Chicago — Completing the puzzle that is psoriasis treatment demands that all of the pieces fit precisely into place.
This includes assessment of the extent of the psoriasis, evaluation of the patient's psychosocial needs, the role of the Psoriasis Foundation, and then the drug and/or photo therapy regimen, itself.
According to dermatologist, Steven R. Feldman, M.D., Ph.D., professor of dermatology, Wake Forest University, Winston-Salem, N.C., comprehensive psoriasis treatment is predicated on the following systematic approach.
"Dermatologists should start by addressing psychosocial needs because psoriasis has a tremendous impact on people's lives. Then they should decide if the person has relatively localized psoriasis, in which case they might be amenable to topical treatment or if they have more extensive psoriasis that needs phototherapy or systemic treatment, and if they need systemic treatment that might include biologics. Once all of these issues are addressed individually, the dermatologist should consider how they all fit together," Dr. Feldman says.
"This approach has been used by the American Academy of Dermatology's regional psoriasis training program, which was first developed in the Psoriasis Foundation's chief residents' meeting where they educated dermatologic residents about psoriasis treatment," he explains.
Dr. Feldman pointed out how important the psoriasis patient's psychosocial needs are, and how often they are least considered.
"We encourage dermatologists to sit within touching distance to their psoriasis patients and to feel the psoriasis," he says. "Make sure you put your hands on the psoriatic lesions. Unlike the general public, we dermatologists know that it's safe to do that. Patients with psoriasis have a feeling of isolation, and dermatologists can do a lot to reduce that sensation simply by putting their hands on the lesions," Dr. Feldman says.
Listening to the patient's concerns and asking questions pro-actively about the kinds of things that bother psoriasis patients are critically important to establishing a trusting relationship that can foster good compliance.
"It's important that the patient trust in the dermatologist and be willing to follow the physician's guidance, because all too often poor compliance limits our patients' improvement. In fact, this may account for a lot of what's made psoriasis so frustrating for the dermatologist and for the patient," Dr. Feldman says.
In addition, Dr. Feldman tries to encourage all his psoriasis patients to join the National Psoriasis Foundation.
"It's a great way to learn all about the disease while empowering them to gain access to available treatments and support research toward a cure," he says.
Dr. Feldman made his remarks during a psoriasis symposium at the American Academy of Dermatology Academy '05 that provided a comprehensive overview of treatment.
"There are so many new things that are happening in psoriasis research and treatment today, but there are a tremendous amount of older, well established therapies that dermatologists need to keep up with, too," Dr. Feldman says. "Rather than focus on individual agents, we need to look at how they fit into the perspective of psoriasis treatment as a whole," he adds.
Topical therapies, phototherapy and conventional systemic psoriasis treatments continue to be the appropriate choice for legions of psoriasis patients, and the emergence of exciting new biologic treatments represents a tremendous advance for the patients who need them. The question, Dr. Feldman says, is 'Who is an appropriate candidate for biologics?'
Phototherapy has been around for thousands of years, he points out, has a terrific safety profile, is very effective for the skin involvement and is reasonably priced.