Dr. Kim Papp recalls treating a patient who suffered from psoriasis, a chronic inflammatory condition. He had patches of thick, red, scaly skin on his palms and the soles of his feet, which made it impossible for him to work at his job as a machinist.

Dr. Papp, a dermatologist, submitted an insurance claim on the man’s behalf, and it was denied because his psoriasis was not designated as “severe.”

He is one of many psoriasis patients who struggle to get treatment even though the effects of their disease are debilitating. Many insurers provide coverage for severe cases of psoriasis by using a classification system based on one or two criteria used in research.

The first is a rating on the Psoriasis Area and Severity Index (PASI), a scale that accounts for the percentage of the affected body surface area and plaque appearance. The second criteria, called the Dermatology Life Quality Index (DLQI), measures the impact of the psoriasis on a patient’s quality of life. But many healthcare providers see those measurements as flawed.

The PASI score doesn’t take into consideration where the lesions are located on the body, which is a significant factor. For example, a small patch of psoriasis would likely be less problematic on a patient’s calf than on the soles of his feet, where it might prevent him from walking.

The DLQI score might determine that a patient can exercise without determining whether she actually will exercise — something that would require her to expose patches of red, scaly skin in public.

“The standard measurement tools don’t paint a full picture,” says Dr. Melinda Gooderham, Medical Director at the SKiN Centre for Dermatology and SKiN Laser Clinic in Peterborough, ON. “Psoriasis that is classified as moderate can be just as debilitating as psoriasis that is classified as severe. Diagnosis shouldn’t be based on numbers and statistics only.”

“The key question to ask is, ‘What is the overall impact of a patient’s disease on his or her daily life?’” adds Dr. Papp, who is head of Probity Medical Research in Waterloo, ON.

Patients find hope

Insurance coverage varies among plans and continues to evolve. A specialist considers their patient’s coverage along with other factors when making a treatment plan, which could include topical ointments, light therapy, and systemic medication.

When it comes to systemic medication, most patients prefer pills over injectables, notes Dr. Gooderham. But in all cases, patients should explore their options with the help of a dermatologist.

Patients should be proactive in getting the right treatment, says Dr. Papp. “As a psoriasis patient, you should expect an appropriate response to your disease.”