Access Gaps and Treatment Failure in Plaque Psoriasis Care

In ‘Access Gaps and Treatment Failure in Plaque Psoriasis Care,’ our panel explores remaining barriers to optimal care.

Returning after a break in filming, Andrew Mastro, MS, PA-C, asks Alexa Hetzel, MS, PA-C, whether a persistent gap remains in plaque psoriasis care despite the expanding menu of oral and injectable options, whether tied to a specific patient population or to access itself. Hetzel answers that access remains the biggest unresolved issue. She describes patients facing wait lists of up to a year for a dermatology appointment, a delay she considers far too long for a visible, often painful skin disease, and notes that some of those patients end up seeking care elsewhere or turning to primary care physicians who may not be equipped to secure systemic therapy on their behalf. She frames the priority as getting patients to the right point of care where their disease can be properly understood and treated, rather than leaving them stalled outside the system entirely.

Mastro pivots to a related clinical question: how to think through a patient who either fails to respond as expected or begins losing response over time, whether on a biologic or an oral therapy. Hetzel breaks this down into primary and secondary failure. A true primary failure, in which a patient does not respond to any option, prompts her to revisit the original diagnosis, since she has come to expect meaningful response across the therapies available today. For patients breaking through on a pill or continuing to lean on topical therapy, she probes for the real story before assuming treatment failure, since patients do not always disclose missed doses or inconsistent use up front.

Hetzel says she gives a new therapy a full 16-week trial before drawing conclusions, unless there is no response at all, and likes to see patients back within a month to review photos, confirm access to medication, and catch early signs of nonadherence. That early follow-up, she says, lets her serve as an active advocate for the patient's continued use of therapy rather than waiting until a full course has already failed to intervene.

In the final episode, ‘Shared Decision-Making in Plaque Psoriasis: Route and Patient Trust,’ Mastro and Hetzel close the series with a conversation on route of administration, patient skepticism, and building lasting trust.