While about a million Canadians live with psoriasis, one in three will go on to develop psoriatic arthritis, said Rachael Manion, executive director of the Canadian Association of Psoriasis Patients and the Canadian Skin Patient Alliance, during a session supported by UCB Canada Inc. at Benefits Canada‘s 2022 Chronic Disease at Work event in February.

Psoriasis isn’t just a skin disease or a rash, she explained. Rather, it’s an immune system disease that isn’t contagious but isn’t easy to live with. “You don’t have to live with a severe form of psoriasis for it to have a severe impact on your life.”

Psoriasis and the underlying inflammation can cause a variety of other problems, noted Manion. It can impact the metabolic system, as well as the cardiovascular system, which is the leading cause of death for people with psoriasis. It usually appears between the ages of 15 and 25; however, incidence may also peak between ages 50 and 60.

Read: How can employers support women with inflammatory arthritis, psoriasis?

In addition, psoriasis is an episodic disease, so people experience periods where their condition is well controlled and then can have a flare up or a period of worsening of the disease where they may require a completely different approach to managing their disease.

“There’s no cure for this condition, but we know treatments work well,” said Antonella Scali, executive director of Canadian Psoriasis Network, also speaking during the session.

The treatment gold standard is to control the underlying inflammation, which can lead to a corresponding symptom reduction, said Manion.

“Providing multiple treatment options for psoriatic disease is essential,” she noted, because the conditions may vary over time. Certain treatments may be appropriate for different populations or at different stages of life, added Scali, As well, because of individual comorbidities, some drugs may be more appropriate than others.

It’s very common for people living with psoriatic disease to reach a point where their treatment stops working, noted Manion. “Their immune system has essentially outsmarted it and they need to look to something with a different mechanism of action or something that works in a slightly different way.”

Read: Plan sponsors get a primer on autoimmune conditions

Phototherapy is an evidence-based standard of care for psoriasis and may be used when systemic drugs aren’t an option, said Scali. However, access to phototherapy in Canada is challenging and some patients must travel for hours to get to a clinic, so she recommended benefits plan sponsors consider expanding coverage for home phototherapy units.

More than 50 per cent of Canadians with psoriatic disease said their condition has had a negative impact at work, according to a survey. It also reported that the majority of this group access medications and other health services through their — or their partners’ — employer-sponsored benefits plan, but also reported difficulties with access.

For example, 37 per cent of respondents said their benefits plan only reimbursed some prescribed medications, which can be challenging because treatment needs can change throughout the course of the disease, noted Scali. Almost 30 per cent indicated their benefits plan limits the amount of money the plan will reimburse, which — depending on the cost of the treatment — may result in an expensive out-of-pocket patient copayment, she added. In addition, she said 12 per cent reported difficulty navigating administrative processes such as prior authorization, which can cause delays, for example, if they experience a flare up and need a treatment quickly.

Read: How to handle a workplace accommodation

Scali suggested plan sponsors support members with psoriatic disease through workplace accommodations to work comfortably, which can be as simple as having a humidifier at their workstation or more frequent breaks.

Pain management programs can also be an important part of extended health benefits, she said, because pain is a common symptom of psoriatic disease and can make life challenging when it isn’t well controlled.

“Living with a chronic and episodic disease like psoriasis . . . is exhausting and . . . a little bit like a roller coaster ride,” said Scali, encouraging expanded access to employee assistance programs in addition to social worker and psychologist services. “When [psoriatic disease] is well controlled, people do better — they do better at work, they do better at home, they do better mentally and physically.”

“Private health benefits are important, because when you live with psoriatic disease, it takes a lot of effort and a long time to either get well or just to stay well,” added Manion.

Read more coverage of the 2022 Chronic Disease at Work conference.