Paradigm Shifts in the Management of Plaque Psoriasis: Advanced Practice Provider Perspectives - Episode 3

Diagnosing and Treating Patients With Plaque Psoriasis

Published on: 

Diagnosis and management of plaque psoriasis as discussed by advanced practice providers.


Lakshi Aldredge, MSN, ANP-BC, DCNP: One of the other things that is interesting is the journey the patients have, how many providers they’ve seen. I’m curious, Matt, have you had patients who have seen multiple providers? What advice would you give primary care providers as to when they should refer to a dermatology provider? I know it can be challenging.

Matthew Brunner, MHS, PA-C, DFAAPA: Yes, I definitely see patients who are all over the charts in terms of their experience. Sometimes they’re coming straight from primary care, other times they’re coming from other specialists’ offices. It’s surprising, but not all dermatology practices are utilizing systemic agents to treat patients. Often times, I’ll see patients who come from another practice and they’ve been given a jar of triamcinolone and told pretty much “good luck,” and sometimes without a lot of guidance. Patients need to understand both the way to properly utilize corticosteroids and topical therapy, but also expectations.If you think about the way that itch impacts you, it can really take away from your quality of life. If you’re living day in and day out with this constant itch, that’s a huge negative, and that’s an important part. I also like the point you made in talking about the digits and looking for the arthritis. Looking at those distal phalanges and looking at the nails, and I always look for oil drop signs, and some of those other changes in the nails that we know are associated with psoriasis. If you’re seeing the psoriasis on the distal phalanges, it’s likely that the psoriasis is already involved in those joints, and that’s a sign that we can pick up on early in the patient’s care before they may be starting to have things like sausage digits, or enthesitis. Those are other important parts of that diagnosis and catching those changes early.

Lakshi Aldredge, MSN, ANP-BC, DCNP: Absolutely. One of the biggest challenges, I think back, before I went into dermatology, I was in primary care, and our knowledge of psoriasis was very limited at that time. Sometimes with all of the other things that primary care providers have to deal with and consider in treating the whole patient, psoriasis and skin diseases take [only a small amount] of their time and energy. It’s really important for primary care NPs [nurse practitioners], and PAs [physician assistants] and physicians and DOs [doctors of osteopathic medicine], to know when to refer patients to a specialist. I try to advise them that, if you can control psoriasis, mild, even moderate disease, with ointments or creams, I think that’s great, and if [the patients are] otherwise healthy, they’re not at high risk for developing other comorbidities, such as heart disease and diabetes, I think it’s perfectly reasonable to control them with a topical agent. However, when they start having more significant disease, or if they are the type of patient who has risk factors for developing heart disease and diabetes, those are the types of patients we want to see in our dermatology clinics, so that we can get them on a systemic treatment, which is targeting the immune system, whether it be with pills or biologic injections. That’s the key. If you have a patient who has more moderate or severe disease, and they have more high-risk factors for developing those comorbidities, I think primary care providers should feel very comfortable referring them to dermatology.

Matthew Brunner, MHS, PA-C, DFAAPA: Thank you for watching HCPLive® Peers & Perspectives®. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peers & Perspectives® and other great content right in your inbox.

Transcript edited for clarity.