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Evolution of Plaque Psoriasis


Experts discuss how the understanding of plaque psoriasis has changed over the years and, with that, how the treatment landscape has expanded.

Alexa Hetzel, MS, PA-C: Psoriasis has been around for so long; we started getting treatment options in the 1920s and thought it was just a topical condition. Now we really understand that it’s more of a systemic autoimmune condition. Jennifer, how do you feel that’s changed over the last even 5 or 10 years of how we approach psoriasis as a skin condition vs a systemic condition?

Jennifer Conner, MPAS, PA-C: The way that I’ve thought about psoriasis over time has certainly changed over my 17 years of practice. When I first began, I really thought about it as a disease of the skin and of the joints, but now I think about this as a systemic disease. When I have that discussion with my patients, the way that I talk to them about their psoriasis is very different now than it was 17 years ago. I’m asking them about their joint pain, but I’m also having a discussion with them about, do you have a primary care provider? Are you having your blood pressure checked? Do you have your blood sugar checked? Are you having your cholesterol checked? I’m making sure they understand the comorbidities that go hand in hand with psoriasis. So it’s a much bigger discussion. A lot of these patients don’t realize the comorbidities and all the relationships between psoriasis and metabolic syndrome.

Laura Bush, DMSc, PA-C: I was going to echo that. I have been practicing in dermatology for 20 years, 31 as a PA. When I started practice there were basically topical medicines, UV [ultraviolet] therapy. I even remember when etanercept came out. We view the disease state now as a whole body disease, and I explain that to my patients. This is not just happening on the skin, this is a whole body disease, it is an inflammatory cascade that is within multiple areas of your body. That kind of helps them grasp that they need something more when they do.

Alexa Hetzel, MS, PA-C: I feel like that’s helped me so much to counsel patients to understand why we talk about systemic or biologic options instead of them thinking, “It’s just on my skin, I just need a cream.” That’s not the truth. Terry, what do you think about the expansion that we have and the treatment options for patients? Where we’ve kind of started and where we’ve come to now in 2023?

Terry Faleye, MPAS, PA-C: I think the expansion has grown. ...I’ve been in dermatology now for 15 years, and before that I was in rheumatology, and especially for me there, it was the opposite, dealing with patients from the psoriatic arthritis component and not even seeing the skin component or even considering that aspect, but seeing the treatment landscape in itself change is amazing. Before, you felt like yes, you had options and creams, but you knew that potentially you would not meet benchmarks with some of these patients, especially with certain topicals. Now I feel like we have an arsenal; it’s like you have this magic purse and in that we have so many options available for our patients that we can confidently see them. Not only that, we know that we can make a big difference and honestly change the trajectory of their lives.

Alexa Hetzel, MS, PA-C: I mean, you can use many different things together too. We all probably are the same, type-A overachievers, so we can get to 100% now. We don’t have to worry about 50%. I love 100%, it sounds so much better.

Laura Bush, DMSc, PA-C: I agree. That’s my goal. Get them 100% better.

Transcript edited for clarity

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