Ushering in a New Era of Psoriasis Treatments

Abstract

I often find myself counseling my patients about this being an “exciting time” to be a psoriasis patient. This is due to the fact that our knowledge of the disease has evolved at such a rapid pace, and, with it, our ability to clear the skin in both a safe and efficacious manner has become more advanced than ever before.

In my dermatology training, a dermatologist teacher of mine often used the metaphor of a tree when discussing treatment options for managing psoriasis with his patients. His rationale was quite simple: this metaphor was understandable to all patients of all backgrounds including those with lower health literacy. I have found this simplistic treatment discussion so useful in my own discussions with patients now that I am in independent practice that I often find myself “borrowing” it as an educational tool on a near-daily basis.

In this patient counseling discussion, I refer to some of the more traditional agents for psoriasis, including methotrexate or cyclosporine as cutting the trunk of the immune-system tree. As such, these medications are associated with a higher risk of side effects, including infections and immunosuppression. These older treatments can also require extensive workup and monitoring during treatment. They also often take between six to twelve weeks for optimal onset of action. Unfortunately, by that time, we may often observe a loss of motivation on the part of the patient as they struggle with active disease that does not seem to be effectively managed according to their expectations of the therapy. Additionally, the patient may be lost to follow up before the medication has started to work and this can pose another challenge in the utilization of these older treatments. Patients (and physicians) are often nervous to try these agents which underscores the need for safer and more effective treatment options.