Optimal Management of Plaque Psoriasis: Expert Nurse Practitioner Perspectives - Episode 2
Melodie S. Young, MSN, A/GNP-C: We know that it is a visible disease, but we also know there’s a misery index associated. It’s really itchy. Patients report their top complaints about their disease. We used to think it just embarrasses them, and I’ve had some providers say things like, “It's cosmetic,” and that maybe I shouldn’t look at using a biologic for a cosmetic condition. Of course, that makes my eyes want to pop out of my head and smoke come out of my ears because it is not just a cosmetic condition. It is a dangerous disease, and it’s something we can fix if we try.
Patients complain of itch and pain, but they also complain and tell stories about things like, “I have to be careful about what color the interior of the car is because if it’s dark and I sit down in somebody’s car to go to lunch with them, when I stand up, there will be flakes everywhere, and it’s so embarrassing.” Or they think about wearing dark-colored clothing or light-colored clothing because psoriasis bleeds. It cracks.
I heard it described as feeling like dried oatmeal on the skin, and when you move, you feel so constricted. You’re dying to just pick that plaque off. But of course, it bleeds, and it escalates the itching, the plaque, and the growing problem with it. We see that it has a well-documented impact on the psychological aspect, whether it’s depression or suicidal ideation, which is associated with psoriasis, and we also know that it can have an impact on your ability to make a living.
I have a couple of nurse anesthetists who have told me how miserable it was to try to pop the top off medications when you don’t have your nails, to try to draw medicine. Nails are really important. They’re not just here for looks.
There is also genital psoriasis. I know you could speak about that, you take care of a lot of guys in the VA [US Department of Veterans Affairs]. I’m sure you've had some discussions about that.
Lakshi M. Aldredge, MSN, ANP-BC, DCNP: I’ve had folks come in, a husband and wife, where the wife was sure that her husband had been cheating on her and that the husband had caught a sexually transmitted disease. It was devastating for them as a couple in their relationship. They had been married for 35 years. You’re absolutely right.
First of all, the physical symptoms are not only pain and itching, but sleep is a huge issue because they’re scratching all night. I have even had a patient tell me that the morning routine for them was that her husband would peel her off of the sheets in the morning because she’d scratched so much, bled, and the sheets would stick to her. I know that the stories Mel and I are telling you sound dramatic, but they are true-life cases.
I had another lovely gentleman who worked for a big advertising company in New York, and he had been demoted because he was doing a sales pitch, and his hands were affected. As Mel said, when you’re out there advertising and talking with your hands, the company representative said, “We don’t want him working on our advertising campaign,” and it was literally a loss of livelihood for him and his family. To the suicidality issue, he considered taking his own life. He has twin daughters, and when they were 6 years old, he would take them for walks, and one day one of them said, “Daddy, could you not hold my hand today,” because she did not want to touch his psoriasis. These are real-life stories.
It is not just the physical itch, pain, and sleep disorders, but the psychology of this disease is devastating as well. As Mel mentioned, it’s not just a disease of that patient, it’s a disease that affects the whole family.
I had a 45-year-old female veteran who had never had a relationship with anybody because she had genital psoriasis, and she thought, “Who would ever want to be in a relationship with me with this disease we don’t have a cure for?”
If nothing else, I think Melodie and I would want you to leave with this: if you are a provider, and you have a patient with psoriasis sitting in front of you, think of them as a whole person. Ask them about what their disease is keeping them from doing and how it keeps them from experiencing joy in their lives. That’s what the goal is. We want them to have a joyful, healthy, productive life, and this disease often keeps them from doing that. We as providers, now can thankfully get them clear or near clear, and that is our goal.
Transcript Edited for Clarity