Beyond the Skin: Navigating Psoriasis Treatment and Patient Burden
Management of psoriasis can often involve trialing several medications, extensive patient counseling, and working with insurance companies to get the optimal treatment for our patients. The extent of psoriasis can also be varied, ranging from being localized to a BSA <10% to near full body involvement with possible nail and joint involvement. Accordingly, dermatologists vary their treatments.
For limited psoriasis, most practitioners will start with a topical. In milder involvement, topical steroids or non-steroidal agents can simply be used as monotherapy. Kircik et al review the data for a combination treatment of halobetasol propionate with tazarotene. They analyze the adverse events of the combination compared with either agent independently, as well as how this combination can be used to break the cycle of simply using topical steroids in patients with psoriasis.
Once psoriasis becomes more extensive and/or there are signs of joint or nail involvement, systemic treatments are often needed. While these used to be nonselective immunosuppressants, the treatments of choice now are biologics, typically IL-17 or IL-23. Daniele et al describe some of the structural insights into IL-23 biologics, detailing the exact mechanism of action of this class. They also provide insights into class switching and mechanistic insights that are pertinent to practitioners who regularly use these medications. Gargiulo furthered this discussion by analyzing efficacy and safety of Guselkumab, an IL-23 biologic, in a two-year retrospective study. They detail PASI 90 and PASI 100 responses throughout, and provide detailed information on their cohort.
While our treatments for psoriasis and psoriatic arthritis have drastically evolved over the past decade, some of the biggest roadblocks for dermatologists can be patient counseling, especially when starting a biologic. Maynard et al analyzed the perceptions of biologics in patients with psoriasis and psoriatic arthritis on Reddit. In searching over 1,000 posts, they found overall positive sentiments along with a significant number of users being dissatisfied with biologics. It is critical for dermatologists to understand what general patient sentiment is prior to prescribing these medications to best counsel our patients. Finally, Lee et al examined how psoriasis severity impacts workplace absenteeism. This is important for any practitioner treating patients with psoriasis to understand, in order to understand the externalities associated with the disease process and the overall burden of the disease. It also emphasizes the need to diagnose and treat psoriasis and psoriatic arthritis as early as possible to best help our patients.
REFERENCES
2. Structural Insights: What Makes Some IL-23 Biologics More Effective in Psoriasis
