Racial Differences in Perceptions of Psoriasis Therapies: Implications for Racial Disparities in Psoriasis Treatment

Abstract

In the United States, black patients are less likely than white patients to receive biologic treatment for their psoriasis. We conducted a qualitative free-listing study to identify patient-generated factors that may explain this apparent racial disparity in psoriasis treatment by comparing the perceptions of biologics and other psoriasis therapies between white and black adults with psoriasis. Participants included 68 white and black adults with moderate to severe psoriasis who had and had not received biologic treatment. Each participant was asked to list words in response to verbal probes querying five psoriasis treatments: self-injectable biologics, infliximab, methotrexate, apremilast, and phototherapy. Salience scores indicating the relative importance of each word were calculated, and salient words were compared across each race/treatment group. Participants who had experience with biologics generally associated positive words with self-injectable biologics. Among biologic-naïve participants, "apprehension," "side effects," and "immune suppression" were most salient. "Unfamiliar" and "dislike needles" were salient only among black participants who were biologic naïve. Participants were generally unfamiliar with the other psoriasis therapies except phototherapy. Unfamiliarity with biologics, particularly among black, biologic-naïve patients, may partly explain the existing racial disparity in biologic treatment for psoriasis and might stem from lack of exposure to or poor understanding of biologics.

Content Analysis of Psoriasis and Eczema Direct-to-Consumer Advertisements

“…Together, our findings suggest inadequate patient reach of psoriasis and eczema DTC advertisements that, particularly in the case of psoriasis, mirror and may reinforce existing age and racial disparities in treatment [5][6][7] and poor familiarity with biologics. 10 A similar impact of eczema DTC advertisements on emerging eczema treatment patterns and potential treatment disparities also might be anticipated and is of concern.…”

“…6 Data also suggest existing age and racial disparities in psoriasis treatment in the United States, whereby patients who are older or Black are less likely to receive biologic therapies. [7][8][9] Although the exact causes of these disparities remain unclear, one study found that Black patients with psoriasis were less familiar with biologics compared to White patients, 10 which suggests that the racial disparity in biologic treatment of psoriasis could be due to less exposure to and thus recognition of biologics as treatments of psoriasis among Black patients.…”

Assessing the Effect of Demographic Background on Barriers to Seek Medical Attention for Psoriasis

“…4 At most, only a small minority of people with psoriasis see a physician in any given year. 4 While racial/ethnic differences are associated with obstacles to receiving medical care, 5,6 the impact of other demographics on health care barriers is not well characterized. We assessed the relationship between demographics—including age, gender, education level, and current treatment status—and barriers to seek medical attention for psoriasis.…”

Psoriasis in Patients of Color: Differences in Morphology, Clinical Presentation, and Treatment

“…For clinicians, more attention on the differences would help make earlier diagnoses, personalize physician-patient conversations, and advocate for further education on this issue in residency training programs. Potentially greater impact on QOL with scalp psoriasis 2,5,a Greater BSA involvement in Asian patients 6 More severe disease at presentation 7,a Treatment Preference for foams and lotions for scalp 2,a UV consideration for prevention of hyperpigmentation 8 No known differences in efficacy of systemic treatments 5 Patients with skin of color underrepresented in clinical trials 9 Reduced patient recognition of certain treatments 10 Psychosocial impact Higher DLQI at baseline 6,a Abbreviations: QOL, quality of life; BSA, body surface area; DLQI, dermatology life quality index.…”

“…6,13 Studies show similar efficacy in treatments among races, particularly biologic therapies. 5 However, patients with skin of color historically have been underrepresented in clinical trials, 9 which may contribute to these patients, particularly black patients, being less familiar with biologics as a treatment option for psoriasis, as reported by Takeshita et al 10 Therefore, patient-centered discussions regarding treatment choices are important to ensure patients understand all options available to manage their disease.…”