Spring Dermatology Week 2023: Psoriasis Session Roundup

Supported by the National Psoriasis Foundation, among other associations, Dermatology Week brings together leading subject matter experts from across the field of dermatology for 4 days of virtual classes, live Q&As, and more. Psoriasis was a key topic covered during Spring Dermatology Week 2023, with sessions on delivering better care to patients, understanding barriers to care, achieving more comprehensive care, and addressing health disparities.

Delivering Better Care

This year’s Spring Dermatology Week commenced with a thought-provoking session led by Joel M. Gelfand, MD, MSCE, and Steven R. Feldman, MD, PhD, illuminating the clinical epidemiology of psoriasis and the importance of analytical studies in improving patient care.¹ The discussion, titled “Better Care for Psoriasis Patients,” delved into the seasonal trends of psoriasis and emphasized the necessity of robust research methodologies to enhance clinical practices.

Dr Gelfand initiated the session by reviewing a study substantiating the widely held belief that psoriasis worsens during the spring season. “We had this idea that psoriasis gets worse in the spring, and here are large-scale analytic data now to show, in fact, the hypothesis is probably true,” he explained. The findings underscore the significance of conducting analytical studies with control groups, including placebo groups, to assess therapeutic efficacy.

Furthermore, Dr Gelfand summarized the evolution of clinical epidemiology, stating that modern epidemiology encompasses studies examining the distribution and determinants of health and disease in patient populations. Clinical epidemiology, he added, extends these techniques to critically evaluate diagnostic and therapeutic modalities in clinical practice, thereby informing public health, preventive medicine, and individual patient care decisions.

Building on Dr Gelfand’s insights, Dr Feldman called attention to the importance of understanding the data in these studies. He focused on long-term response studies, which often present observed data without accounting for patient dropouts, potentially skewing the outcomes and portraying a more positive picture.

Dr Feldman referenced a study involving 463 participants over a span of 2 years, where 424 individuals completed the trial. Comparing this with another study that seemingly demonstrated improved patient outcomes over time, Dr Feldman looked at the fine print, revealing that only 63% of the participants remained. “And so, 66% having success out of 63% does not look really all that good,” he concluded, cautioning against drawing hasty conclusions based on incomplete data.

The session served as a reminder of the need for rigorous analytical studies in dermatology, particularly in the context of psoriasis treatment. By conducting well-designed studies and considering factors such as seasonal variations and long-term patient adherence, dermatologists can gain deeper insights into the efficacy of treatments, enabling them to provide better care and improved outcomes for patients with psoriasis.

Understanding Barriers to Care

Psoriasis is undertreated in the United States, leading to patient dissatisfaction, as highlighted by Jeffrey M. Cohen, MD.² During his session, titled “Understanding TYK2 as a Therapeutic Target in the Management of Moderate to Severe Psoriasis,” Dr Cohen shed light on the contributing factors to undertreatment.

According to Dr Cohen, barriers include limited access to care; patient concerns regarding adverse reactions, lab monitoring, and anxiety related to injectable medications; and physician concerns regarding access, adverse reactions, and monitoring requirements. These barriers hinder patients from receiving necessary treatments to effectively manage their psoriasis symptoms.

Overcoming barriers to care is crucial to improving treatment outcomes for patients with psoriasis. Dr Cohen proposed several strategies to address these challenges. Enhancing shared decision-making by utilizing decision aids and providing comprehensive information about available therapies, including their benefits and risks, can empower patients to actively participate in their treatment choices. Moreover, tailoring treatment plans to align with patient preferences and priorities can improve treatment adherence and satisfaction.

To boost adherence, Dr Cohen recommended early follow-up with patients within the first 3 to 7 days after initiating treatment. Leveraging alternative communication methods such as telemedicine can facilitate ongoing patient support and monitoring. Building a strong therapeutic relationship with patients through education and linking medication application to specific actions or events can also increase treatment adherence.

Achieving More Comprehensive Care

In their session, titled “Toward More Comprehensive Care of Psoriasis,” Joseph F. Merola, MD, MMSc, and Joel M. Gelfand, MD, MSCE, explored the pathogenesis of psoriasis and psoriatic arthritis in both the skin and joints, as well as potential advancements in clinical treatments.³

Dr Merola began by accentuating the similarities between the pathogenesis of psoriasis in the skin and joints. He drew attention to the fact that many of the key players, such as cytokines and molecular and cellular factors, are shared between the two. However, he also noted that there are some differences, particularly in terms of the effectors that impact the joints, synovium, and enthesis.

The discussion then shifted to the possibility of using dermatologic therapeutics for joint involvement. Dr Merola pointed out that up to one-third of patients with psoriasis will go on to develop psoriatic arthritis, and most individuals with psoriatic arthritis initially experience skin disease before joint involvement. Therefore, it is important for dermatologists to screen at-risk patients for psoriatic arthritis, especially those who are undergoing treatment for psoriasis. This information is vital in selecting appropriate topical, oral, or systemic therapies.

Dr Gelfand supported Dr Merola’s views and stressed the need for clinical practices to efficiently manage both skin and joint manifestations of psoriasis. However, he acknowledged that operationalizing this can be challenging for many practices at present. Looking ahead, Dr Gelfand expressed hope that advancements in electronic medical records (EMRs) and artificial intelligence (AI) could streamline the process. He envisioned a future where patients with a diagnosis of psoriasis will automatically receive a survey through the EMR upon making an appointment. By filling out the questionnaire, patients would supply valuable information for screening purposes to enable health care providers to identify potential cases of psoriatic arthritis promptly and initiate appropriate interventions.

Dr Merola and Dr Gelfand clarified the importance of recognizing and addressing joint involvement in patients with psoriasis. By considering both the skin and joint aspects of the disease, dermatologists can provide more comprehensive care and improve patient outcomes. Although challenges exist in implementing these practices, the potential integration of EMRs and AI offers a future path for more efficient and effective management of psoriasis and psoriatic arthritis.

Addressing Health Disparities

Junko Takeshita, MD, PhD, MSCE, delivered the presentation, “Health Disparities in Dermatology: Psoriasis.”⁴ She aimed to define and address the health disparities specific to psoriasis, particularly in relation to racial and ethnic factors.

Dr Takeshita described the importance of understanding and recognizing health disparities to diagnose and address them effectively. The National Institutes of Health defines health disparities as differences in the incidence, prevalence, mortality, and burden of diseases among specific population groups in the United States. Dr Takeshita remarked that addressing these disparities is crucial for reducing health care costs and ensuring the well-being of minority populations.

Social determinants of health, including economic stability, neighborhood and physical environment, education levels, access to food and nutrition, community and social contexts, and health care systems, significantly impact health outcomes. Dr Takeshita underscored the need for research to develop a framework for detecting, understanding, and ultimately reducing or eliminating these disparities. By intervening in a timely manner, evaluating the problems, and implementing policy changes, the nation can work toward bridging the gap in health care access and outcomes.

Dr Takeshita also discussed the unique considerations of psoriasis in different skin tones. Although White and Black patients share general concerns about psoriasis, such as visibility, emotional toll, and physical symptoms, there are distinct variations. Black patients are more concerned about scarring or discoloration and the lack of a cure, whereas White patients are more worried about comorbid diseases and hereditary factors.

Dr Takeshita imparted specific guidance on treatment and management considerations, particularly for scalp psoriasis in individuals with dryer or curlier hair. She recommended avoiding hair treatments that require frequent washing and instead using oils and ointments to maintain moisture. Additionally, she indicated the need for higher doses of phototherapy for individuals with darker skin tones to achieve optimal results.

“Equitable psoriasis care necessitates accurate and timely diagnosis, adequate education about the disease and treatment options, and a culturally sensitive approach to medical management,” Dr Takeshita concluded. By addressing disparities and tailoring care to the specific needs of diverse populations, health care professionals can strive for more inclusive and effective psoriasis management.

References

1. Feldman S, Gelfand J. Better care for psoriasis patients. Presented at: Dermatology Week 2023; May 3–6, 2023; Virtual.
2. Cohen JM. Understanding TYK2 as a therapeutic target in the management of moderate to severe psoriasis. Presented at: Dermatology Week 2023; May 3–6; Virtual.
3. Merola JF, Gelfand JM. Toward more comprehensive care of psoriasis. Presented at: Dermatology Week 2023; May 3–6, 2023; Virtual.
4. Takeshita J. Health disparities in dermatology: psoriasis. Presented at: Dermatology Week 2023; May 3–6; Virtual.