Implementation and real-world feasibility of a digital psoriasis self-management app: a 12-month prospective observational study

Background Psoriasis impairs physical and mental health. Evidence for real-world digital disease-management interventions remains limited. Objective This exploratory, single-arm feasibility study assessed real-world feasibility and usage patterns of a digital self-management app for psoriasis over 12 months and explored associations between app engagement and clinical and patient-reported outcomes in two German university dermatology outpatient settings. Methods 182 participants with psoriasis were enrolled and given access to a study app for continuous disease monitoring and weekly patient-reported outcomes. Assessments were conducted at baseline (V0), 6 months (V1) and 12 months (V2). Primary outcomes were feasibility measures: installation, activation (≥1 app login after installation), 12-month retention and sustained engagement (≥10 logins over 12 month, corresponding to ≈20% of study weeks). Changes in the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) were analysed as exploratory outcomes. Results All 182 participants installed the app, a condition of enrolment. Activation was achieved by 70.3% (128/182), sustained engagement 66.5% (121/182), photo upload 61.5% (112/182) an 12 month retention 58.2% (106/182). In paired complete-case analyses, PASI (median 3.0 → 1.0, n = 104; p < 0.001), DLQI (7.0 → 3.0, n = 91; p < 0.001), and HADS-A (7.0 → 5.0, n = 93; p = 0.002) declined significantly after Bonferroni correction ( α = 0.00625); HADS-D (5.0 → 4.0, n = 93; p = 0.033) did not survive correction. The HADS-A baseline median of 7 was already below the borderline-caseness threshold of 8, so this reduction does not represent threshold crossing. In a sensitivity analysis of 75 patients with stable therapy (54, 72.0%, with sustained engagement), within-person PASI change was −0.75 points ( n = 56; 95% CI −1.2 to −0.05; p < 0.001); the DLQI change was smaller (median 0.0, mean −2.5; n = 52; p = 0.012). Higher app use frequency was not associated with greater changes in any outcome. Conclusion Integrating a digital self-management app into routine psoriasis care is feasible in a real-world setting, with 70.3% activation and 58.2% twelve-month retention. Clinical and patient-reported measures declined over the study period, but given the uncontrolled, single-arm design, attrition-related selection toward milder disease, and the absence of a dose-response relationship with app use, these changes cannot be attributed to the app and should be regarded as hypothesis-generating for a future randomised controlled trial. Clinical Trial Registration https://www.drks.de/search/de/trial/DRKS00037907/details , Deutsches Register Klinischer Studien DRKS00037907.