Addressing Adherence: Supporting Patients With Psoriasis

Dermatology Times recently concluded its second annual Horizons in Advanced Practice meeting in Tampa, Florida. The exclusive meeting brought together physician assistants and nurse practitioners from across the country to review complex cases of atopic dermatitis and other type 2 inflammatory diseases, as well as psoriasis, chronic hand eczema, and hidradenitis suppurativa, during sessions led by experts in the specialty.

During the first half of the breakout sessions, Omar Noor, MD, FAAD, dermatologist and co-owner of Rao Dermatology in New York, New York, and a Dermatology Times Editorial advisory board member, presented on how clinicians can support patients with psoriasis and life challenges that complicate treatment adherence.

Noor shared his insights on helping these patients, whether they have dementia, need less frequent dosing due to schedules, or have difficulty with self-administered injectables. The answer, he told attendees, may be in using in-office injectables. Patients can have set appointments and access to support with injections, and health care staff can better monitor potential adverse effects, he said. It also provides additional touchpoints with patients and their caregivers.

Noor said he leverages a buy-and-bill system—which is commonplace in oncology and rheumatology—to administer the medications. An example in dermatology is the injectable IL-23 antagonist tildrakizumab (Ilumya; Sun Pharma), which has a unique indication requiring administration by a health care provider. “We can purchase…and inject the medication in the patient, and then [we can] bill the insurance for the medication,” Noor said. As Noor explained, under the buy-and-bill system, offices can buy as many units as they want and deliver those units to whichever patients they deem appropriate. “If the intended patient doesn’t come in, I can use that injection on [someone] else,” he said.

Case Study

Noor shared the case of a 45-year-old wmoan who had plaque psoriasis (7% body surface area) since she was 28 years old. A trial attorney who frequently travels for cases, she works long hours and has neglected her treatment plan. The disease has progressed, and it now affects her scalp and fingernails. Her medical history is positive for hypertension and anxiety.

The patient reported that she tried various topical corticosteroids intermittently for several years. She had a good initial response with ustekinumab (Stelara; Janssen) but subsequently missed doses. Similarly, she was inconsistent with secukinumab (Cosentyx; Novartis) due to her work schedule and injection fatigue.

While discussing next steps, attendees agreed that reengaging this type of patient could be challenging. Ultimately, they said shared decision-making and proper education are key for such patients.

Scalp psoriasis is not difficult to treat, but some of the options are not ideal, Noor noted. Topicals can be greasy, and remembering to take injections, especially for busy professionals like this patient, can be challenging. The attendees agreed that having this patient come into the office might be a good option. Giving her the assurance that “we’ll do it for you” can be comforting and reengaging, Noor said.

Participants also discussed how they would approach the treatment algorithm. “I always ask about joint involvement,” an attendee said. “It helps me decide whether I want to try a topical or whether I want to be more aggressive and choose a systemic option.”

“It’s important to educate the patients,” another attendee said. “Even when plaques are reducing, if they continue to scratch, it will traumatize the scalp. That’s another reason why, I think, the scalp psoriasis persists.”

Exploring the Data

Noor told attendees that tildrakizumab has been shown to be effective in patients with scalp psoriasis and could be a good option. He shared phase 3b (NCT03897088) data indicating a 60.7% response as measured by Psoriasis Scalp Severity Index (PSSI) 90 (≥ 90% severity reduction from baseline) in patients receiving tildrakizumab 100 mg at week 1 vs 4.9% for patients on placebo. At week 52, 65.2% of patients had achieved a PSSI 90 response, with 81.5% of week 16 responders maintaining response at week 52.¹

Noor also discussed positive data for patients with nail psoriasis. He said that 25.5% and 29.4% of patients receiving tildrakizumab vs 4.5% and 4.2% on placebo achieved modified Nail Psoriasis Severity Index 75 response and Visual Scale to Evaluate Nail Psoriasis Severity scores of 0 or 1, respectively, at week 28.²

The Bottom Line

“Everything, at the end of the day, comes back to communication and how well we communicate with our patients, how well we work as a team [and around patients’ lifestyles] to get them better,” Noor said.

References

1. Sofen HL, Gebauer K, Spelman L, et al. Efficacy and safety of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis of the scalp: week 52 results from a phase 3b, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol. 2025;92(4):816-824. doi:10.1016/j.jaad.2024.12.018

2. Yamauchi P, Kothekar M, Tripathi A, Nishander T, Soule B. Tildrakizumab in nail psoriasis. Poster presented at: American Academy of Dermatology Annual Meeting; March 7-11, 2025; Orlando, FL.