Melodie Young, MSN, ANP-c: Keeping up with Dermatology's Advances

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It's been a whirlwind few years for dermatology. The nurse practitioner discusses modern care teams, comorbid psoriatic disease, and expanding patient inclusion in clinical trials.

Nurse practitioners (NPs) and physician assistants (PAs) are increasingly involved in patient management through specialties including dermatology, where the increasing rate of patients with chronic skin disease has challenged the field to adapt with a modernized care-team approach that involves diverse training backgrounds and even sometimes other specialists with cross-interest in a patient.

In an interview with HCPLive during the Maui Derm 2023 NP + PA Summer Conference in Colorado Springs this week, Melodie Young, MSN, ANP-c, an NP with Modern Dermatology in Dallas, discussed the status of dermatology care today as it relates to these evolving roles and new challenges.

Young emphasized the prevalence and impact of burnout on dermatology, noting a general fatigue from her peers in navigating new challenges, standards—and even new exciting therapies—from the last few years. Indeed, while “tremendous advancements” in available medications have been a net positive, there has been a learning curve from physicians and advanced practitioners alike in establishing their roles with handling them.

“As far as within the community at large…to get them to have confidence and faith in us again, I think we took a pretty large hit,” Young said regarding the general reception of health care providers. “There’s been shifts and changes, some a little negative, that we’ve had to work through. But that’s when growth happens: when things can’t be done the same way anymore.”

On the subject of chronic disease patients with increasing involvement from other specialists—such as with plaque psoriasis—Young stressed her interest in seeing clinical trials better reflect the modern challenges a patient and their clinician may be encountering prior to initiating a biologic or disease-modifying therapy. She noted her NP education, which she said provides a better sense of prioritizing “the whole patient and all of the people who are impacted” by disease.

“If you have a child or teenager with a disease like psoriasis, you can’t just focus on that child,” Young said. “You’ve got to focus on what the school nurse is going to be doing, the parents or grandparents….you’ve got to think about all those factors and not just what is the disease and what are you going to prescribe for it.”

Young explained that pivotal clinical trials for popularizing dermatology drug classes like Janus kinase (JAK) inhibitors have been inundated by fine-tuned inclusion criteria that may not reflect the true average patient.

“In the real world, that’s not what happens,” Young said. “Your psoriatic patients oftentimes are heavier; they tend to smoke; they probably are going to be on anti-depressants. I think we need to have clinical trials that are not so scrubbed clean, that you can get real-world scenarios and patients.”

Young described psoriasis as a “sneaky little disease”—a multisystemic chronic burden that if treated improperly or with limitations may spell unforetold issues for patients. “Being able to have good evidence for the value of having tight control over a disease is super important, and also in all different patient types: ages, races, disease states, genetic differences,” Young said.