Frontline Forum Part 1: Challenges and Opportunities to Enhance Psoriasis Management

Continued in part 2.

As the understanding of psoriasis continues to evolve, the imperative of personalized care has gained prominence, reshaping the traditional paradigms of treatment. In the recent Dermatology Times custom video series “Advancements in Psoriasis Care: Navigating Emerging Therapies and Guidelines,” experts in the management of skin conditions discussed the latest developments in plaque psoriasis management. The panel discussion included Linda Stein Gold, MD, of Henry Ford Health in Detroit, Michigan; Mona Shahriari, MD, of Yale University School of Medicine in New Haven, Connecticut; Michael Cameron, MD, of Cameron Dermatology in New York, New York; Leon Kircik, MD, of Derm Research, PLLC, in Louisville, Kentucky; and George Han, MD, of Hofstra University in Hempstead, New York. The conversation shed light on the evolving paradigms, evidence-based approaches, and need for individualized care in managing this condition (Table).

Navigating Regimen Complexity and Patient-Friendly Adherence Strategies

Stein Gold emphasized the challenges posed by complex treatment regimens and said, “The use of complex regimens with multiple topical agents can lead to lower adherence and less effective treatment.” This sentiment underscores the critical need to streamline treatment approaches to enhance patient adherence and optimize treatment outcomes.

The panelists also highlighted the impact of treatment complexity on patient adherence, with Cameron noting, “The more complex the regimen is, the lower the adherence, which means we’re less effectively [managing] the disease.” This insight underscores the direct correlation between treatment complexity and patient adherence, emphasizing the need for streamlined and patient-friendly regimens.

Furthermore, Shahriari said, “It’s really a matter of simplifying the treatment regimen.” This sentiment underscores the need to reevaluate treatment approaches and streamline regimens to enhance patient adherence and treatment efficacy.

Addressing Steroid Phobia and Attitudes

In the realm of psoriasis management, the emergence of steroid phobia and evolving patient preferences has sparked critical discussions among health care professionals. Kircik highlighted the growing trend of steroid phobia among patients, stating, “There is now this trend that nobody wants to be on steroids.” This observation underscores the shifting attitudes toward steroid-based treatments and the impact on patient-provider discussions regarding treatment options.

The panelists also addressed the concerns surrounding patient preferences for nonsteroidal treatment options, with Stein Gold emphasizing the need to consider alternative therapies, stating, “I think of steroids as a short-term solution to a long-term problem. It’s really a Band-Aid.” This sentiment underscores the evolving perspectives on steroid-based treatments and the need to explore nonsteroidal alternatives to address patient preferences and concerns. Additionally, Cameron provided insights into the prevalence of steroid phobia, saying, “I find that [for] most of my patients, whether they [have] mild, moderate, or severe [disease], I don’t want them using steroids long term.”

Diving Into Current Treatment Guidelines

Psoriasis management guidelines serve as a critical resource, providing evidence-based recommendations for the management of psoriasis. Stein Gold addressed the limitations of current treatment guidelines and said, “The problem is the guidelines are not for psoriasis. They’re being done for atopic dermatitis right now.” This observation sparked a conversation about the need for updated and comprehensive guidelines that align with the evolving landscape of psoriasis management.

The panelists also addressed the implications of treatment guidelines on patient care, with Kircik emphasizing the need for individualized treatment approaches, stating, “We are looking for new topicals that are steroid free or nonsteroidal.”

Shahriari expressed the importance of defining disease severity in treatment guidelines and noted, “I think we need to talk more about the definitions of mild, moderate, [and] severe psoriasis.” This perspective highlights the need for clear and comprehensive definitions of disease severity to guide treatment approaches and optimize patient outcomes.

The panel noted that guidelines are often used against providers by attorneys and insurance companies and can be prescriptive rather than informative. The entire panel agreed that guidelines should be based on a review of the literature and provide a comprehensive overview of available treatments rather than specific recommendations.