Future perspectives on care for patients with psoriasis. What did we learn during the COVID-19

Social distancing during COVID-19 has had a profound impact in many respects on our society. The frequency of anxiety, depression, posttraumatic distress, and stress has increased in many countries (1). Risk factors include female gender, younger age group (≤40 years), presence of chronic/psychiatric illnesses, unemployment, student status, and frequent exposure to social media/news concerning COVID-19. COVID19 likely impacts mental health in patients with psoriasis.

During the COVID-19 pandemic, many patients skipped on visits to dermatology centers, which had a serious impact on the diagnosis and treatment of skin cancer. 115,000 patients were diagnosed with cancer in 2020, a decrease of 4000 diagnoses compared to 2019.

From a postal survey in Germany, we learned that out of 205 respondents, 19.5% missed an appointment and 9.8% changed therapy due to the pandemic. Treatment alterations were initiated by patients (50%) and physicians (40%), whereas cancelations of appointments mostly occurred on patients' request (70%). Changes in treatment and appointments were associated with higher psoriasis severity scores and more frequent disease aggravations (2).

During the pandemic, teledermatology visits became much more common. How did the patients appreciate the change to telemedicine? Out of 894 invitations sent, 168 patients completed our survey (3). The most common reasons respondents liked telehealth were because of time efficiency (81.1%), not requiring transportation (74.2%), and maintaining social distancing (73.6%). The most common reasons respondents did not like telehealth were due to lack of physical touch (26.8%) and feeling they received an inadequate assessment (15.7%). To organize telemedicine it is important that national health authorities create a supportive organizational framework. Helpful changes could the integration of telemedicine into international and national guidelines for public health, the definition of national regulations and funding frameworks for telemedicine, and a communication toolkit to inform and educate the population on the recommended use of telemedicine (4).

Is telemedicine treatment as effective as in-person medical care? Participants were randomized 1:1 to receive online or in-person care (5) (148 patients were randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. Between-group differences in the PASI score and BSA were within prespecified equivalence margins.

Is telemedicine time efficient? This was studied in a comparative investigation (6). In 391 patients, we obtained a concordance between face-to-face and store-and-forward diagnosis of 91.05% (Cohen κ coefficient = 0.906). On an average, only few minutes needs to be added to a normal visit to transmit the cases to an expert teledermatologist. Time for a teledermatologist to view the cases was shorter than for face-to-face care. Patients who were referred using teledermatology triage systems tended to receive primary treatment at the first dermatology appointment and required fewer repeat visits.

In the treatment of psoriasis, telemedicine presents some challenges. For example, some regions of the body may be difficult to examine, and inspection of entire body is limited (a hurdle to complete skin examinations for skin cancer). Last but not least: In person, consultation may provide the most empathic interactions.

Looking into the future, it is my impression that telemedicine will not replace in-person dermatology, but it is an important “add-on” which may permit an improvement in access to care for some patients.

Disclosure statement

No potential conflict of interest was reported by the author(s).