PS73 Financial burden of psoriasis treatments as a psychosocial stressor: impact on disease flares and quality of life

Abstract

Chronic psoriasis often requires costly treatments including emollients, corticosteroids, specialized cleansers and shampoos, and systemic therapies. Nonreimbursed costs can generate significant financial stress, potentially contributing to disease flares and poor adherence through psychoneuroimmunological mechanisms. The aim of this study was to determine the impact of financial stress related to treatment costs on flare frequency, treatment adherence and quality of life in patients with psoriasis. This was an observational study of 115 patients with psoriasis (64 men, 51 women; mean age 42 years, SD 12). Variables assessed included perceived financial stress (0–10 scale), monthly cost of non­reimbursed treatments estimated according to local consumption patterns, flare frequency, treatment adherence using the Morisky Medication Adherence Scale and quality of life using the Dermatology Life Quality Index (DLQI). Patients were stratified into groups with low financial stress (score ≤ 4, n = 28) and high financial stress (score ≥ 7, n = 87) for comparison. Patients with high financial stress had significantly higher monthly non­reimbursed treatment expenditures (approximately 2–2.5 times higher, P < 0.001) than patients with low stress. Treatment ­nonadherence was markedly more frequent in the group with high stress (60% vs. 18%, P < 0.001). High financial stress was associated with higher monthly flare frequency (mean 1.2, SD 0.4 vs. mean 0.5, SD 0.2; P < 0.001) and substantially worse quality of life (DLQI mean 15, SD 4 vs. mean 6, SD 3; P < 0.001). Significant differences were observed between groups across all clinical and psychosocial parameters. The financial burden of nonreimbursed psoriasis treatments represents a major psychosocial stressor that triggers disease flares and significantly impacts adherence and quality of life. The mechanism likely involves chronic stress-induced inflammatory activation, nonadherence leading to disease worsening, and psychological burden creating a vicious cycle. These findings highlight the need for improved treatment coverage, psychological support and targeted therapeutic monitoring for patients experiencing high financial stress. Addressing financial barriers may represent an important intervention point for improving psoriasis outcomes through the psychodermatological pathway.