New research suggests that patients with psoriasis involving a small area of the body may experience a disease burden similar to those with more extensive skin involvement. This finding challenges the traditional approach of reserving systemic treatments for patients with body surface area (BSA) involvement greater than 10%.
The study, published in *Dermatology and Therapy*, analyzed data from the CorEvitas Psoriasis Registry. It focused on individuals who had not received systemic treatment before and who began biologic therapy between April 2015 and September 2023. Researchers divided patients into three groups based on BSA: low (less than 3%), medium (3% to 10%), and high (more than 10%). They evaluated health-related quality of life, itch, pain, fatigue, psoriatic arthritis, disease characteristics, and medical history at the time patients started biologic therapy.
Out of 1,640 patients who began biologic treatment, 7% had low BSA involvement, 46.9% had medium BSA, and 46.2% had high BSA. Despite differences in the amount of skin affected, patients reported similar levels of burden across all groups. Measures of pain, itch, fatigue, and quality of life showed substantial overlap. In comparisons of high and medium BSA groups, overlap ranged from 0.52 to 0.59. When comparing low and high BSA groups, overlap values were between 0.60 and 0.70. These results suggest that patients with limited skin involvement can still face serious symptoms and reduced quality of life.
The study also highlighted that the emotional toll of psoriasis often exceeds its physical effects. Even patients with small affected areas may struggle with depression, anxiety, and social isolation due to visible lesions, low self-esteem, and stigma. This points to the need for patient care that addresses both physical and mental health.
Researchers acknowledged certain limitations. Some patients started or changed biologic therapy up to a year before they entered the registry, which could have influenced the data. The low BSA group was relatively small, reducing statistical power and creating wider confidence intervals. This smaller group may reflect prescribing habits, with doctors choosing biologics for low-BSA patients only when other signs of severe disease, such as psoriatic arthritis, are present. The higher rate of psoriatic arthritis in the low BSA group may also have influenced results related to fatigue.
Despite these limitations, the findings support the use of biologic therapies for patients with a high disease burden, regardless of how much skin is affected. Researchers concluded that treatment decisions should consider the full impact of the disease on patients’ lives, not just the extent of visible skin involvement.
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