Challenges in Managing Plaque Psoriasis”

Welcome back to another HCPLive Peer Exchange series. In this episode titled "Challenges in Managing Plaque Psoriasis," the moderator, Dr. Linda Stein Gold, and expert panelists, Dr. Jeffrey Crowley and Dr. James Song, discuss the most pressing challenges facing dermatologists treating moderate to severe plaque psoriasis patients in 2026 and the significant quality of life impact of residual disease.

Dr. Song identifies three core challenges. First, despite an increasingly robust treatment landscape, drug discontinuation remains a significant problem, with 30 to 50% of patients stopping or switching their first therapy within the first couple of years. He stresses the need for better patient-to-drug matching to reduce unnecessary switching. Second, he raises the more aspirational goal of addressing systemic comorbidities beyond skin clearance, noting emerging evidence that early skin clearance may prevent or delay the onset of psoriatic arthritis and cardiometabolic disease. Third, he highlights ongoing access barriers, particularly for patients who fall below the 10% BSA threshold commonly required by payers.

Dr. Stein Gold reinforces the importance of framing psoriasis as a systemic disease when counseling hesitant patients, noting that this perspective often improves patient willingness to pursue systemic therapy.

Dr. Crowley then addresses the quality of life impact of residual disease, citing clinical trial data showing incremental quality of life improvements as patients progress from PASI 75 to PASI 90 to PASI 100. He emphasizes that even small amounts of remaining disease, particularly in visible or sensitive areas like the face, can meaningfully affect patient wellbeing and may necessitate a change in therapy.

In the next episode, "Identifying and Managing Patients with Moderate Psoriasis," panelists will continue their discussion on plaque psoriasis and highlight the complexities of defining disease severity beyond BSA alone, the quality of life impact of moderate disease in high impact areas, and the practical framework for identifying systemic therapy candidates using updated IPC guidelines on topical treatment failure.