Jason Hawkes, MD, MS

Effect of High-Impact Site Involvement on Quality of Life

Video content above is prompted by the following:

What are some areas of the body that are particularly challenging to treat in psoriasis? What is your approach to treatment for these areas?

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Panelists discuss how treating psoriasis in anatomically challenging areas such as the scalp, face, genitals, intertriginous zones, palms, soles, and nails requires specialized approaches due to unique barriers including limited penetration of topicals, skin sensitivity, mechanical friction, and psychological impact, necessitating tailored treatment strategies that may include modified vehicle formulations, careful steroid use, targeted phototherapy, or earlier consideration of systemic agents including biologics for these high-impact sites even when overall body surface involvement is limited.

Learnings From the VISIBLE Study in Skin of Color

Data, while limited, show that biologics are safe and effective treatment options across skin tones. How do you take these data into consideration when deciding on treatment for your patients with skin of color?

Panelists discuss how despite limited but encouraging efficacy and safety data from studies like VISIBLE (guselkumab) and various subgroup analyses supporting biologic use across diverse skin tones, clinicians must still consider unique presentations and concerns when treating patients with skin of color, including postinflammatory hyperpigmentation, follicular presentation patterns, cultural perspectives on treatment, and historical underrepresentation in clinical trials, while emphasizing the importance of personalized discussions about treatment expectations and outcomes specific to different skin phototypes.

Advancing From Topicals to Systemic Treatment in Psoriasis Management

What are some potential reasons for undertreatment in psoriasis despite a wide range of available treatment options in recent years?

Panelists discuss how undertreatment in psoriasis persists despite expanded therapeutic options due to multiple barriers including limited physician awareness of disease impact, insurance restrictions, socioeconomic disparities, patient concerns about medication safety, inadequate screening for comorbidities like psoriatic arthritis, outdated treatment paradigms, health care access challenges, and the failure to recognize that even limited disease in high-impact areas may warrant systemic therapy.

Exploring Undertreatment of Psoriasis in Skin of Color

How common is undertreatment in psoriasis? What patient types are most commonly undertreated?

Patients with skin of color, low socioeconomic status, low BSA but high-impact site involvement

Gondo, 2024—31.7% of patients with moderate to severe disease treat psoriasis with OTC, complementary, or topical therapy only.

In patients with mild objective measures for assessing psoriasis but high-impact location involvement, 32.8% of patients were only using OTC or topical therapy.

Panelists discuss how undertreatment remains pervasive in psoriasis management, with recent data from Gondo (2024) revealing that nearly one-third of patients with moderate to severe disease receive only over the counter (OTC), complementary, or topical therapies, while similarly high percentages of patients with mild disease but high-impact location involvement are undertreated, with disparities particularly affecting patients of color, those of lower socioeconomic status, and individuals whose limited body surface area (BSA) involvement in sensitive or visible areas significantly impacts their quality of life despite not meeting traditional severity thresholds.

Jason Hawkes, MD, MS

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