Personalizing Psoriasis Care Across Varying Patient Profiles

At an exclusive Dermatology Times Case-Based Roundtable event in Princeton, New Jersey, Omar Noor, MD, FAAD, co-owner of Rao Dermatology in New York, New York, led an in-depth discussion titled “Optimizing Psoriasis Management: Personalizing Treatment Strategies Across Patient Profiles.” The event brought together dermatology clinicians from diverse practice settings to examine the complexities of tailoring psoriasis therapy using real-world cases and emerging clinical data.

Noor walked attendees through 3 distinct cases highlighting treatment challenges in older patients and high-impact-site psoriasis. The discussion emphasized shared decision-making, the role of health care provider (HCP)-administered therapies, and the unique attributes of tildrakizumab (Ilumya; Sun Pharmaceuticals) for select patient types.

Case 1: Supporting Treatment in an Older Patient

The first case involved a 74-year-old man with a 15-year history of chronic plaque psoriasis and comorbidities including mild cognitive impairment, obesity, hypertension, and hyperlipidemia. The patient, a retired schoolteacher, lived independently but was increasingly struggling to self-manage his condition. He had previously used topical agents and apremilast (Otezla; Amgen, Inc.) but discontinued therapy due to adherence challenges.

“The largest challenge for this individual was around their declining mental status,” Noor explained. “This patient would have difficulty remembering to self-inject and could potentially miss injections—not be compliant, and therefore, have their plaque psoriasis flare.”

Attendees discussed the option of HCP-administered biologic therapy to address the cognitive and adherence burdens. One clinician noted the added value of relieving caregiving responsibilities: “Taking one thing off the patient’s family’s plate—being responsible for this medication—might help the entire situation,” Noor recalled.

The conversation also touched on broader implications of family-centered care and the psychosocial reach of chronic dermatologic disease.

“A highlight from this case was the ability to communicate appropriately when talking to patients,” Noor said. “We understand that the disease is right in front of us but appreciating that this disease extends even beyond the patient—to their family, as well—is critical.”

Case 2: Planning for Continuity of Care in a Patient Nearing Medicare Eligibility

The second case involved a 64-year-old man with moderate plaque psoriasis on his back and a busy retirement lifestyle marked by frequent international travel. The patient had previously used topicals, which he found messy and ineffective, and was seeking a low-maintenance solution compatible with travel.

“The main treatment challenge in this scenario was around the patient’s age and access to medication,” Noor said. “If we find a treatment option that works, we want to feel confident we’ll be able to maintain that into his Medicare age, as well.”

The case highlighted the importance of proactive planning as patients approach Medicare eligibility. Attendees discussed how dosing intervals and storage requirements can affect treatment adherence in mobile lifestyles. Tildrakizumab’s every-12-week dosing and room-temperature storage for up to 30 days was discussed as an option.

“A key point in discussing this individual was around this patient’s travel and how tildrakizumab offered the ability to keep the medication out of the fridge for up to 30 days,” Noor said. “That allowed a lot of flexibility... not everyone at the table had known that fact about tildrakizumab.”

Noor also reviewed recent data from the reSURFACE trials (NCT01722331; NCT01729754), which showed that tildrakizumab provided comparable Psoriasis Area and Severity Index reductions in patients with and without metabolic syndrome. That is an important consideration for this patient with hyperlipidemia and obesity.

Case 3: Addressing High-Impact Plaque Psoriasis in a Busy Working Professional

The final case involved a 48-year-old woman with long-standing plaque psoriasis affecting her scalp and fingernails. As a retail manager with a high-stress job, the patient reported difficulty keeping up with self-injections and was frustrated by visible symptoms that affected her self-perception and daily interactions.

“The challenge with this individual was how extensive the plaque psoriasis was in the scalp and how this patient was frustrated, as they had lived a very busy lifestyle,” said Noor. “They wanted to clear their scalp psoriasis, as it affected the way that they felt people viewed them.”

The discussion highlighted the emotional and social burden of scalp and nail involvement and reviewed clinical data supporting tildrakizumab’s efficacy in both areas. “A highlight was the discussion around tildrakizumab’s ability to influence plaque psoriasis in the scalp,” Noor said, noting the medication’s appeal to patients seeking efficacy with minimal dosing burden.

Given the patient’s previous nonadherence with secukinumab (Cosentyx; Novartis Pharmaceuticals) and ustekinumab (Stelara; Janssen Biotech), the group recommended a pivot to HCP-administered therapy. Ultimately, the patient initiated tildrakizumab every 12 weeks, a regimen that aligned with both her medical needs and lifestyle preferences.

Clinical Engagement and Therapeutic Enthusiasm

Reflecting on the evening, Noor emphasized the value of case-based education in dispelling misconceptions and fostering thoughtful discussion.

“There were a lot of myths or misperceptions around tildrakizumab as an option,” he said. “Most of the attendees came out of the discussion having a better understanding of the value of tildrakizumab through a lot of different lenses.”

The conversation centered around consistent themes: the importance of tailoring therapy based on lifestyle, age, and cognitive function; the growing role of HCP-administered biologics; and the relevance of real-world data in everyday decision-making.

“This is a legitimate and potentially great option for these individuals,” Noor said, “and really, should be an option utilized more in practice.”

Attendees gleaned practical insights into managing psoriasis across diverse patient types. By weaving together clinical trial data, real-world scenarios, and personal perspectives, the roundtable spotlighted the power of individualized care and the ongoing evolution of biologic therapy in dermatology.

“We know that every patient scenario is different, but it’s always good to remember that every encounter with a different provider also provides a different scenario,” Noor said. “It was nice to hear how different people looked at the treatment options for plaque psoriasis from a different lens, giving their personalized treatment strategies for these individual patient cases.”