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Psychiatric morbidity is frequent in patients with psoriasis. We compared the effectiveness of dermatological vs. interdisciplinary dermatological and psychiatric care for psoriasis. Adults with moderate-to-severe psoriasis were randomly allocated to dermatological (n = 24) or interdisciplinary care (n = 23) and treated accordingly. Primary endpoint was the mean change in Dermatology Life Quality Index (DLQI) at 6 months. Data was analysed by intention-to-treat. Mean ± SD change in DLQI was 7.5 ± 7.3 and 10.5 ± 9.9 after 6 months of dermatological and interdisciplinary care, respectively (p = 0.27). At baseline, 10 patients in the interdisciplinary treatment group (43%) had at least one psychiatric disorder. These patients showed significantly better DLQI response (DLQI change 14.8 ± 9.7) than patients receiving dermatological care only (p = 0.03). Ninety percent of psoriasis patients with DLQI scores exceeding psoriasis area and severity index (PASI) scores had comorbid psychiatric disease. Although psychiatric co-treatment is not generally required for patients with moderate-to-severe psoriasis, those patients with higher DLQI scores than PASI scores might benefit from interdisciplinary care.

Background: The German psoriasis registry PsoBest records the long-term efficacy, safety, patient benefit and treatment regimens of psoriasis., Patients and Methods: Patients with moderate or severe psoriasis are included in PsoBest when treatment with a conventional systemic agent or biologic is started for the first time. Observation time is five years. Standardized physician and patient case report forms are obtained every three to six months. Baseline data of patients included by 31 December 2012 are presented and compared to the national health care study PsoHealth 2007 (n = 2,009)., Results: 602 dermatology practices and clinics have been registered and 199 have recruited n = 2,556 patients (63 % by practices, 37 % by clinics). Initially, n = 808 received biologics (316 adalimumab, 34 efalizumab, 209 etanercept, 75 infliximab, 22 golimumab, 152 ustekinumab) and n = 1,651 conventional systemic therapy (928 fumaric acid esters, 518 methotrexate, 161 cyclosporine A, 191 other drugs or UV treatment). Compared to PsoHealth, patients in PsoBest had on average a higher disease severity (PASI 14.7 vs. 10.1; DLQI 11.0 vs. 7.5; EQ-5D VAS 54.0 vs. 64.5), shorter disease duration (18.2 vs. 21.3 yrs.), lower age (47.3 vs. 51.5), higher rates of psoriatic arthritis (20.5 vs. 19.1 %) and nail psoriasis (55.0 vs. 35.6 %). On average patients receiving biologics were younger, more often male and had higher disease severity and comorbidity., Conclusions: Patients in PsoBest represent patients with a high burden of disease., (© 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)