Patients with psoriatic disease in Mexico reported that their body image is affected by more than just visible skin lesions and joint symptoms. Functional limitations, fatigue, anxiety, depression, and nail involvement are also associated with poor body image, according to a study published in Reumatología Clínica. These findings highlight the importance of comprehensive multidisciplinary care.

“This study stems from IMPACTO, a cohort of patients with psoriatic disease whom we followed at our institute. From the outset, we wanted to go beyond measuring psoriasis or psoriatic arthritis activity and incorporate different aspects of patients’ experiences with the disease,” said Guillermo Arturo Guaracha-Basañez, MD, rheumatologist and clinical researcher in the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, and an author of the study, in an interview with Medscape’s Spanish edition.

The researchers also examined the impact of the condition on body image because it is rarely addressed during medical consultations. This topic is particularly relevant in Mexico and Latin America, where regional data remains limited. “We often extrapolate what we know from other populations, and having our own data helps us better understand our patients’ experiences,” Guaracha-Basañez said.

Study Design and Findings

The descriptive, cross-sectional study included 91 adults with psoriatic disease who were evaluated at the institute between 2022 and 2024. The median age was 58 years, and 53.8% of the participants were women. Dermatologists diagnosed psoriasis in 37.4% of the participants, whereas rheumatologists diagnosed psoriatic arthritis in 62.6%.

Clinical assessments included demographic characteristics, disease activity measures, and patient-reported outcome questionnaires. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI), Disease Activity Index for Psoriatic Arthritis (DAPSA), and Nail Psoriasis Severity Index.

Body image was assessed using the Spanish-language version of the Multidimensional Body Self Relations Questionnaire. The researchers evaluated four dimensions: the importance that participants placed on physical appearance, behaviors intended to maintain physical fitness, self-rated physical attractiveness, and attention paid to physical appearance.

The assessment also included factors commonly associated with psoriatic disease, such as disability, quality of life, mood disorders, and fatigue.

Although the participants generally had mild skin disease activity (median PASI score, 2.5), difficult-to-treat areas were common, affecting 71 patients (78%). Among the 71 patients, 57.7% had one affected area, 36.6% had two, and 5.6% had three affected areas. The most commonly affected sites were the nails (52.7%) and scalp (37.4%), followed by the intertriginous areas (17.6%), palms and soles (5.5%), and genital area (2.2%).

Patients with psoriatic arthritis generally showed moderate disease activity (median DAPSA score, 18.8). Compared with patients with psoriasis, they had more comorbidities (P = .034), greater disability (P = .001), higher Psoriasis Disability Index scores (P ≤ .001), and poorer quality of life (P = .002).

The researchers found no statistically significant differences in body image between patients with psoriasis and those with psoriatic arthritis. However, greater disease activity, as measured by the PASI and DAPSA scores, was associated with poorer body image in both groups.

In the multivariable analysis, functional limitations, poorer quality of life, anxiety or depression, and greater nail involvement were independently associated with poorer body image.

“We expected to find a link between greater psoriasis or psoriatic arthritis activity and poorer body image, and we did find associations in that direction. However, when we looked at the issue more broadly, other important factors emerged, including functional limitations, fatigue, and symptoms of anxiety or depression,” Guaracha-Basañez explained.

One key finding was that body image was not solely determined by visible skin changes or disease activity scores. “It also has to do with what a person is able to do, how they feel, and the way the disease changes their relationship with their own body,” he said.

Carlos Tzalam Vega Nava, MD, an internist and rheumatologist in the Rheumatology Service at Hospital General Tacuba, part of Mexico’s Institute for Social Security and Services for State Workers, Mexico City, and a member of the patient advocacy organization Asociación Unidos contra la Psoriasis, was not involved in the study. He described its findings as “very valuable.”

“The authors show how psoriasis extends beyond the skin and joints, affecting patients’ quality of life,” Vega Nava said.

He added that the findings reinforce the clinical importance of functional limitations, chronic fatigue, anxiety, depression, and nail changes in how patients perceive themselves.

“Seeing that difficult-to-treat areas, such as the nails, or physical exhaustion can affect self-esteem and body satisfaction as much as, or even more than, the extent of skin lesions should make us rethink our approach to care,” Vega Nava said.

Multidisciplinary Approach

The researchers emphasized that the findings support multidisciplinary care that addresses both the physical and psychological aspects of psoriasis.

“The findings clearly underscore the need for a more comprehensive approach to psoriatic disease. Controlling inflammation is essential, but our findings remind us that this does not necessarily resolve all the problems affecting the patient,” Guaracha-Basañez said.

Psoriatic disease can affect the skin, nails, and musculoskeletal system and contribute to fatigue, emotional distress, and impaired quality of life. Guaracha-Basañez stressed the importance of coordinated care involving dermatologists, rheumatologists, mental health professionals, and other specialists, as needed.

“Effective teamwork and communication are essential to keeping patient care at the center of decision-making and ensuring that patients’ concerns and symptoms, such as fatigue, are not overlooked in the focus on technical details,” Vega Nava said.

Practical Considerations

Clinicians should not assume that the extent of skin lesions or disease activity scores fully captures the burden of psoriatic disease, Guaracha-Basañez advised. During consultations, simple questions about fatigue, physical function, mood, and how the condition affects patients’ perceptions of their bodies can help identify concerns that might otherwise go unrecognized.

“Not everyone needs to complete a body image questionnaire, but clinicians should create space for these concerns to emerge during the consultation,” he said.

Vega Nava agreed that clinicians should ask about these issues rather than rely exclusively on routine disease activity measures. Physical examination is also important because patients may conceal skin or nail lesions due to embarrassment or dissatisfaction with their appearance. Examining skin and nails in a safe, supportive environment can help patients feel more comfortable discussing their experiences and concerns, he said.

Guaracha-Basañez also emphasized the importance of asking about symptoms that may seem minor to clinicians but can be highly significant to patients, including nail changes.

“We shouldn’t limit ourselves to asking ‘how is your skin?’ or ‘how are your joints?’ We should also ask how the person is coping with the disease,” he concluded.

Guaracha-Basañez and Vega Nava reported having no relevant conflicts of interest.

This story was translated from Medscape’s Spanish edition.