Psoriasis is a chronic, immune-mediated inflammatory skin disease that affects approximately 2–3% of the global population. Clinically, it is characterized by well-demarcated erythematous plaques with silvery scales, often involving the scalp, elbows, knees, and lower back. The disease course is typically chronic and relapsing, with variable severity across individuals. Severity is commonly classified as mild, moderate, or severe based on the Psoriasis Area and Severity Index (PASI), the Body Surface Area (BSA) affected, and the Physician's Global Assessment (PGA), which are also standard measures in pivotal clinical trials assessing therapeutic efficacy.1

Around one-third of patients present with moderate-to-severe forms of the disease,1 which often require either traditional systemic therapies (e.g., methotrexate, cyclosporine) or biologic agents and small-molecule inhibitors, as topical treatments and phototherapy are usually insufficient at these stages. Beyond its cutaneous manifestations, psoriasis significantly affects patients' health-related quality of life (HRQoL), interfering with daily activities, impacting physical appearance, and contributing to social stigmatization.2 In Spain, the estimated prevalence of psoriasis is approximately 2.3% of the population, with no significant differences between sexes,3 reflecting a considerable disease burden at the national level as well.

Improvements in patient-reported outcomes may vary depending on patient characteristics and treatment type.4 Differences related to gender have been observed, with women generally reporting greater impairment in HRQoL compared to men, even at equivalent levels of clinical severity.2 Other demographic and clinical factors may also influence both the initial impact of psoriasis and the treatment response.5,6

Regarding therapeutic approaches, biologic and immunomodulatory therapies have significantly improved HRQoL outcomes in moderate-to-severe psoriasis.7 Indeed, the proportion of patients achieving a DLQI score of 0–1 (indicating no impact on daily life) increases markedly after the initiation of biologic agents compared to traditional systemic treatments.8 However, the magnitude of this benefit can vary between therapeutic classes. Evidence from multiple comparative clinical trials and meta-analyses indicates that therapies targeting the IL-17 and IL-23 pathways achieve greater improvements in both clinical severity and patient-reported outcomes compared with TNF-α inhibitors.9–11

Indeed, the proportion of patients achieving a DLQI score of 0–1 (indicating no impact on daily life) increases markedly after the initiation of biologic agents compared to traditional systemic treatments 4.12,13 In pivotal clinical trials, therapies targeting IL-17 and IL-23 pathways (such as secukinumab, ixekizumab, or guselkumab) have shown PASI 90 response rates above 70%, alongside consistent HRQoL improvement, confirming their superiority over earlier TNF-α inhibitors.14

In recent decades, the systematic use of Patient-Reported Outcome Measures (PROMs) has transformed the evaluation of health outcomes, particularly in domains related to HRQoL, by incorporating the patient's perspective into clinical practice and research.2 PROMs were developed to complement clinician-reported measures, capturing the subjective impact of disease and treatment on daily functioning and well-being. Their implementation has progressively expanded across multiple chronic conditions, including dermatological diseases.15 In psoriasis, PROMs have been increasingly adopted in clinical trials and real-world studies to quantify the burden of symptoms and to evaluate therapeutic benefit beyond clinical signs. Although early pivotal trials primarily focused on objective outcomes such as the Psoriasis Area and Severity Index (PASI), more recent studies have integrated PROMs as secondary or even co-primary endpoints, underscoring their relevance in assessing patient-centered outcomes.16

To objectively assess this impact and longitudinally monitor therapeutic outcomes, PROMs are widely used. The Dermatology Life Quality Index (DLQI) is one of the most validated and internationally utilized PROMs for evaluating the burden of psoriasis on patients' quality of life.8 Additionally, the Psoriasis Symptoms and Signs Diary (PSSD) is a psoriasis-specific PROM that records, over a seven-day period, the intensity of key symptoms (e.g., itching, pain, burning) and signs (e.g., redness, scaling, cracking).9 Further information and practical recommendations on the use of PROMs in dermatology and psoriasis can be found in international guideline and consensus documents.17,18

In recent years, the role of telepharmacy has emerged as an innovative tool to improve the follow-up of patients with psoriasis and other chronic diseases. Internationally, telepharmacy is increasingly implemented across various healthcare settings and has been evaluated in numerous studies, showing improvements in clinical outcomes, patient satisfaction, and healthcare efficiency.2,19 Telepharmacy applies telemedicine principles to pharmacy practice, allowing safe, flexible, and patient-centered pharmaceutical care delivery remotely. Through information technologies, close pharmacotherapeutic follow-up can be maintained, including remote monitoring of clinical parameters and electronic collection of PROMs (ePROMs) to assess patient progress, as clearly emphasized in a recent MAPEX guidance document published by the Spanish Society of Hospital Pharmacy (SEFH).20 In accordance with this framework, SEFH has defined key domains for telepharmacy—including therapeutic monitoring, patient education, multidisciplinary collaboration, and remote medication delivery—that support the structured integration of ePROMs into routine care. This comprehensive model reinforces equity and personalization in patient follow-up, offering a solid foundation for implementing telepharmacy strategies in the management of psoriasis.

Within this context, the TELEPROMpsoriasis study aimed to evaluate the evolution of HRQoL and cutaneous symptoms over 12 months in a cohort of patients with moderate-to-severe plaque psoriasis treated with biologic or small-molecule inhibitors and monitored through the NAVETA telepharmacy platform. The study employed two validated ePROMs—the DLQI and PSSD-7 days—to longitudinally monitor clinical response and patient well-being. Additionally, it explored the achievement of predefined clinical thresholds (DLQI ≤1 and PSSD-7 days <20) and assessed whether these outcomes differed by treatment history (biologic-naïve vs biologic-experienced) or gender. Finally, the study examined the correlation between the two instruments to evaluate their concurrent validity in remote patient monitoring.

Ethics Approval: TELEPROMpsoriasis study is part of a wider project with approval by the Research Ethics Committee of the Balearic Islands (IB 4542/21 EOm).

In the TELEPROMpsoriasis study, HRQoL was monitored over 12 months using the ePROMs DLQI and PSSD-7 days in patients with moderate-to-severe psoriasis treated with biologic or small-molecule therapies via a telepharmacy program.

Both measures showed significant improvement over time, indicating meaningful gains in symptom control and psychosocial well-being. The proportion of patients achieving clinically relevant thresholds (DLQI ≤1 and PSSD-7 days <20) increased progressively throughout follow-up, indicating a marked improvement from baseline to month 12. These improvements underscore the effectiveness of advanced systemic therapies—including anti-TNF, IL-17 and IL-23 inhibitors—in reducing disease burden and enhancing HRQoL, in line with previous reports.5,22,23

Gender-based differences were also evident. Women consistently reported worse HRQoL scores and were less likely to achieve clinical targets, particularly during the first six months of follow-up. This trend, observed in previous literature, may reflect heightened psychosocial sensitivity or differences in treatment perception among women with psoriasis, even at comparable levels of disease severity.24 These findings emphasize the need for gender-sensitive approaches in clinical practice and HRQoL monitoring.

When stratified by treatment history, biologic-naïve patients consistently showed better outcomes than biologic-experienced patients, particularly at the later stages of follow-up. By the end of the study, a markedly higher proportion of biologic-naïve patients achieved optimal HRQoL thresholds, suggesting that earlier initiation of advanced therapies may yield greater benefits. A descriptive comparison across pharmacological classes (Anti-TNF, Anti-IL-17, Anti-IL-23) did not reveal statistically significant differences in HRQoL evolution, indicating that improvements were comparable among patients treated with different biologic mechanisms in routine clinical practice. Treatment persistence remained high across all subgroups, and discontinuations due to adverse events were infrequent, aligning with the favorable safety profiles described in clinical trials and real-world studies.25

Moreover, a strong and consistent correlation between DLQI and PSSD-7 days was observed at all timepoints, remaining high throughout follow-up. This reinforces the concurrent validity of both tools and illustrates how symptom improvement and perceived well-being evolve in parallel.

These results should be interpreted in light of the analytical approach used. Due to missing questionnaire responses and varying sample sizes across follow-up visits, analyses were based on non-parametric comparisons of score distributions at each follow-up time point rather than within-subject longitudinal models. Accordingly, the observed reductions in DLQI and PSSD-7 day scores reflect consistent differences across successive follow-up visits and between groups, but do not formally quantify individual-level change over time.

The integration of telemonitoring platforms such as NAVETA into chronic disease management offers a scalable and patient-centered strategy to enhance engagement, optimize resource use, and ensure continuity of care.21 The participation levels and satisfaction observed in this study support the feasibility and acceptability of telepharmacy-based follow-up in dermatological settings. These findings align with previous evidence indicating that digital tools can facilitate communication between patients and healthcare professionals, promote adherence, and sustain patient involvement over time.

By facilitating remote ePROMs collection, NAVETA enables timely therapeutic feedback, supports shared decision-making, and improves the overall experience with pharmaceutical care. These findings are consistent with growing evidence supporting digital health tools to enhance treatment adherence, monitor HRQoL, and tailor care in immune-mediated inflammatory diseases.26,27

These findings collectively suggest that the systematic use of ePROMs through telepharmacy platforms provides a comprehensive picture of patient progress, extending beyond traditional clinical metrics. Improvements in both HRQoL and symptom scores reflect not only therapeutic efficacy but also enhanced patient engagement and self-awareness regarding disease management. The consistency observed between DLQI and PSSD-7 trends supports the reliability of combining general and symptom-specific PROMs to capture multidimensional changes in well-being.

Furthermore, the results highlight the relevance of integrating patient-reported data into routine clinical workflows. Telemonitoring tools such as NAVETA can help identify early non-responders, support timely clinical decisions, and maintain patient motivation over time. This approach aligns with the current paradigm of personalized and value-based healthcare, where patient experience and quality of life are recognized as essential treatment outcomes in chronic inflammatory diseases.

This study is not without limitations. The absence of a control group without telepharmacy follow-up precludes direct comparison of outcomes. Selection bias is possible, as participants required basic digital literacy, excluding patients without access to or familiarity with digital tools. Additionally, attrition over time may have introduced follow-up bias.26,27 Another limitation is that the analysis did not differentiate between patients who discontinued previous biologic therapies due to loss of efficacy or adverse events, nor whether treatment switches involved a change in the pharmacological mechanism of action. These factors could influence HRQoL trajectories and should be explored in future studies.

In conclusion, the TELEPROMpsoriasis study demonstrates that telepharmacy-supported monitoring using validated ePROMs (DLQI and PSSD-7 days) effectively captures the longitudinal evolution of HRQoL and cutaneous symptoms in patients with moderate-to-severe psoriasis treated with biologic or small-molecule therapies. The progressive improvement observed in both measures confirms the capacity of digital follow-up to reflect meaningful clinical benefit.

The analysis of predefined HRQoL thresholds (DLQI ≤1 and PSSD-7 days <20) showed that a substantial proportion of patients reached optimal outcomes over time, supporting the clinical relevance of these targets in real-world settings. Differences according to treatment history and gender indicate that prior biologic exposure and sex-related factors influence perceived well-being, underscoring the importance of individualized patient monitoring.

A strong correlation between DLQI and PSSD-7 days further validates their combined use for remote assessment, confirming that improvements in symptom severity translate consistently into better quality of life. Overall, these findings reinforce the value of PROM-based, patient-centered care and highlight the potential of telepharmacy platforms such as NAVETA to enhance digital equity, adherence, and continuity of care in chronic dermatological conditions.

All authors are members of the Working Group of the Spanish Society of Hospital Pharmacy (GTEII-SEFH), except for Jaime Notario Rosa, María Eugenia Escrivá Sancho, and Salvador Herrera-Pérez.

Gabriel Mercadal-Orfila: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Resources, Project administration, Methodology, Investigation, Funding acquisition, Data curation, Conceptualization. Piedad López Sánchez: Writing – review & editing, Investigation. Nuria Padullés-Zamora: Writing – review & editing, Investigation. Aránzazu Pou Alonso: Writing – review & editing, Investigation. Olatz Ibarra-Barrueta: Writing – review & editing, Investigation. Emilio Monte-Boquet: Writing – review & editing, Investigation. Joaquín Borrás Blasco: Writing – review & editing, Investigation. Patricia Sanmartin-Fenollera: Writing – review & editing, Investigation. Cristina Capilla Montes: Writing – review & editing, Investigation. María Angeles Bernabéu Martínez: Writing – review & editing, Investigation, Conceptualization. Jaime Notario Rosa: Investigation. María Eugenia Escrivá Sancho: Investigation. Salvador Herrera-Pérez: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Methodology, Investigation, Formal analysis, Data curation, Conceptualization.

This study is part of a wider project with approval by the Research Ethics Committee of the Balearic Islands (IB 4542/21 EOm).

This research was funded by the Spanish Society of Hospital Pharmacy (SEFH). All the funding was awarded to GTEII-SEFH.