Experts discuss the role and importance of physician assistants in the treatment and care of plaque psoriasis (PP).
Lauren Miller, MPAS, PA-C: You and I are both physician assistants [PAs]. What role do you think we play in the treatment of these patients with plaque psoriasis?
TJ Chao, MPAS, PA-C: I think we play a primary and growing role in the treatment of these patients. We can diagnose, we can treat, we have the authority to select which products we want to use in our practice, typically. If you look around the country, more and more dermatology PAs and nurse practitioners are taking that primary role in the treatment of patients, specifically with biologics.
Lauren Miller, MPAS, PA-C: Yes. I work for a Mohs surgeon, so his focus is skin cancers and surgery. I’m in charge of the general dermatology. When it comes to diagnosing, treating, and managing, I’m the primary provider for conditions like plaque psoriasis and other inflammatory conditions.
Let’s talk about the progressive nature of the disease. One, do you feel like the disease is progressive, and what is the risk for developing other conditions?
TJ Chao, MPAS, PA-C: In regard to the skin portion of the disease itself, I don’t think it’s progressive. I think there could be a variety of courses that can be affected by a variety of things in a particular patient. There can be situations where maybe they’re not as healthy. They [may be] living a proinflammatory lifestyle where they eat badly, drink a lot of alcohol, smoke, and are under a tremendous amount of stress. That could have a severe impact on the disease itself. Then you have patients who may wax and wane, things may trigger the eruptions throughout their life, and there’s no predictable course.
Now, when you’re talking about psoriatic arthritis, that’s a different animal. We definitely know that’s progressive. We know that even in a small amount of time, if we don’t treat our patients with a proper therapy, we could have joint deformity and joint destruction occurring. In regard to other disease states, we know there’s a strong interplay with comorbidities, with things like metabolic syndrome, as well as obesity, depression, and inflammatory bowel disease. There’s a lot going on with these patients. It’s more than just the skin.
Lauren Miller, MPAS, PA-C: There are definitely some risk factors when we talk about plaque psoriasis. If they have scalp [or] nail involvement, [that] gives you a clue to what their risk is going to be for psoriatic arthritis that could develop.
TJ Chao, MPAS, PA-C: That’s right.
Lauren Miller, MPAS, PA-C: Which then could affect what we are going to do for treatment.
Transcript edited for clarity.