The definition of well-being in psoriasis has been previously described as an initial part of the Inpsight project, highlighting the main components to be addressed [20]. Continuing the previous work carried out and placing this study within the framework of the Inpsight project, this analysis aims to assess the importance of each component, exploring differences in perspectives between patients and HCPs. To the best of our knowledge, this represents the first attempt to evaluate the relative importance of these components from the perspective of both patients and HCPs.

Physical and emotional dimensions emerged as the most relevant for patients and professionals, with the social dimension being the least relevant. However, their relative importance varied: patients prioritized the physical dimension, while professionals emphasized the emotional factors.

This difference highlights a gap in perception between patients and HCPs. Although patients generally expressed satisfaction with their treatment, they highlighted factors relevant to their experience that professionals may undervalue. The difference in perceptions encountered in this study may be partly due to the easier recognition of physical symptoms, like pain and itching, by the patients. However, emotional issues like depression or stigmatization are harder to identify, even though they may impact patients' well-being. This misalignment warrants further examination, as it could hinder efforts to address the factors that most significantly impact patient well-being [27]. Moreover, these results suggest that HCPs, at least in this study, appear to be more aware of the emotional impact of psoriasis than what is commonly reported in previous studies that also recognized this awareness in the case of the patients [28, 29]. This may reflect, at least in Spain, that HCPs are recognizing the emotional burden more than before. However, this may not be the case globally, and further research is needed to assess whether this shift is occurring universally or if it is specific to certain regions or healthcare system.

The physical burden of psoriasis plays a central role in patients’ lives, as evidenced by concerns about pain, discomfort, itching, and lesions in functional areas. These factors directly impair QoL and have been consistently associated with worse outcomes in previous studies [5, 20]. Patients indicated that they are most concerned about pain/discomfort, itching, and lesions in functional areas. Pain, discomfort, and itching have a direct negative impact on patients with psoriasis, being associated with poorer QoL [30,31,32]. Skin lesions, especially in visible or functional areas, have been identified as debilitating factors that generate a tremendous burden on patients with psoriasis [33]. These components can affect patients not only physically but also emotionally and socially, as their burden can affect different dimensions They may also be associated with an increase in stress [34], as well as various psychiatric disorders such as depression [35], anxiety [36, 37], and sleep disorders [37], as previously reported by other authors.

The fact that patients are more impacted by these physical components, and that their perspective differs from HCPs, who focus primarily on the emotional dimension, may explain their importance for people with psoriasis. As patients, they see physical impairments as potential barriers to everyday life, affecting their mental health and well-being [36, 38]. In this context, different studies have highlighted the fact that skin lesions are an important source of stigmatization for patients, leading them to cover them up to avoid distress [39, 40]. Another study found that depressive symptoms increased as the QoL of patients with psoriasis became poorer [41], suggesting that patients may consider the idea that better physical health might improve their emotional and psychological dimensions. Physicians, however, recognize the long-term psychological burden of psoriasis, including stigma, anxiety, and depression, viewing emotional well-being as pivotal to overall QoL [38, 42, 43]. This difference highlights the need for a holistic approach that aligns patient and physician priorities in psoriasis management.

Self-esteem, mood disorders, and stigmatization/shame were the emotional components considered more critical by HCPs. These components could be directly associated with physical impairments, contributing to increased disease burden. Different studies suggest that the severity of psoriasis, related to the visibility of severe lesions, low self-perception, and other psychopathologies, is associated with lower self-esteem [6, 44, 45]. The impact of these factors and low self-esteem in patients can also undoubtedly cause them to experience stigmatization and shame, also expected consequences of psoriasis [46, 47], further contributing to a decline in their QoL. As previously mentioned, several studies have shown the risks of having mood and psychiatric disorders for patients with psoriasis [35, 36, 43], affecting their psychological and emotional state, despite efforts to downplay them and the complications of psoriasis [42, 48]. The physical effects resulting from the patients’ emotional state could be vital in understanding the outcomes reported by HCPs in this study. Assessing the emotional dimension could generate uncertainty among physicians, as they can quickly examine physical conditions, encountering more difficulties in evaluating the emotional components and prioritizing them over others. A more comprehensive approach from HCPs through improved specialized training and the ability to identify, understand, and provide patients with more emotional support could narrow this gap between patients and HCPs.

This study has some limitations. Despite the significant number of participants, all of them were required to have participated in the previous phase of the Inpsight project and to be members of the Acción Psoriasis group, preventing new participants from joining the study and limiting the range of answers.

The study was conducted in Spain, providing a comprehensive view of the Spanish cultural context, although variations might have arisen if the surveys had been conducted globally. Nevertheless, the responses obtained are likely to be similar, as no major differences would be expected.