Focus on Psoriasis: A Report from the 25th World Congress of Dermatology (WCD)

The IPC symposium presented an international review of the global challenges met with psoriasis regarding epidemiology, genetic diversity, clinical presentations, diagnosis, and management, shedding light on patients’ perspectives and value-based healthcare.

• Dr. Claudia de la Cruz presented “A Patient-Inclusive Approach in the Treatment of Psoriasis: A Principal Without Borders.” She highlighted the patient perspective as an independent dimension in the management of psoriasis and how it is crucial to consider the patient’s perspective about the disease (e.g., quality of life, inaccessibility to treatment, and impact on education, career, and social life), which can differ from the healthcare provider’s perspective.
  
  
• Prof. Jo Lambert presented “An International Perspective on Value-Based Healthcare,” discussing the application of value-based healthcare in psoriasis. As treatments for psoriasis are quite expensive, an adequate healthcare cycle for psoriasis patients can put the patients on effective medications rapidly with better results and, thus, less frequent follow-up visits. This can achieve an overall more cost-effective healthcare service for the patients.
  
  
• Dr. Johann Gudjonsson presented “Genetic Differences Across the Globe,” reviewing the diversity of the biological processes involved in psoriasis. As different genetic predispositions across the globe may explain this diversity, the types and frequency of risk genes for these predispositions differ between ethnic groups. This likely contributes to the heterogeneity of molecular pathways, clinical presentations, and treatment responses between races and skin colors.
  
  
• Prof. Mohammad Huq presented “Pitfalls in Diagnosis and Phenotypic Differences Related to Skin of Color,” where he illustrated the diagnostic challenges with psoriasis to consider in different skin colors. Challenges include underdiagnosis, atypical morphology, and diversity in severity, distributions, and frequency of subtypes. Post-inflammatory hyperpigmentation in skin of color complicates the evaluation of the disease activity. This is in addition to diagnostic confusion with other dermatological conditions. People of color are four times more likely to require a skin biopsy or dermoscopy to diagnose psoriasis and wait three times longer for a definitive diagnosis. Further, cultural factors affect the patient’s willingness to seek medical attention and delay diagnosis.
  
  
• Prof. Mahira El Sayed presented “Therapeutic Challenges Related to Skin of Color.” She discussed the difference between race and ethnicity and reviewed definitions in the literature for “skin of color.” In terms of skin color, psoriasis is different regarding genetic basis, clinical presentation, and treatment availability and effectiveness. In low-income countries, treatment choice is primarily based on economic availability. She highlighted that there are unmet needs for clinical guidelines on managing patients with plaque psoriasis in Africa and the Middle East. There are also unmet needs for educating dermatologists, access to biologics, and more biosimilars.
  
  
• Prof. Chris Griffiths presented “Availability of Therapies Across the World: Data from the GPA,” explaining unmet needs for psoriasis epidemiology. The Global Psoriasis Atlas (GPA) addresses vital questions about psoriasis epidemiology. To map epidemiology, accurate diagnosis is essential. GPA studies showed limited accessibility to therapies in some regions, e.g., Chile.
  
  
• Dr. Hoseah Waweru presented “Every Patient in the World Has the Right to Optimal Treatment.” He emphasized that psoriasis patients worldwide deserve optimal care. We must address treatment access barriers, be patient-centered, and use better outcome measurements to achieve this.