Physician Spotlight: Jerry Bagel, MD, FAAD

New treatments continue to change the playing field for patients with moderate-to-severe psoriasis, but a significant treatment gap still exists. Unless and until, this gap is shored up, psoriasis patients will continue to suffer and face stigma. An expert weighs in.

Why is advocacy so important within the psoriasis community?

Dr. Bagel: It is not just patient advocacy, but patient-physician advocacy that is important. Physicians aren’t always aware of how much psoriasis patients suffer from this disease psychologically, metabolically, physically, professionally, and in terms of reduction in their quality of life. Only 20 percent of patients with severe psoriasis are being treated adequately. Advocacy is about education. We need to let patients know that there are better treatments available today and we need to educate physicians about the monitoring methods for these treatments so that they are more comfortable treating psoriasis.

Is there really still a stigma associated with psoriasis?

Dr. Bagel: Yes. The recently released Clear About Psoriasis Survey from the National Psoriasis Foundation showed that 85 percent of moderate-to-severe psoriasis respondents have suffered from social stigma like discrimination and humiliation because of their disease. These patients are made to feel dirty and ugly. As many as 50 percent will avoid intimate relationships, increasing their risk for depression and suicidal ideation. Severe psoriasis patients are also more likely to be economically challenged, compared with their mild-to-moderate counterparts, and all psoriasis patients have a higher frequency of poverty compared to people without this inflammatory skin disease. This is due to many factors. They have very poor self esteem and they don’t sleep well so they go to work, but don’t perform their job as well as others. They also have increased absenteeism.

How can we reduce this stigma?

Dr. Bagel: We know that biologics improve the disease, depression, and quality of life for our patients. It all comes back to patient and physician advocacy. We need to keep educating patients about their treatment options. We also want doctors to become more comfortable prescribing available treatments and monitoring patients on them, which will shore up the treatment gap and improve quality of life and stigma. It’s not that difficult to treat moderate-to-severe psoriasis and it can be done well in a relatively short period of time. These patients come back in 12 weeks with a big smile. This is very rewarding for all involved. n