Paradigm Shifts in the Management of Plaque Psoriasis: Advanced Practice Provider Perspectives - Episode 2

Plaque Psoriasis: Assessing Disease Severity

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Advanced practice providers share their perspectives on assessing and grading the disease severity of plaque psoriasis.


Matthew Brunner, MHS, PA-C, DFAAPA: Another interesting concept here is understanding psoriatic arthritis. It’s an interesting comorbidity, and we have the opportunity as dermatology providers to be able to pick up on that potential complication, and to address it early. Many of these patients don’t understand that the disease can be linked, and that the destruction that comes from psoriatic arthritis can be permanent and can impact their activities of daily living and even their ability to work. It’s important to approach that and to evaluate that as a part of your new patient encounter, and on subsequent patient encounters as well, because those are symptoms that can develop over time.

Lakshi Aldredge, MSN, ANP-BC, DCNP: I totally agree, and I love what you said, Matt, about starting the conversation by sitting down, because I’ve had patients who’ve said they’ve been to multiple providers. Sometimes when patients have severe psoriasis, they’ve said that the provider doesn’t even go into the room, they just stand at the door and look at them and say, “You have really bad psoriasis, I can’t help you. This is a chronic disease, and you just need to learn to live with it,” which is devastating for a patient to hear. The severity as you mentioned, can be graded in several ways. First of all, how much of their body surface is affected, and typically, you hear mild, moderate, and severe. We tend to gauge it by body surface area [BSA] being 1 palm, or 1% BSA, and 0% to 5% is considered mild disease, 5% to 10% BSA is considered moderate, and anything above 10% is considered severe. But I think you made an excellent point of getting to know the patient and understanding how their psoriasis impacts them. For example, a patient may have psoriasis just on their scalp, which is a relatively small body surface area, maybe 2%, 3%, 4% BSA, which is technically considered mild. However, if you have those big, thick, white plaques of psoriasis all over your scalp, it is so itchy and it feels like somebody stuck papier-mache on your scalp. Think about the psychological impact of wearing that for the world to see. That can be severe disease, even though it’s a smaller body surface area.

You made a very excellent point in that you don’t just look at their skin, but you assess for other symptoms, such as joint stiffness and pain, which can be an indicator of early psoriatic arthritis. We know about 30% of patients with psoriasis can develop psoriatic arthritis. From the initial interview, sitting down with the patient, hearing their story, understanding where they’ve come from, and also starting to assess for the comorbidities, and educating patients along the way with each visit—this makes it less overwhelming for patients, and helps them to realize that you truly are a provider who is in it for the long haul with them.

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.