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The cross-specialty collaboration between dermatologists and these fields has been a daily occurrence, as inflammation-targeting drugs and comorbid patients have brought team closer together.
As covered in the first segment of a Q&A with Brad Glick, DO, MPH, the modern dermatology care team is converging—not only with different practice backgrounds, but with implicated specialists treating a patient comorbid inflammatory diseases.
In the second segment of the interview leading up to the Fall Clinical Dermatology 2023 Conference for PAs & NPs in Orlando this weekend, Glick, dermatologist with Glick Skin Institute and assistant clinical professor of dermatology at the Herbert Wertheim College of Medicine at Florida International University, discussed the merge of dermatology with rheumatology, gastroenterology, and other fields—and what that could implicate for disease diagnosis and cross-specialty treatment management.
HCPLive: Everything from the American Academy of Dermatology (AAD) Annual Meeting down to smaller meetings have really taken a greater embrace to addressing the rheumatic, gastric, pulmonary, and otherwise implications of care for these patients who are facing cross-inflammatory chronic disease, as well as these agents that could be cross-beneficial for them, and establishing better ties.
What are your thoughts on, going forward, a greater marriage of the specialties and creating multi-specialty care teams?
Glick: That's such a great topic and such a great question. I think it's crucial, how we approach patient disease states. If you're practicing in a little bit of a bubble right now, and you're not picking up that phone or sending a text message or an email to your rheumatologist, your GI doctor, your immunology partners...I can think of 5-6 years ago, before we got a lot of these new therapies that we do now, that the conversations with some of our partners in similar or collaborative, immune-mediated diseases were very different conversations. And now I have them every day—mostly with rheumatology, a lot with GI, and much more recently with my allergy/immunology or even pulmonary partners, as you say, because of the therapies that we share—whether it be interleukins like dupilumab. We need to collaborate.
Some of the biologic therapies that we use for psoriasis—we have some patients with psoriatic disease that may develop uveitis, so we need to pick up the phone and call our ophthalmology partners. These are conversations that are crucial, they're critical, and we're having more of them now than we ever did before. And that really plays into our partners within our practice, the members of our care team. And it's not just our advanced practice practitioners; it starts with our biologic coordinators, it's our medical assistants that work in the back of the office, that are participating in the care of these patients. It really is a dermatology care team. I know it is in my practice, and hopefully it is around the country.
It's important conversations that we're having with our colleagues—for instance, some of the dosing regimens and the prescribing regimens that we have for our patients. Let's say with psoriatic disease, they may be slightly different; the dosing regimen may be a little bit more potent for the skin disease side of the inflammatory disease than with our rheumatology partners. So we need to make sure that we use the dose that is more effective for maybe the larger target, using psoriasis as an example because we see differences in dosing regimens.
HCPLive: There's discussion in fields including pulmonology that the overlap of chronic diseases such as asthma and COPD is just as impactful as the disparities of the diseases, and that it should be considered when distinctly diagnosing disease and prescribing therapy—conceptually, to indicate viable therapies for treating the overlapping systemic effects instead of worrying so much about the symptoms that create the disparity itself.
Do you see that as like a viable strategy going forward in dermatology? Or do you feel like we're in a really clear spot of identifying patients that clearly fit into disease subtypes versus another?
Glick: I have to say, I'm chuckling a little bit, because this is a very complex question—it dives into so many areas. You know, we can think pharmacologically here, we can think clinically here. I'm not a pulmonary specialist, but when I think of asthma and COPD, they are seemingly different diseases, but there's some cross-therapeutic possibilities, if you will. So, I really think in dermatology, we're in a great spot right now. We have so many drugs in the toolbox; we've learned so much in terms of the benefits that we've received from patients simply donating their skin, so called, from the bench to the bedside, then back to the bench. We've learned so much about the immunology of inflammatory diseases, and a lot of these therapies that we have in our toolbox— let's take the Janus kinase (JAK) inhibitors, they cross over into the management of so many disease states that we treat as dermatologists, that our rheumatology and GI partners treat. And then when I think of drugs like PDE4 inhibitors—they've been used in pulmonary medicine for many years, and we use them now in dermatology and rheumatology.
There's a lot of opportunity for cross-therapeutic collaboration as well, too. And so, I think we're in a great spot, and we've all got a lot more to learn about these therapies and how they cross over into other disease states. But of course, while it sounds terrific that a drug let's say like a JAK inhibitor or a TYK2 inhibitor works not only in skin disease, but we also have to think about the safety side too and where that plays into our collaborative approaches to our patients—how it may impact someone's GI tract. We have biologic therapies that are relatively contraindicated in the setting of inflammatory bowel disease.
To your question—and I think I'm answering it because it's so complex—there are some unique strategies moving forward that we can have therapeutically as long as we are having conversations and collaborating with our rheumatology partners, GI partners, pulmonary partners, allergy/immunology partners, ophthalmology partners—and of course, in those specialties, really the influx of advanced practice practitioners that are participating with our colleagues.
HCPLive: Is there anything else you want to add relevant to the meeting this weekend?
Glick: Well, I'm excited. You know, doctors like (Mark) Lebwohl, (Darrell) Rigel and (James Q.) Del Rosso, April Armstrong and Greg Goldenberg...they put on amazing talks. There's such a high level of education. And so, I'm excited to be a participant. I'm excited to be a speaker as well. I've been speaking at this meeting a few times, and I love the opportunity to collaborate with my colleague—my physician colleagues, and also my advanced practice practitioner colleagues. It's an amazing opportunity for us to learn from each other, and then go back to the clinic on Monday and do great things for our patients.