Psoriasis diagnoses in primary care delayed by years

Psoriasis may be underdiagnosed in UK primary care settings, according to research led by academics from the University of Manchester.

The findings, published in the British Journal of General Practice, show that missed opportunities for early diagnosis of the potentially debilitating condition are relatively common in general practice.

Doctors already know that delays in the diagnosis and initiation of treatment are associated with deterioration in patients’ quality of life.

GPs are most often the first point of contact for people with the condition, rather than dermatologists.

The researchers found that patients who are later diagnosed with psoriasis are twice as likely to be prescribed steroid or antifungal creams as people without psoriasis, suggesting such treatment may mask the signs and symptoms of psoriasis and contribute to a further delay in diagnosis.

‘We already know that early diagnosis of psoriasis can improve the effectiveness of treatment for psoriasis, so these findings are pertinent,’ said lead author Maha Abo-Tabik, a PhD research student at the University of Manchester. ‘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.

17,320 psoriasis cases and 99,320 controls were 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 – a minor skin condition – at six months before the diagnosis of psoriasis.

They were twice as likely to be diagnosed with eczema or tinea corporis – a fungal skin infection – a year before diagnosis.

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

And they were prescribed topical corticosteroids or topical antifungals in the year before diagnosis twice as often as those without psoriasis.

Chris Griffiths is emeritus professor of dermatology at the University of Manchester, said: ‘Psoriasis is a long-term disease affecting around 3% of people in the UK, which substantially affects their quality of life and is linked with other serious medical conditions such as arthritis, heart disease and depression.

‘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.

‘It is crucial that diagnosis and treatment start as soon as possible, if patients are to reduce the risk of life-long impairment.’

Photo by Clarissa Watson