Psoriasis management online?

A glimpse into the future care of psoriasis patients was given at a trial presented by Prof. April Armstrong of the Keck School of Medicine [20].

According to her trial, an online care model for psoriasis patients was just as good as traditional in-person care. “After the year 2020, there will be more people above the age of 65 than below nine years. The demand in dermatology care will outstrip the supply in future,” she said. In years to come, more and more patients with chronic skin diseases will lack regular access to dermatology providers, but teledermatology could eventually relieve the pressure of this demand.

The researches decided to assess this model in psoriasis patients because it is a chronic skin disease with a number of co-morbidities, where a team approach by a primary care practitioner (PCP) together with a dermatologist might be particularly valuable. For the study, either PCP or psoriasis patients took standardised photographs of their skin. The photos were uploaded to a connected site where dermatologists could access the images, evaluate them, and provide recommendations directly to the patient and the PCP.

The study enrolled 300 patients randomised 1:1 with online to in-person care. A change in the PASI index was the primary study outcome. Over 12 months, the difference in the average change in the PASI between the online and in-person groups was -0.271. The average change in BSA between the two groups was -0.053%. Between-group differences in PASI and BSA were within the pre-specified equivalence margins, which means that the two interventions were equivalent for this endpoint.

“It was really astonishing for us how small the difference between the groups was,” said Prof. Armstrong. In addition, the online model fared better in the PGA. As Prof. Armstrong pointed out, the online group was believed to have lower disease activity during the study compared to the in-person group and had less side effects.

“With our trial, we demonstrated that this model really works,” said Prof. Armstrong. For physicians, it will be equally important to know whether they get paid for their cooperation and whether they could be sued more. These questions will be crucial to making online care successful.

20. Armstrong, A. Abstract 6730, AAD Annual Meeting, February 16–20 2018



Posted on 20 December 201825 March 2021