Effects of the early period of the COVID-19 pandemic on psoriatic disease severity and treatment

Background and Design: The coronavirus disease-2019 (COVID-19) pandemic caused unexpected and drastic changes in the modus operandi of global healthcare. Psoriasis is a dermatosis that necessitates the provision of special healthcare services in dermatology clinics, due to its severe effects on quality of life and its socioeconomic consequences. This study aimed to identify pandemic-related problems experienced by psoriasis patients followed up in our outpatient clinic, thereby revealing the effects of the COVID-19 pandemic on these patients.
Materials and Methods: This study included 64 patients with plaque psoriasis who were followed up at the Psoriasis Outpatient Clinic of Aydýn Adnan Menderes University Faculty of Medicine, Department of Dermatology 6 months before and after the start of the pandemic in Turkey. A questionnaire was used to inquire how the patients were affected by the pandemic; median Psoriasis Area and Severity Index (PASI) scores and number of hospital visits were compared with pre-pandemic values.
Results: Thirty-six patients (56.3%) stated that the pandemic had no effect on their disease, 20 patients (31.3%) reported a deterioration of their disease. The most common reasons thought to aggravate disease were pandemic-related stress and changes in treatment regimen. Treatment of 43 patients (67.2%) remained the same during the pandemic. There was a change in treatment in 21 patients (32.8%). The median number of patient visits to our outpatient clinic was 3 before the pandemic, which dropped to 2 during the first 6 months of the pandemic (p<0.001). PASI scores were compared on an individual basis, and 30 patients (46.9%) in the study group had an increase in their median PASI scores during the pandemic.
Conclusion: The COVID-19 pandemic led to fewer patient visits to the hospital and difficulties in managing patient compliance to treatment. Our study showed that approximately half the psoriatic patients being treated had an increase in the severity of their disease during the COVID-19 pandemic. A considerable percentage of these patients linked this deterioration with the pandemic.

COVID-19 pandemisi erken döneminin psoriazis hastalarýnýn hastalýk þiddeti ve tedavileri üzerine etkileri

Amaç: Beklenmedik bir þekilde ortaya çýkan koronavirüs hastalýðý-2019 (COVID-19) pandemisi saðlýk sistemi iþleyiþinde deðiþikliklere neden olmuþtur. Psoriazis kronik seyri, yaþam kalitesini ciddi anlamda etkilemesi ve hastalýðýn yüksek sosyo-ekonomik önem arz etmesi nedeniyle dermatoloji polikliniklerinin özel saðlýk hizmeti sunumu gerektiren bir durumudur. Çalýþmamýzda polikliniðimizde takipli olan psoriazis hastalarýnýn pandemi nedeniyle yaþadýðý aksaklýklarý, tedavilerine uyumlarýný belirleyerek COVID-19 pandemisinin hastalar üzerindeki etkilerinin ortaya konmasý amaçlanmýþtýr. Gereç ve Yöntem: Çalýþmaya Aydýn Adnan Menderes Üniversitesi Týp Fakültesi, Deri ve Zührevi Hastalýklarý Psoriazis Takip Polikliniði’ne 18.03.2020 tarihi öncesi 6 ayda ve ayný tarihten 6 ay sonrasýna kadar olan süreçte baþvuran ve takibine devam edilen 64 plak tip psoriazis hastasý alýnmýþtýr. Hastalara sorulan anket sorularý ile pandemiden nasýl etkilendikleri deðerlendirilirken, pandemi döneminde medyan psoriazis alan þiddet indeksi (PAÞÝ) deðerleri, ortalama hastane baþvuru sayýlarý retrospektif dosya taramasý yapýlarak pandemi öncesi deðerleriyle karþýlaþtýrýlmýþtýr.
Bulgular: Hastalarýn anket sorularýna verdikleri yanýtlarda 36 hasta (%56,3) pandemi sürecinin hastalýklarý üzerine etkisi olmadýðýný, 20 hasta (%31,3) ise hastalýk þiddetinde artýþ olduðunu belirtmiþtir. Psoriazisi þiddetlendirdiði düþünülen en sýk nedenler pandemi süreci iliþkili stres ve tedavi deðiþiklikleri olmuþtur. Pandemi sürecinde 43 hastanýn (%67,2) tedavisi ayný kalýrken, 21 hastada (%32,8) tedavi deðiþikliði olduðu kaydedilmiþtir. Pandemi öncesi hastalarýn takip polikliniðine geliþ sayýlarýnýn medyan deðeri 3 iken pandeminin ilk 6 ayýnda 2’ye düþtüðü saptanmýþtýr (p<0,001). Bireysel olarak karþýlaþtýrýlan PAÞÝ deðerlerinde çalýþma grubunda 30 hastanýn (%46,9) pandemi sonrasý medyan PAÞÝ deðerinde artýþ olduðu görülmüþtür.
Sonuç: COVID-19 pandemisi hastalarýn hastane baþvurularýnda azalma ve tedavi davranýþlarýný yönetmede zorluklara neden olmuþtur. Çalýþmamýzda takip olgularýn yaklaþýk yarýsýnda COVID-19 pandemisi döneminde hastalýk þiddeti artmýþtýr. Bu hastalarýn azýmsanamayacak bir oraný hastalýk þiddetinde artýþtaki tetiklenmeyi pandemi ile iliþkilendirmiþtir.