Management of Psoriasis in Africa and the Middle East: A Review of Current Opinion, Practice and Opportunities for Improvement

Abstract

Psoriasis is a common, chronic, systemic, inflammatory disease of the skin that is often associated with inflammatory musculoskeletal disease. Psoriasis impacts on affected individuals and on society at many levels, being associated with considerable economic burden and impaired quality of life. This article aims to provide dermatologists and their allied healthcare professionals, particularly those practicing in Africa and the Middle East, with a review of the current understanding of psoriasis, its treatment and impact, as a backdrop for further discussion of the management of psoriasis in these regions. Insight into the real-life, day-to-day challenges and unmet needs currently facing dermatologists in Africa and the Middle East is provided by the authors, most of whom are experienced dermatologists practicing in this region.

<p>The Unmet Need for Clinical Guidelines on the Management of Patients with Plaque Psoriasis in Africa and the Middle East</p>

“…The literature search returned a total of 145 publications and 10 of these described patients in Africa or the Middle East. Of these 10 publications, there were 4 research articles ( Table 1 ), 20 – 23 3 reviews ( Table 2 ), 8 , 24 , 25 2 guidelines (1 from South Africa in 2010 and 1 from Saudi Arabia in 2014; Table 3 ), 26 , 27 and 1 case study (published in Hebrew). 28 Two of the 4 research articles described non-interventional studies and 2 reported data from studies on the safety and efficacy of phototherapy (1 in patients with plaque psoriasis localized to the scalp or palmoplantar areas and 1 in patients ≥65 years of age).…”

Disease burden and treatment challenges of psoriatic arthritis in Africa and the Middle East

“…Population-based studies have estimated the prevalence of PsA in the United States to be 0.25% [95% confidence interval (CI) 0.18-0.31%] [20] and in the United Kingdom to be 0.19% (95% CI 0.185-0.193%) [26]. However, a comparison with African and Middle Eastern populations is not currently possible since the majority of research into PsA has been carried out in Western countries and there are very few published studies on the prevalence and burden of PsA in Africa and the Middle East [5,18], which was evident in our literature search. Consequently, the reported global estimates of incidence and There was a lack of consensus in the use of biologics for the treatment of psoriasis and PsA in clinical practice, which was attributed to low physician awareness, high cost, and non-adherence Conaghan et al [9] Multi-national survey of dermatologists and rheumatologists in the Asia-Pacific region and the Middle East…”

“…There is a lack of reliable data on the prevalence and burden of PsA in Africa prevalence may not be reflective of this very large and diverse region [5]. Indeed, the lack of local registries, reliable diagnosis, and reporting of PsA has led to the impression that it is relatively rare in Africa and the Middle East, when in fact the burden of the disease is unknown [16]; a similar observation has been reported for rheumatoid arthritis (RA) [27].…”

“…This chronic immune-mediated inflammatory disease is characterized by multiple manifestations including peripheral arthritis, enthesitis, dactylitis, spondylitis, and psoriatic skin and nail disease [1,2], which may occur alone or in combination [3]. Since PsA is a clinically diverse and heterogeneous disease, both in presentation and severity [4], management is particularly challenging and requires an interdisciplinary approach [5]. Recent advances in the understanding of the immunological mechanisms underlying PsA are providing new insights into the pathogenesis of the disease [6], enabling the development of targeted therapies that can improve patient outcomes [7].…”

“…However, there is still much to learn and both the diagnosis and treatment of PsA remain suboptimal [7]. This is particularly true for the large and diverse region of Africa and the Middle East, where very few studies into PsA have been carried out, and consequently the extent of the disease burden is poorly understood and improvements in the management and treatment of PsA are much needed [5].…”