life, affecting not only their physical appearance and emotional, but also conditioning their free time, the quality of their rest and, even, their family or partner relationships.
In this context, the correct management of the challenges surrounding psoriasis can only be carried out from a holistic knowledge of the disease, its nuances and varieties that allow a differentiated and personalized approach to the psoriatic patient.
This is the fundamental pillar of the report “Not all psoriasis is the same. The challenge of personalization”, in which the Spanish Academy of Dermatology and Venereology (AEDV) and Acción Psoriasis have worked together, with the support of Boehringer Ingelheim, to analyze the situation of the care approach to psoriasis in our country and offer a series of recommendations that could improve the individualization of the psoriatic patient.
An essential first step is a correct diagnosis, which should be as early as possible in the course of the disease, in order to optimize the use of available resources and indicate the best possible treatment for each case, as well as to minimize the impact of the disease. pathology on the quality of life of the patient who suffers from it. This early diagnosis acquires special relevance for those more minority, infrequent and difficult to classify clinical entities.
Better coordination between levels of care (primary care and specialized care) is only possible through more and better training for health professionals on psoriasis and its different clinical entities. This action should favor both better management by primary care of the milder variants, as well as rapid referral to the dermatologist of those more extensive forms or infrequent clinical variants, such as the aforementioned PPG.
The promotion of research is essential to increase the standards in the management of the different variants of the disease. In addition, the healthcare reality in our country is multifaceted and complex, and also includes differences in equity in terms of diagnosis, management, and access to therapeutic innovation.
Quality assistance cannot ignore the patient himself and we must guarantee his access to rigorous information and with familiar language about his pathology, as well as being able to favor the active role of the patient, so as to enable him to participate in joint decision-making. decisions about your illness.
Successfully tackling all these challenges, optimizing available resources and working jointly and in coordination with patients, healthcare professionals and the Administration is the best guarantee for obtaining the best results. This must be carried out as soon as possible and efficiently in one of the diseases that is an example of the qualitative leap that Medicine has experienced in recent decades.
The next challenge is to make the scar that psoriasis leaves on the life prospects of many patients simply history. From the AEDV and Acción Psoriasis we believe that it is possible.
Dr. José Manuel Carrascosa is head of the Dermatology Service of the Germans Trias y Pujol University Hospital, vice president of the Spanish Academy of Dermatology and Venereology (AEDV) and coordinator of the Psoriasis Group (GPS) of the AEDV
Dr. Pablo de la Cueva is head of the Dermatology Service of the Infanta Leonor University Hospital, president of the AEDV Center Section and secretary of the AEDV GPS
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