Mild to Moderate Psoriasis Linked with Indicators of Suboptimal Treatment, Disease Control

Mild to moderate psoriasis is associated with indicators of suboptimal disease control and treatment, new data suggest, and dermatologists may underestimate such patients’ severity and treatment needs.1

These data resulted from a recent paper exploring real-world data and clinical characteristics of patients living with mild to moderate psoriasis. Alexander Litvintchouk, PharmD, MS, of Johnson & Johnson, led a team of other investigators in authoring this paper.

Litvintchouk and coauthors noted the high prevalence of various forms of psoriasis, expressing the general lack of widespread agreement on psoriasis’s categorization. Nevertheless, they noted the condition is usually classified based on the severity of impacted body surface area (BSA) and skin, with mild (< 3%), moderate (3%–10%), or severe psoriasis (> 10%) being the 3 common categories.2

“Although there is considerable real-world data on the clinical characteristics and treatment patterns of those with moderate-to-severe [psoriasis], data for patients with mild PsO and how this compares with patients diagnosed with moderate [psoriasis], are limited,” Litvintchouk and colleagues wrote.1

Design and Notable Findings

Over the course of the analysis, the investigative team set out to characterize how adult patients living with newly diagnosed mild or moderate psoriasis are managed in routine practice. To do this, the team evaluated patients' clinical features, demographic information, choices in psoriasis treatment, and subsequent disease course. They implemented data from the Adelphi Real World Psoriasis Disease Specific Programme, a cross-sectional survey with retrospective chart review carried out between December 2021 - March 2022.

Litvintchouk et al looked at the responses of dermatologists located in Italy, France, Spain, Germany, and the United Kingdom. Each of these dermatologists completed record forms for 7 to 8 consecutive adult patients. In their responses, these clinicians would draw on medical documentation as well as their own diagnostic judgment. The dermatologists would report information from the time of diagnosis and at the initiation of their patients' most recent therapies.

There were 209 dermatologists who took part, contributing the necessary information on 875 patients. Among these 875 individuals, 40.7% were also able to provide self-reported data.1 At first presentation, Litvintchouk and colleagues found 35.3% of patients were described as having mild psoriasis. Although this was the case, the investigators also noted 79.7% of this group had a body surface area (BSA) involvement between 3% - 10%.

The team further highlighted the assignment of another 64.7% with a diagnosis of moderate psoriasis, although 62.8% of these individuals were shown to have a BSA greater than 10%. When disease evolution was evaluated from diagnosis to the beginning of the current treatment, patients who were initially categorized as mild in their disease presentation were shown to have a markedly larger increase in relative BSA compared with patients diagnosed labeled as moderate (mean change 113.2 ± 307.2% versus 17.7 ± 93.6%; P < .001).

At the time of diagnoses, Litvintchouk and coauthors found topical agents and phototherapy were implemented in most cases. Significantly increased use was observed among those labeled mild (94.9%) as opposed to patients labeled moderate (85.5%; P < .001). Those classified as moderate were significantly more likely to begin treatment with systemic agents at the time of diagnosis (P < .001) and to be given biologics both at the time of diagnosis (p = 0.029) and at the time of the survey (P < .001).

Additionally, the investigative team found measures of quality of life also indicated a the moderate group had a greater burden. This was reflected in the Dermatology Life Quality Index (P = .006) and in patients' Work Productivity and Activity Impairment scores (P = .002 and P = .006). Overall, the study authors conclusions suggest many of those labeled as having mild psoriasis show clinical indicators of more extensive disease at presentation.

This pattern would suggest a portion of patients with psoriasis diagnosed with mild disease may actually meet criteria for greater severity. This would expand the number of patients deemed eligible for advanced treatments, including biologic agents, according to current guidelines in Europe. These data indicate that dermatologists may be underestimating both severity of psoriasis impacts and therapeutic needs in those with mild to moderate disease.

“A better understanding of the reasons disease severity is underestimated and improved classification of PsO severity would likely increase access to more efficacious and novel advanced treatments and contribute to enhancing patients' clinical outcomes and QoL,” the investigative team concluded.1

References

1. E Goddard, A Keal, J Hetherington, et al. Patient Characteristics, Disease Profile and Treatment Patterns in Mild and Moderate Psoriasis Patients: Results From Real-World Clinical Practices in Five European Countries (PROSPECT Study). JEADV Clinical Practice 0 (2025): 1-12, https://doi.org/10.1002/jvc2.70244.

2. Menter A, Strober BE, Elmets CA, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019 Apr;80(4):1029-1072. doi: 10.1016/j.jaad.2018.11.057. Epub 2019 Feb 13. PMID: 30772098.