Plaque Psoriasis Treatment Selection Considerations

There are numerous treatment options available for patients with plaque psoriasis, including topical therapies, systemics, and biologics. In a recent Dermatology Times® DermView® series titled, “Perspectives into the Management of Plaque Psoriasis,”¹ Lauren Miller, MPAS, PA-C, and Tj Chao, MPAS, PA-C, review the types of patients they see with plaque psoriasis and how they discuss treatment options based on each individual patient.

The series featured Lauren Miller, MPAS, PA-C, and Tj Chao, MPAS, PA-C

The full DermView series includes 10 in-depth episodes of Miller and Chao reviewing their roles in plaque psoriasis management as physician assistants, as well as a close look at the types of available treatment options.

The Role of Physician Assistants in PP Management

Chao, a board-certified dermatology physician assistant at Atlanta North Dermatology & Skin Care, began this episode’s discussion by explaining what the physician assistant's role in plaque psoriasis management is and the types of cases he sees.

“Well, 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. I think if you look around the country, more and more, dermatology [physician assistants] and nurse practitioners are taking that primary role in the treatment of patients, specifically with biologics,” said Chao.

Miller, a board-certified physician assistant at Southern Skies Dermatology, agreed with Chao and noted that as a physician assistant currently working with a Mohs surgeon, she is mainly in charge of general dermatology and diagnosing and treating inflammatory conditions such as plaque psoriasis.

Caring for Pediatric Patients With PP

“I look at pediatric patients the same as I do adults, right? So, if my goal is to get an adult clear, or to improve their quality of life, I want to treat the pediatric patients the same. The same things that I look at for adults, whether it be severity, so we look at BSA, the location what comorbidities they have, [or] maybe if they have tried any other therapies in the past, I'm going to approach them the same way that I would adults,” said Miller.

Chao also mentioned how teenagers today are growing up in a very different world compared to 15-20 years ago. Now, factors like social media are a constant pressure in a teenager’s life.

“I think the trauma that could be inflicted by patients is a lot greater now than it was maybe in the past. So, my approach is if mom and dad want to treat with a systemic agent, and by the way, we have great systemic agents now to treat the disease, as well as good topicals we can get the patients just as clear as adults. And honestly, the kids deserve the freedom. They deserve to have a normal childhood,” concluded Chao.

Drug Class Considerations for Patients With PP

Miller began this episode by asking Chao if there are any reasons he may select one specific drug class over another.

“I think it goes down to what the patient is looking for, what risks they're worried about, what do they want to avoid, and what are they willing to do? It's really a decision between the patient mainly, and then myself, in regard to do they want to dose less frequently, is cost a factor for them, and how does that cost affect their decision-making? I think it's a really complex decision,” said Chao.

Miller also explained how providers often have to talk with patients who may have had a family member or friend that did not respond well to a specific treatment, to explain that everyone’s response is different and does not mean the treatment is ineffective.

Click here to watch the full series.

Reference

1. Miller L, Chao T. Perspectives into the management of plaque psoriasis. Dermatology Times. Published May 17, 2023. Accessed June 16, 2023. https://www.dermatologytimes.com/dermview/perspectives-into-the-management-of-plaque-psoriasis