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  • Practice Management

Key Takeaways for the Management of Plaque Psoriasis


Experts in dermatology share final thoughts on the treatment of plaque psoriasis and the ever-changing treatment landscape.

Nicholas Brownstone, MD: I just wanted to point out that treating psoriasis is really an art and a science these days with so many different therapies. It’s amazing how far we’ve come. We have over 10 FDA-approved biologics for psoriasis. If you take a cursory glance, they all treat psoriasis, but if you really take a look at the details, you’re going to find some interesting things. Tildrakizumab is the only biologic that‘s covered by Medicare Part B. Etanercept has in the package insert that it’s safe for elderly patients. Ixekizumab in the package insert says it can treat genital psoriasis. I think as topicals come out, we have to pay attention to details like with the remittive effect with tapinarof. That’s special data. We need to keep these things in mind because it’s an art and a science. If you can look at these details and understand them, then it’s going to make your patient care way better and make you a better clinician.

James Q. Del Rosso, DO: Expounding on that is, specifically with tapinarof, there are no contraindications. There are no precautions and there are no warnings in the FDA-approved label. That’s extremely rare.

Benjamin Lockshin, MD, FAAD: I spent so much time prescribing ointments in the steroid era because I think ointments work better and patients don’t like to use them, so they won’t overuse them. New topical creams that are thin and light, patients like to use them, and they don’t get all over their sheets, all over their clothing. A new topical cream increases compliance, increases patient satisfaction, and has good physician and patient buy-in, which is really important in terms of our dialogue. We can write as many scripts as we want, but we don’t have control over what they do in their house.

Dawn L. Sammons, DO, FAOCD, FAAD: The one thing we haven’t touched on…we’ve touched on the periphery about patient compliance. I came from an era where everything we had was topicals or orals. Orals were every single day. You were taking your cyclosporine, your acitretin or methotrexate once a week. But they were taking their folic acid every day. Then we had our topicals that were twice a day application, often with multiple tubes because they had to use them in different places. And we’ve come to this place where we have biologics, like you alluded to.

James Q. Del Rosso, DO: Four injections a year. Right.

Dawn L. Sammons, DO, FAOCD, FAAD: Or orals that are once a day. Now we have topicals that work just as effectively, if not more so, that are once a day. I think that makes a big difference in our patients’ experience. They’re far more likely to follow through with the therapies we prescribe because they’re simpler. Let’s be honest, I’m pretty type A; I don’t know that I could go home and do a topical twice a day every day, for however long it took to get things clear.

Nicholas Brownstone, MD: Life is complicated enough. So, an injection 4 times a year, a topical agent once a day, is really great for our patients.

James Q. Del Rosso, DO: Any other final comments on managing psoriasis?

Dawn L. Sammons, DO, FAOCD, FAAD: This is the best time that we’ve ever seen to be a dermatologist treating patients with psoriasis. Hands down, it’s the best time for patients who have psoriasis, and I tell them that. Oftentimes, they’re devastated when I tell them they have psoriasis because…they’ve already done the research. They know that this is sort of a lifelong condition. I say this is the best time if you have to have psoriasis…because we have drugs that…can help them live as if they don’t have psoriasis.

James Q. Del Rosso, DO: I think that’s very well said. On that note, thank you for watching this Dermatology Times® Around the Practice®. If you enjoyed the content, please subscribe to the newsletter to receive upcoming programs and other great content right in your inbox. I want to thank all of you for the conversation and your great insights, and for sharing your experience. Thank you.

Transcript edited for clarity

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