Oral Therapies for High-Impact Areas in Psoriasis, with Andrew Alexis, MD, MPH

Following a presentation titled ‘Optimizing Treatment Strategies for Moderate-to-Severe Plaque Psoriasis: Addressing High-Impact Areas and Recalcitrant Disease,’ the HCPLive editorial team spoke with the presenter, Andrew Alexis, MD, MPH, professor of clinical dermatology and the vice-chair for diversity and inclusion for Weill Cornell Medicine.

First, Alexis was asked about his presentation regarding high-impact areas of psoriasis, such as the palms, soles, and scalp. Specifically, Alexis spoke on the ways in which these areas present such unique clinical challenges for dermatologists. He walked through ways in which psoriasis in these locations can impact patients’ quality of life and which areas clinicians commonly underestimate.

“There are so many examples of how psoriasis, involving these high-impact areas, can affect patients' quality of life, ranging from just day-to-day function,” Alexis explained. “We can think of patients who have severe involvement of their palms not being able to actually use their hands effectively to go through their normal daily, personal, and professional activities. Psoriasis, involving the soles literally impacts people's ability to walk because of the pain of bearing weight on severely involved soles. These are two examples.”

Alexis was asked a variety of other questions as well, including the ways in which oral targeted therapies fit into the current treatment landscape for these difficult-to-treat areas.

“Historically, patients with involvement of these high-impact areas but still limited in percent body surface area were managed with topicals, and topicals alone,” Alexis said. “And historically, there hasn't been as much embracing of using systemic therapies for such areas. That's not necessarily on the part of clinicians. It's also often dictated by the payer, where one can have quite a bit of difficulty getting a systemic medication approved for a patient with limited body surface area. But all that aside, we recognize how valuable targeted oral or injectable therapies are for managing patients with these high-impact areas of psoriasis.”

Alexis noted his own recommendation that one have a low threshold for moving to oral, targeted or biologic therapies for individuals with involvement in these high-impact areas, provided they are not responding to topicals or a course of high-potency corticosteroids and other advanced topicals.

“If the patient is still not achieving the goal of being clear or almost clear, or at least having in having improvement in their daily functioning, there's no reason to wait and not consider escalating to an oral targeted therapy or an injectable biologic,” Alexis explained. “Many of which have data supporting the use for scalp psoriasis and other high-impact areas.”

For additional information on these oral therapies and their use in psoriasis, view the full interview above.

The quotes contained in this interview summary were edited for the purposes of clarity.

Alexis's disclosures include the following: Consultant (Fees/Honoraria): AbbVie, Amgen, Boehringer Ingelheim, Canfield Scientific, Eli Lilly, Janssen, Janssen Scientific Affairs, LEO Pharma, L'Oréal USA, Pfizer, Symrise; Other (Equipment/Financial Benefit): Aerolase (Equipment), Elsevier, Medscape, Springer Science & Business Media, UpToDate, Wiley-Blackwell.