(b) and rheumatologists (c) not initiating or continuing biologic therapy Fig. 3 Most common reasons for patients discontinuing conventional oral therapy (a) and for dermatologists (b) and rheumatologists (c) not initiating or continuing conventional oral therapy MAPP Survey Results from US Patients and Physicians 93 biologic therapy effectiveness, while 69.0 and 97.0 % of rheumatologists, respectively, reported satisfaction. However, 53.2 % of dermatologists and 17.0 % of rheumatologists were dissatisfied with the long-term safety of conventional oral therapies; 17.8 % of dermatologists and 15.0 % of rheumatologists reported dissatisfaction with the long-term safety of biologic agents. Nearly 80 % of dermatologists and more than 50 % of rheumatologists reported that they were somewhat or very concerned about the overall long-term use of conventional oral or biologic therapy. Overall, most survey respondents (87.8 % of patients, 98.0 % of dermatologists, and 98.0 % of rheumatologists) felt there was a strong or moderate need for better therapies. Among patients, 51.5 % indicated that current therapies can be worse than the condition itself, compared with 30.7 % of dermatologists and 12.0 % of rheumatologists. In addition, 48.5 % of dermatologists and 31.0 % of rheumatologists reported that an important issue is patients leaving their practice because of frustration or dissatisfaction with currently available therapies. 4 Discussion MAPP was unique in its design as a large-scale, multinational, population-based survey that included patients with psoriasis and/or PsA, as well as physicians. The results of the current report reflect the findings from the US respondents, including patients, dermatologists, and rheumatologists, with a goal of identifying the similarities and discrepancies in patient and physician responses, as well as the challenges and unmet needs of diagnosis, assessment, and treatment. To participate in the MAPP survey, patients were not required to be under the care of a physician, receiving treatment, or a member of a patient organization. A substantial proportion of patients who participated had not seen an HCP for their psoriasis within the previous 12 months. The reported reasons included that they did not feel an HCP could help, demonstrating frustration with the current management options. This was mirrored by approximately half of the dermatologists and one third of the rheumatologists, who agreed that they were concerned about patients leaving their practice because of frustration or dissatisfaction with currently available therapies. Of those patients who had seen an HCP within the previous 12 months, approximately 30 % of both psoriasis and PsA patients saw a primary care physician, not a specialist, which is slightly higher than the rate of 22 % recently reported by the National Psoriasis Foundation (NPF) [17]. When asked about factors that affect disease severity, patient and physician responses differed. Patients, especially those with psoriasis, consistently placed more emphasis on pruritus than did physicians. US psoriasis patients [15] and global psoriasis patients [14] reported itching as the most important factor contributing to disease severity, followed by the location and size of lesions. In contrast, just over 10 % of US dermatologists cited itching as the most important factor. This finding may be related to the fact that itching is not currently captured in most physician assessments or in the most commonly used psoriasis assessment tools, including those used in clinical trials but not often in practice, such as the Psoriasis Area and Severity Index and the physician’s global assessment of disease severity [18]. Even among PsA patients, itching was cited by nearly 15 % of patients as the most important factor contributing to disease severity. Overall, these findings suggest that patients may assess disease severity differently from physicians, and tend to consider symptoms beyond those usually assessed in a physician visit. Improved communication between patients and physicians may help to foster the understanding of all aspects of disease that impact patient quality of life. Joint pain was reported by more than half of the patients with a diagnosis of psoriasis alone. However, fewer than 20 % of dermatologists reported that their psoriasis patients had joint pain. Although more than three quarters of both dermatologists and rheumatologists agreed that PsA may go undiagnosed because of failure to connect skin and joint symptoms, fewer than 60 % of dermatologists discussed this risk with all of their psoriasis patients. A separate report recently highlighted the underdiagnosis of PsA in dermatology treatment centers, where approximately 40 % of patients diagnosed with PsA by a rheumatologist had not been diagnosed by their dermatologist [9]. The MAPP