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Making the right topical treatment choice in psoriasis


Nearly 80 percent of patients experience limited-to-moderate psoriasis disease, and topical therapies account for the majority, if not all, of their treatment. But the choice of topical treatment depends on the patient.

Topical treatment choices in psoriasis depend on the patient's need, physicians say. (©AdobeStock, 183817067)

CHICAGO―For most patients with psoriasis, topical treatments play a considerable role in therapy.

Nearly 80 percent of patients experience limited-to-moderate psoriasis disease, and topical therapies account for the majority, if not all, of their treatment. But, finding a treatment protocol that works with their lifestyle can be difficult.

During the 20th annual National Psoriasis Foundation residents meeting, Abby Van Voorhees, M.D., a dermatologist at Eastern Virginia Medical School, discussed with residents what they should consider when designing the right treatment options for patients with topical therapies and the difficulties they could face.

“Our patients find it tough to adhere to the different treatment protocols, and that creates problems,” she said. “Residents-in-training assume patients will use topicals twice daily, and I find myself asking them, again and again, if doing something like that would fit into their lives. Frequently, they sheepishly tell me no.”

When talking with patients, she said, it’s important to discuss the patient’s preferences and lifestyle. Knowing more about them can help a resident prescribe a topical therapy regiment that will meet their needs. For example, Dr. Van Voorhees said, when treating a patient for a scalp or hair condition, consider the patient’s race, gender, and haircut. What a white male with a buzz cut would be willing to use is likely far different from what an African-American woman with longer hair will find acceptable, she said.

In addition, she said, residents should pay close attention to the body area they’re treating. Is it hair-bearing or extremely dry?

She also discussed methods that can more efficiently drive topical medications into the skin than simply rubbing the ointments in.

“It’s critical for residents to know how to optimize topical treatments,” she said. “They must put in the effort to try to improve the adherence rate for patients with psoriasis. These strategies are part of the way to do that.”

Overall, she said, residents must learn and remember that each patient will present with their own unique set of circumstances and preferences. It’s their job to find a treatment protocol that will fit within the patient’s daily life.

“They need to individualize  the use of topical medication for the location and for the person in order to allow for effective treatment,” she said. “No longer does one-size-fits-all medicine work. In order to achieve success with patients, it requires that kind of personalized, individual approach.”

Van Voorhees, A. “Optimizing Topical Therapies,” 20th Resident Meeting National Psoriasis Foundation, Chicago, Illinois. Oct. 20, 9:45-10:15am.

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