Saakshi Khattri, MD

Advancing From Topicals to Systemic Treatment in Psoriasis Management

Video content above is prompted by the following:

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

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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disparities, patient concerns about medication safety, inadequate screening for comorbidities like psoriatic arthritis, outdated treatment paradigms, health care access challenges, and the failure to recognize that even limited disease in high-impact areas may warrant systemic therapy.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.

Navigating Biologic Treatment Selection in Psoriasis and Psoriatic Arthritis

With so many biologics approved for psoriasis treatment, how do you navigate choosing a biologic therapy for your patients?

Panelists discuss how selecting among the numerous approved biologic therapies for psoriasis requires a personalized approach that weighs factors such as efficacy data, safety profiles, comorbidities, insurance coverage, and administration preferences, with patient preferences playing a crucial role in the decision-making process, as involving patients in treatment selection enhances medication adherence and satisfaction and ultimately improves long-term outcomes.

Incorporating Clinical Guidelines in Psoriasis Management

Current treatment guidelines (AAD-NPF Guidelines) recommend biologic therapies for the management of moderate to severe psoriasis. When do you consider biologics for your patients?

Panelists discuss how biologic therapies for psoriasis are increasingly considered earlier in treatment algorithms based on the American Academy of Dermatology-National Psoriasis Foundation (AAD-NPF) Guidelines and updated International Psoriasis Council (IPC) severity classifications, with decisions influenced by disease extent, impact on quality of life, presence of psoriatic arthritis, treatment history, patient preferences, and the recognition that prompt intervention with biologics can prevent disease progression and comorbidities in patients with moderate to severe disease.

Saakshi Khattri, MD

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