Lessons from Psoriasis Action Month: Insights from Three Patient Journeys

As part of Psoriasis Action Month, patient narratives reveal the complex interplay between disease severity, comorbidities, and psychosocial burden in psoriasis management. Cases like those of Ayesha Patrick, Brian Lehrschall, and Janene Tirado illustrate the heterogeneity of psoriasis, spanning common chronic plaque forms, rare pustular variants, and the compounded impact of multimorbidity. These stories underscore the importance of timely diagnosis, culturally competent care, and multidisciplinary management in optimizing outcomes.

Ayesha Patrick’s journey underscores the challenges and gaps in care for women of color with psoriasis. Ayesha lived with symptoms for much of her life without a formal diagnosis. Early manifestations, including flaking scalp and dry skin, were misattributed to “winter itch” or dandruff. It was not until college that she was formally diagnosed with psoriasis. Initially mild, her disease escalated during the COVID-19 pandemic, presenting simultaneously as plaque, guttate, and inverse psoriasis.

Virtual care during this period posed unique challenges. Ayesha recalls feeling vulnerable exposing her skin over video visits, particularly with severe scalp involvement characterized by relentless flaking and inflammation. This acute flare highlighted the systemic and psychosocial impact of psoriasis and emphasized the importance of timely, patient-centered care.

Ayesha’s experience highlights several critical clinical considerations. Psoriasis often presents differently in patients with darker skin tones, appearing purplish or gray rather than red, yet educational resources and clinical training frequently underrepresent these variations. This knowledge gap contributes to delayed diagnosis and mismanagement. Additionally, standard treatment regimens may not account for hair texture or cultural hair care practices, as illustrated by Ayesha’s experience with a daily medicated shampoo that caused hair loss.

Her advocacy led to the creation of Sistas with Psoriasis (now The PsoriaSis Collective), emphasizing culturally informed support, education, and access to reliable resources. Ayesha’s story underscores the need for clinicians to actively validate patient concerns, provide individualized treatment strategies, and recognize how disease presentation may vary across populations.

Key takeaways for practice include early recognition, culturally competent patient education, consideration of hair care practices in treatment planning, and the importance of connecting patients with advocacy networks. Clinicians are encouraged to ensure that their diagnostic approach and management strategies reflect the diverse presentations of psoriasis, particularly in patients of color.

Patient stories can provide important insights into the complexities of multimorbidity. One such example is Brian Lehrschall, diagnosed with psoriasis at age 13, who rapidly progressed to near–total body surface area involvement. Over time, he also developed psoriatic arthritis, with pain and stiffness limiting physical activity. Biologic therapies reduced his skin involvement to approximately 25% body surface area (BSA), but he continued to live with persistent disease burden.

Reduced activity contributed to weight gain and, ultimately, the development of type 2 diabetes. His diabetes was first identified during an acute episode of severe hyperglycemia (blood glucose >800 mg/dL). Initial management with metformin was insufficient, prompting escalation to a glucagon-like peptide-1 (GLP-1) receptor agonist. This intervention produced substantial weight loss (initially approximately 30 pounds, later exceeding 100 pounds with a switch to another GLP-1 agent).

Notably, weight reduction yielded dual benefits: improved glycemic control and an unanticipated improvement in psoriatic arthritis symptoms, with reduced hip, knee, and back pain. These changes facilitated increased mobility and physical activity, which further supported weight management and enhanced quality of life.

Brian’s case underscores several clinical considerations:

• Comorbidity burden: Psoriasis and psoriatic arthritis frequently coexist with cardiometabolic disease, creating complex management needs.
• GLP-1 receptor agonists: Beyond glycemic and weight outcomes, patients may experience musculoskeletal and inflammatory improvements that positively affect arthritis symptoms.
• Care coordination: Optimal outcomes required input from dermatology, rheumatology, and endocrinology, reinforcing the importance of a multidisciplinary approach.

This case highlights the potential for GLP-1 therapy to improve outcomes across multiple domains in patients with overlapping chronic conditions. It also demonstrates the value of encouraging incremental physical activity and shared decision-making to enhance adherence and patient engagement.

Janene Tirado’s experience with generalized pustular psoriasis (GPP) and palmoplantar pustulosis (PPP) highlights the diagnostic and management challenges associated with rare psoriasis subtypes. Her journey illustrates the potential severity of these conditions and the critical importance of timely, accurate diagnosis.

Janene first noticed atypical blisters on her foot during a golf tournament, initially presumed to be an allergic reaction. Within hours, lesions rapidly progressed bilaterally, accompanied by fever and impaired mobility. She initially presented to an emergency department where she was misdiagnosed with tinea pedis and discharged with topical antifungals. Overnight, her condition worsened, with extensive pustular eruptions, incapacitating pain, and systemic symptoms.

When she eventually accessed dermatologic care, she was diagnosed with GPP—a rare, potentially life-threatening psoriasis variant requiring specialized management. Her case emphasizes the need for clinicians to maintain a high index of suspicion for pustular forms of psoriasis, particularly when rapid lesion progression and systemic symptoms occur. Early recognition and intervention are essential to mitigate complications and improve outcomes.

Janene’s post-flare course has been marked by residual scarring, ongoing sensitivity, and functional limitations, underscoring the long-term impact of GPP/PPP on quality of life. Her experience also highlights the psychosocial burden associated with delayed diagnosis and mismanagement.

Her story reinforces several key considerations: the importance of patient-centered evaluation when common diagnoses fail to align with clinical presentation, awareness of rare psoriasis phenotypes, and early referral to dermatology specialists. Supporting patients through education, anticipatory guidance, and evidence-based therapy can improve both clinical outcomes and patient resilience in managing rare psoriasis subtypes.