Analysis Shows How Pandemic Led to Worsened Conditions for Patients With Psoriasis

A recent research letter describes the effect of coronavirus disease 2019 (COVID-19) pandemic on patients with psoriasis in China, who suffered from declines in mental health and exacerbations of disease.

Publishing in the Journal of the American Academy of Dermatology, researchers sought to determine the association of outdoor activity restriction and income loss with patient-reported outcomes of psoriasis through web-based surveys.

The 926 surveys were collected between February 25 and March 6, 2020. Multivariable logistic regression was used to estimate the associations with adjustments. The effect size was presented as adjusted odds ratio (aOR); P <.05 was considered statistically significant.

The mean age of the patients was 33.1; 36.9% were female. There was 1 reported confirmed infection with COVID-19. Certain aspects of the pandemic were all individually associated with worsened psoriatic symptoms:

• Nonadherence to treatment (aOR = 3.69; 95% CI, 2.67-5.18)
• Stress (aOR = 1.17; 95% CI, 1.11-1.23)
• Quarantine (aOR = 2.05; 95% CI, 1.33-3.18)
• Income loss (aOR = 1.51; 95% CI, 1.06-2.15)

Additionally, researchers found that 43.7% (405) of respondents experienced moderate-to-severe exacerbation of psoriasis.

It is already known that lost work or a reduction of hours makes it difficult for patients with chronic conditions to afford treatment. “Loss of income and work-related benefits experienced by the unemployed consequently lead to impaired health outcomes, through mechanisms involving unhealthy coping behaviors and increased psychological distress,” noted the researchers.

In this study, income loss was heavily associated with treatment nonadherence as well as increased stress as well as symptoms of anxiety and depression, which can lead to a worsening of psoriasis symptoms.

Although income loss was associated with nonadherence, it was not associated with utilizing health care services.

Outdoor activity restrictions and quarantines were also positively associated with the exacerbation of psoriasis, stress, and symptoms of anxiety and depression, but were not associated with nonadherence to treatments.

The authors noted that outpatient facilities and services may be temporarily unavailable, which can limit patient accessibility to treatments, especially for those who are not accustomed to using telehealth. This can disrupt treatment and contribute to a a worsening of symptoms.

Researchers suggested that telemedicine, increased supply of medications, and mental health interventions are needed for patients with psoriasis in order to improve their health outcomes.

Reference

Kuang Y, Shen M, Wang Q, Xiao Y, Lv C, Luo Y, Zhu W, Chen X, Association of outdoor activity restriction and income loss with patient-reported outcomes of psoriasis during the COVID-19 pandemic: A web-based survey. J Am Acad Dermatol. Published online May 11, 2020 doi:10.1016/j.jaad.2020.05.018