An audit conducted by the British Association of Dermatologists (BAD), looking at the way in which newly published NICE guidelines on assessment and management of psoriasis patients are being implemented across the UK, is being released to mark World Psoriasis Day on Tuesday (29th October 2013).

On the whole the results were very positive. However, despite NICE prioritising holistic assessment of people with psoriasis, the audit revealed that psychological support for psoriasis patients in Britain has more than halved in the past six years compared to a similar audit in 2007. Where psychological support is available, psoriasis patients commented that waiting lists were often lengthy with actual access to treatment being sparse. Furthermore, psoriasis patients are often presented with issues of fairness when seeking psychological assistance, with limited resources being reserved for the most severe cases.

The British Association of Dermatologists, representing UK dermatologists, undertakes audits of services for psoriasis patients to make sure that they are getting the right treatments and that guidelines are being followed. In many respects, the UK is a world-leader in psoriasis treatment with dermatologists in the UK producing world class research into the disease and its treatment. However the audit highlights some important areas for improvement, most notably in the area of psychological support. This is an area of concern for the BAD which is currently in the process of creating a government-funded website to provide psychological support for people with skin conditions, in addition to this the association runs a web-based register of biologic and conventional therapies for psoriasis (BADBIR).

The BAD has also frequently raised the issue of an insufficiency in the number of dermatologists compared to the number of people requiring treatment for skin diseases, including psoriasis. If we were to have the same provision as the USA, Germany, Italy or France we would need around 6,000 consultant dermatologists, currently we have 684.

The problem is exacerbated by the fact that GPs – who see around 13 million people each year presenting with a skin problem – have very little training in dermatology, around six days on average. This leads to extra referrals to hospitals, or delays in treatment and diagnosis. Lack of training and awareness of psoriasis in primary care is also recognised as a key barrier to effective implementation of the NICE guidelines. The British Association of Dermatologists has raised these concerns with the Department of Health, the Royal College of GPs and Health Education England.

Psoriasis is a common autoimmune disease that affects 2% of the UK population. The condition causes rapid skin cell growth, most frequently appearing as raised, red, scaly plaques. Ranging in severity, psoriasis is a chronic and often painful condition which affects all age groups and both sexes. People with psoriasis may also develop psoriatic arthritis.

Beyond the physical implications, the debilitating effects of psoriasis are known to expand into the realms of depression, anxiety and suicide. In a recent national study 10,400 psoriasis patients in the UK were found to suffer from depression, 7,100 from anxiety and 350 from suicidal tendencies*. UK psoriasis patients are 39% more likely to succumb to depression than non-sufferers, with those who are severely inflicted being 72% more likely to possess mental health issues.

In spite of this, state provided psychological care for psoriasis patients in the UK appears to have decreased in the past six years (as discovered in the BAD’s ‘The assessment and management of patients with psoriasis – where are we?’ – conducted 2013 with over 1000 respondents), having fallen from 44% of hospitals providing dermatological psychological support to just 20%. The situation is further exacerbated by the fact that just over half of hospitals record psoriasis sufferer’s Dermatology Life Quality Index (DLQI) – the benchmarking system which ranks and monitors skin condition sufferers’ current life satisfaction, serving as a warning signal when a ranking crosses the threshold.

Positive steps

• In March 2013 The British Association of Dermatologists (BAD) was awarded government funding for a groundbreaking project that will bring together two major areas of healthcare, to benefit the lives of millions of people. The Department of Health Innovation, Excellence & Strategic Development Fund grant, of £97,000 over three years, will enable the BAD to develop a website that will act as a hub for psychological support specifically targeted at skin disease patients. The project will be the first of its kind to unite the specialties of dermatology and mental health, which have a significant overlap.

The causal link between mental health issues and skin disease is twofold – skin disorders cause psychological traumas, and conversely, psychological factors like stress can trigger or worsen certain skin diseases. However, Psycho-dermatology services (which provide emotional support specifically for skin disease patients) are extremely limited in the UK and very few dermatology departments even have direct access to general psychiatrists. The website will bring together, and link to, existing disease specific resources, support groups, forums and help-lines.

• The British Association of Dermatologists’ Biologic Interventions Register (BADBIR), a web-based register of biologic and conventional systemic therapies for psoriasis. Many patients find that conventional topical and systemic treatments will help them to control their psoriasis, however, for some with moderate or severe psoriasis these treatments are ineffective. New therapies called biologics have been developed by pharmaceutical companies to help control these more severe cases of psoriasis. As with most drugs, there are risks and side effects. Because this type of drug is new these risks and side effects need to be monitored carefully. Five years ago the British Association of Dermatologists set up BADBIR to do just that.
It currently involves over 7551 patients and 140 dermatology departments. The data it will provide over the coming years will be invaluable for the safe use of biologics in clinical practice. A UK and Ireland-wide dermatology clinical research network has been established that provides a framework for future studies in other diseases. The patient database also provides a useful resource for further research into psoriasis and some new studies have already begun as a result of this.

Nina Goad, of the British Association of Dermatologists said: “More often than not treatments of skin conditions focus on the visible symptoms, completely overlooking the equally impactful psychological consequences of disease. It is increasingly evident that the UK is in serious need of a robust psycho-dermatological infrastructure where patients suffering with psychological conditions originating from skin disease can seek accessible, comprehensive care. Currently the opposite is occurring, and whilst organisations such as the BAD are taking action, more needs to be done across the public health system. Specifically, funding needs to be allocated for Clinical Psychologists dedicated to dermatology patients.”

World Psoriasis Day is on the 29th of October.
*OLIVIER C, ROBERT P, DAIHUNG D, et al. The Risk of Depression, Anxiety, and Suicidality in Patients With Psoriasis: A Population-Based Cohort Study. Arch Dermatol. 2010;146(8):891-895. doi:10.1001/archdermatol.2010.186.

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For more information please contact the British Association of Dermatologists’ Press Office
Email: comms@bad.org.uk Tel: 0207 391 6084 / 6094