COVID-19 affects patients and care

Be aware of the impact of social distancing on patients with psoriasis. “It hits them,” Prof. Peter van de Kerkhof (Radboudumc, the Netherlands) emphasised [1]. Telemedicine in the treatment of psoriasis is an important ‘add-on,’ but not a complete replacement.

From the start of the COVID-19 pandemic to 17 May 2020, rates increased in the general population concerning anxiety (6.33% to 50.9%), depression (14.6% to 48.3%), post-traumatic stress disorder (7% to 53.8%), psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) [2]. Risk factors associated with distress measures included female gender, younger age group (≤40 years), presence of chronic and psychiatric illnesses, unemployment, student status, and frequent exposure to social media and news concerning COVID-19. “One can imagine that in patients with psoriasis, in whom the social functioning is impaired and impacted by their disease, the effect of COVID-19 on mental health will be quite severe,” Prof. Van de Kerkhof added.

A postal survey in Germany among patients with psoriasis (n=205) demonstrated that 19.5% missed an appointment and about 10% changed therapy due to the pandemic [3]. Treatment alterations were encouraged by patients (50%) and physicians (40%), whereas cancellations of appointments mostly occurred at patients’ request (70%). Changes in treatment and appointments were associated with higher psoriasis severity scores and more frequent disease aggravations. “So, not only on the mental aspect but also on the physical aspect of psoriasis, COVID-19 has had its impact,” Prof. Van de Kerkhof concluded.

Telemedicine

Telemedicine may provide an opportunity to guarantee adequate treatment of psoriasis during the pandemic. A US survey was sent out to patients who attended telehealth appointments during the COVID-19 pandemic [4]. Out of 894 invitations sent, 168 patients completed this survey. Respondents most commonly liked telemedicine because of time efficiency (81.1%), not requiring transportation (74.2%), and maintaining social distancing (73.6). On the other hand, the most common reasons respondents did not like telemedicine were due to lack of physical touch with the doctor (26.8%) and the feeling they received an inadequate assessment (15.7%) because the doctor had not really seen their skin. Few patients reported that they were unlikely to undertake another telemedicine visit (9.94%) or recommend a telemedicine visit to others (6.92%).

Because the regulations for telemedicine were not always optimal during the COVID-19 pandemic, authors from France and Italy published a call to action and suggested a framework for telemedicine in healthcare [5]. Their first recommendation was to integrate telemedicine into international and national guidelines for public health. Secondly, the definition of national regulations and funding of frameworks for telemedicine should be optimised. Thirdly, they advised that a communication toolkit should exist to inform and educate the population on the adequate use of telemedicine.

A controlled trial (NCT02358135) randomised adults with psoriasis to online care (n=148) or in-person care (n=148) [6]. Between-group differences in the Psoriasis Area and Severity Index (PASI) score and body surface area (BSA) were within prespecified equivalence margins. “So, these methods of care can be performed quite well,” concluded Prof. Van de Kerkhof.

There are some difficulties with telemedicine. Firstly, special regions are either embarrassing for the patient or difficult to visualise, such as lesions in the genital area or on the elbow or scalp. Also, the inspection of the entire body surface is difficult with telemedicine. In-person consultation provides the best empathic interaction. Investigation of the joint, tendinitis, and dactylitis, as well as screening for uveitis, inflammatory bowel disease, and auto-immune disease is difficult via the internet.

1. Van de Kerkhof, P. Insights on how COVID-19 affects the care of patient: Innovations in the research landscape in the past year. 6^th World Psoriasis & Psoriatic Arthritis Conference, 30 June–3 July 2021.
2. Xiong J, et al. J Affect Disord. 2020;277:55–64.
3. Ninosu N, et al. Eur J Dermatol. 2021;31:183–91.
4. Yeroushalmi S, et al. J Drugs Dermatol. 2021;20:178–83.
5. Ohannessian R, et al. JMIR Public Health Surveill. 2020;6:e18810.
6. Armstrong AW, et al. JAMA Netw Open. 2018;1:e183062.

 

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Posted on 17 September 202120 September 2021