A European perspective on the challenges of managing psoriasis

Psoriasis affects approximately 2% of the world’s population and results in disability similar to or exceeding that associated with other major illnesses such as diabetes mellitus, rheumatoid arthritis (RA), depression, and cancer. 1,2 It is chronic and incurable and can develop at any age. The disease is characterized by unpredictable periods of remission and relapse. As an added complication, the nature and morphology of the disease may be altered by therapy such as psoralen plus UVA. The lifelong nature of psoriasis invariably means a requirement for therapy that may be used long term. Clinical management is currently dictated by the physical and psychologic aspects of the disease coupled with historic response to therapy, with physical aspects identified as mild to severe. Perhaps we should instead consider psoriasis as easy or difficult to treat. This philosophy is exemplified by the holistic tool used for psoriasis measurement, the Salford Psoriasis Index. 3 New systemic therapies require reconsideration of psoriasis treatment paradigms.