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The Pathogenesis of Plaque Psoriasis


Benjamin Lockshin, MD, FAAD, comments on how the evolution of the pathophysiology of plaque psoriasis has led to more targeted therapies to treat the disease.

James Q. Del Rosso, DO: Hello, I'm Dr Jim Del Rosso, a dermatologist in Las Vegas, Nevada. When I was asked to moderate and present in this Dermatology Times® Around the Practice®, I was both honored and happy to have the opportunity to do it. In this program, I get to talk about the management of plaque psoriasis, new topical advances and discuss systemic therapies with 4 other dermatologists that are colleagues and people I know very well. A few important things before we get started. Number one is the opinions expressed by each of the individuals on this panel are only their opinions. They do not reflect the opinion of Dermatology Times® or any other company or agency. Second, there are no head-to-head studies comparing the 2 new topical non-steroidal agents that were approved by the FDA (Food and Drug Administration) over the last year or so. That's Vtama [tapinarof] which is nifedipine cream and ZORYVE which is roflumilast cream. Information is discussed with regard to both of these agents. The opinions are those of the individual clinicians, there are no head-to-head studies. Both are supported by FDA approval and a large body of data. I hope you enjoy the program.

Hello, and thank you for joining this Dermatology Times® Around the Practice® series titled “Advances in the Management of Adult Plaque Psoriasis.” I’m Jim Del Rosso, a dermatologist in private practice in Las Vegas, Nevada, and the research director of JDR Research. In this series, I’ll be moderating a panel discussion and case study review on the clinical and practical management of patients affected by plaque psoriasis. Joining me is Dr Nicholas Brownstone, a dermatology resident at Temple University Hospital in Philadelphia, Pennsylvania. We have Dr Brad Glick, a board-certified dermatologist and dermatologic surgeon in Margate and Wellington, Florida. He also runs a dermatology residency at Larkin Community Hospital in South Miami. We have Dr Ben Lockshin, the director of the clinical trials center at DermAssociates in Silver Spring, Maryland. Finally, we have Dr Dawn Sammons, the CEO and founder of Oakview Dermatology in Athens, Ohio. That’s my old stomping ground at Ohio University. Dawn also runs a residency program in dermatology at OhioHealth. Let’s get started.

Ben, I’ll start with you because I’m a little older and I remember the pathophysiology psoriasis that we understood when I started, which was back when dinosaurs roamed the earth. It was a lot different from what we understand now. A lot of our therapies were more shotgun-type therapies. With a greater understanding of the pathophysiology of the disease, are we evolving to more targeted therapies?

Benjamin Lockshin, MD, FAAD: That’s a great question. In the 20 years since I started practicing, things have changed radically in the landscape between newer systemic treatments and a large push toward evolving topical therapies. A lot of it is based on our understanding of the pathophysiology of what’s going on. We understand cytokines that are driving this process. Rather than using broad-acting medications, like prednisone or systemic cyclosporine, we’re thinking of things that cast a smaller shadow and hit the targets but don’t have collateral damage. We live in an era where we’re utilizing treatments medication like Vtama or Zoryve [roflumilast], which do a good job of treating the disease we see without affecting the surrounding skin.

James Q. Del Rosso, DO: When you think about topical corticosteroids, for example, they’re hitting so many different areas that could be involved in the pathophysiology. You could have the wrong diagnosis and still get the patient better in many cases because it’s touching on so many things.

Benjamin Lockshin, MD, FAAD: Yes, it’s like shotgun medicine. I always laugh when I see patients who come in from their primary care physician after getting Lotrisone, which a combination of clotrimazole and betamethasone that treats everything. I’m like, “That was definitely given by your primary care doctor.”

James Q. Del Rosso, DO: Exactly.

Benjamin Lockshin, MD, FAAD: Now we’re getting even more sophisticated in terms of what we do. We’re like, “We know what your disease process is.” We’ve got something that’s trying to directly act at the overexpression of these cytokines.

Transcript edited for clarity

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