Patients who are later diagnosed with psoriasis are twice as likely to be prescribed steroid or antifungal creams than people without psoriasis, which may mask the signs and symptoms of psoriasis and contribute to a further delay in diagnosis.

Psoriasis may be underdiagnosed in UK primary care settings, according to research out of the University of Manchester in The British Journal of General Practice.

Patients who are later diagnosed with psoriasis are twice as likely to be prescribed steroid or antifungal creams than people without psoriasis, which may mask the signs and symptoms of psoriasis and contribute to a further delay in diagnosis.

The research team includes members of the Global Psoriasis Atlas (GPA), a collaboration between three leading international organizations in world dermatology: International Federation of Psoriasis Associations (IFPA); International League of Dermatological Societies (ILDS), and International Psoriasis Council (IPC).

“We already know that early diagnosis of psoriasis can improve the effectiveness of treatment for psoriasis, so these findings are pertinent,” says lead author Maha Abo-Tabik, a PhD research student at The University of Manchester, in a news release.

“The World Health Organization, for example, has highlighted how many people suffer needlessly from psoriasis due to missed or delayed diagnosis. That is why we think it is essential to design additional dermatology training for primary care professionals to improve their diagnostic skills for psoriasis.”

The researchers carried out extensive analysis of electronic health records from more than 700 general practices between 2010 and 2017 across the UK, comparing clinical diagnoses and treatments between people with and without psoriasis. There were 17,320 psoriasis cases and 99,320 controls used from the Clinical Practice Research Datalink Gold database.

They repeated the analysis with 11,442 cases and 65,840 controls extracted from a second database called Clinical Practice Research Datalink Aurum – with similar results.

Patients with psoriasis were up to eight-times more likely than those without psoriasis to be diagnosed with pityriasis rosea at six months before the diagnosis of psoriasis, they found. Patients with psoriasis were twice as likely to be diagnosed with eczema or tinea corporis one year before diagnosis.

They were also more likely to report symptoms of psoriasis such as dry skin, rash, skin texture changes and itching than controls up to five years before diagnosis.

Moreover, patients with psoriasis were prescribed topical corticosteroids or topical antifungals in the year before diagnosis twice as often as those without psoriasis.

“The findings from this study suggest the diagnosis of psoriasis may be missed or delayed by up to five years for some individuals hence leading to a potentially detrimental delay in establishing an appropriate treatment regimen,” says GPA Director Chris Griffiths, Emeritus Professor of Dermatology at The University of Manchester, Head of the Dermatology Theme at the NIHR Manchester Biomedical Research Centre and Honorary Consultant Dermatologist at Salford Royal NHS Foundation Trust.  “It is crucial that diagnosis and treatment start as soon as possible, if patients are to reduce the risk of life-long impairment.”