212 Concerns about Psoriasis Differ by Race: Implications for Patient-Centered Goal-Setting and Counseling

Psoriasis is a systemic inflammatory disease that is associated with major medical comorbidity and negative psychosocial effects. In the U.S., while psoriasis is most common among whites, some data suggest that it may be more severe and have a greater negative impact on quality-of-life among minorities. Little is known regarding the experience of and concerns about psoriasis among different racial/ethnic groups. In order to better understand patients’ perspectives of psoriasis and whether they differ by race, we performed semi-structured interviews of 68 individuals (white N=36, black N=32) with moderate to severe plaque psoriasis. The interview assessed knowledge of and experience with psoriasis, as well as patients’ beliefs and attitudes towards treatment. Data were independently coded by two members of the research team using NVivo 11. Median (interquartile range, IQR) age was 52 (40-63) years and duration of psoriasis was 13.5 (6.5-26.5) years; 71% were female. These characteristics were similar between white and black subjects (p>0.05). The team identified “concerns about psoriasis” as an important theme. Across all subjects, major themes related to the concerns about psoriasis included discomfort due to the physical presentation and symptoms of psoriasis with concerns ranging from the visual unsightliness to both subtle and overt indications of social and emotional isolation. In particular, concerns about scarring and disease recurrence were prominent among blacks, whereas concerns about comorbid disease beyond psoriatic arthritis and the heritability and possibility of future children having psoriasis were specifically notable among whites. In sum, we found that white and black patients with psoriasis had both shared and specific concerns about psoriasis that may be important for medical providers to consider when discussing disease course and treatment options and goals among a diverse patient population.