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  • Practice Management

Take-Home Pearls on the Management of Plaque Psoriasis


Alexa Hetzel, MS, PA-C; Jennifer Conner, MPAS, PA-C; Terry Faleye, MPAS, PA-C; Laura Bush, DMSc, PA-C; and Lakshi Aldredge, MSN, ANP-BC, share take-home messages regarding the treatment of patients with plaque psoriasis, highlighting listening to and educating patients.

Alexa Hetzel, MS, PA-C: So what’s our take-home message? What do we have to say to our peers when we’re managing plaque psoriasis, [to someone] not as well versed in plaque psoriasis? What do we tell them, what pearls do we give? Go ahead, Laura.

Laura Bush, DMSc, PA-C: Don’t be afraid to treat. Learn the mechanism of action so you feel comfortable with the drug. It is just shocking to me how many practices still use zero systemic or biologic medication. What I would say to my peers and what I hope to lead by example is, “Learn the medications, learn the mechanisms of action, and don’t be afraid to treat your patient.” They want to be clear. They want 100% clearance and you’re not going to get them clear just on topicals. We have this bag of tricks, let’s use them, but let’s use them correctly and appropriately.

Alexa Hetzel, MS, PA-C: Terry?

Terry Faleye, MPAS, PA-C: I would say listen to your patients, first and foremost. A lot of times patients come in, and we know that they’ve gone to multiple providers or they’ve [gone] to dermatology offices across the board. Sometimes it’s all a matter of just listening to your patients and what they’re telling you and what they are willing and wanting to do. But I think at the same time, [we need to educate] them in regard to this disease state, because I think that we are constantly battling Dr Google. And now we [have] ChatGPT and some other stuff that’s on the board…. There are so many information sources that are in our patients’ ears. And so it’s correctly educating them about what this disease is…. Psoriasis and psoriatic arthritis, it’s a marriage, so you can’t do one without the other. Just remembering that, when we’re thinking about this, that it is the whole skin and it’s the whole body. Like Laura said, knowing that we’re treating the whole patient and not losing sight of that.

Alexa Hetzel, MS, PA-C: Jennifer, what would you say?

Jennifer Conner, MPAS, PA-C: Perfect segue. I was going to say to think about and treat the whole patient. Not just their skin, [but also] their joints, the systemic manifestations, the psychosocial impact that it has on them. And then really look at them and talk to them about where the psoriasis may be affecting them. One thing that I’ve learned, especially over the past couple of years with some of the datathat we’ve had on intertriginous psoriasis and genital psoriasis [is that] many of these patients don’t realize that they have psoriasis in those areas. They write it off as a yeast infection [or] something else. And they’ve been told that by their primary care or urgent care, and they’re being treated as such. I look at them and say, “Well, let me see.” [They tell me], “I get a little irritation under my armpits or my groin.” And it’s actually psoriasis and they didn’t realize it all this time. So actually look at these patients and talk to them about it because there are some data out [stating that] a lot of patients aren’t even being asked about psoriasis in those areas. It’s up to us to ask the questions and to actually look at them head to toe.

Alexa Hetzel, MS, PA-C: Lakshi, what do you have for our other colleagues?

Lakshi Aldredge, MSN, ANP-BC: I have 3 pearls. The first is embrace psoriasis as a disease. Do not let the wide variety of treatments that we have intimidate you. Be the person in your practice who wants to take care of [patients with] psoriasis, become an expert in it. It’s easy to do, and it’s such a highly rewarding group of patients to treat. The second important thing is, every time a patient sits down in front of you, remember the journey that they’ve taken to get to you. For many of them it’s a very long journey. One of the things that I tell them is, “I am so glad you’re here. I’m going to be your partner with this and we’re going to become friends.” You can visibly see the big sigh of relief. It is so empowering [for the patient] to hear that you are in it with them for the long haul. It makes all the difference in their trust level for you and that they’re willing to listen to you and your treatment recommendations.

And finally, the third thing, to Laura’s point, is to really know your drugs [and] your treatments. Utilize medical science liaisons from your companies, including your sales reps. They can provide you with a wealth of information. I know oftentimes you only have 5 or 10 minutes; give them that time. They will provide you with so much valuable information and pearls. Nobody has time to go home at the end of the day and read 10 articles. They can give you snippets of information, especially from the most recent congresses or meetings. I’ve found that to be incredibly helpful in helping to keep myself up-to-date on these new agents. So those are my pearls.

Alexa Hetzel, MS, PA-C: For me, it touches on everything that you have all said and very basically comes down to time. Spend the time with your patients. We may have 10 minutes scheduled, 5 minutes scheduled, or we’re behind, or we’re starving and need to take a bite of food, but I’d rather be 10 minutes behind and spend the time with the patient. I’ll go into the next room and say to the next person, “I’m sorry I’m behind. This patient needed that time and one day you’ll need that time for me and I will give it to you too.” But I am not leaving that room until I know that they’re comfortable and I’m comfortable. I think that sometimes we just need to slow down. We’re always [going]. We can stop just for them for a minute because it’s so impactful on their quality of life, and then it makes us feel good. Then we have great stories to tell.

Thank you for watching this Dermatology Times® Around the Practice. If you enjoyed the content, please subscribe for our newsletter to receive upcoming programs and other great content right in your inbox.

Transcript edited for clarity.

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