Five expert dermatology clinicians discuss the changing landscape of plaque psoriasis treatments and research for adult patients.
In recent years, evolving understandings of the pathophysiology of plaque psoriasis have led to advances in therapeutic options, including the US Food and Drug Administration’s approvals of tapinarof and roflumilast cream in June and July 2022, respectively. These advances and more were discussed in the recent Dermatology Times® Around the Practice® custom video program titled, “Advances in the management of adult plaque psoriasis.”1
Panelists James Q Del Rosso, DO; Nicholas Brownstone, MD; Benjamin Lockshin, MD, FAAD; Brad Glick, DO, MPH; and Dawn L Sammons, DO, FAOCD, FAAD, discussed clinical and practical management of the condition through the use of these new therapies and understandings. This Around the Practice series contains 10 episodes. Here are a few episodes you don’t want to miss:
Nicholas Brownstone, MD, a dermatology resident at Temple University Hospital, began discussion with his colleagues by offering his insights as a current resident and member of a new generation of dermatologists.
“In residency, we look in a textbook and have a bunch of agents that treat psoriasis,” Brownstone said. “They all do different things. But I don’t think we’re learning how to use these creatively and the potential of some of these therapies. Some of our mentors and program directors teach that way, but some don’t. It’s very important for doctors to train with these agents while they’re in residency and get comfortable with them.”
James Del Rosso, DO, a practicing dermatologist at the Las Vegas Skin and Cancer Clinics, noted that it can be important for residents starting out in dermatology to thoroughly understand new drugs and their respective methods of action.
“As physicians, we want to be in the know, down to the granular details about how these things work because that’s how you learn about new indications, new mechanisms, and new off-label treatments,” Brownstone replied. “I always like to say: the devil is in the details.”
“Our go-tos are still corticosteroids. But as we’re learning more about nonsteroidal anti-inflammatory topicals, we may see a little paradigm shift,” said Brad Glick, DO, MPH, assistant clinical professor of dermatology at the Herbert Wertheim College of Medicine at Florida International University and practicing dermatologist at the Glick Skin Institute, while discussing rapid treatment selection for patients with plaques impacting the extremities. “I might use a high-potency corticosteroid, particularly in the absence of areas that are difficult to treat.”
Clinicians went on to discuss topical calcineurin inhibitors as a treatment option. Compared to newer treatment options such as tapinarof, Del Rosso described slow rates of improvement and irritation, including stinging or burning.
“I think of this as a Venn diagram of safety, efficacy, tolerability, and obviously access to these medications,” said Benjamin Lockshin, MD, FAAD, director of clinical trials at US Dermatology Partners. “Earlier we alluded to the fact that our biggest concern with steroids is patients using the wrong location and having adverse events. But the other side of the coin is that some of the medications we use, like topical retinoids, which have moved toward the fringe aspect of treating psoriasis, are limited by their tolerability.”