Optimal Management of Plaque Psoriasis: Expert Nurse Practitioner Perspectives - Episode 10
Melodie S. Young, MSN, A/GNP-C: What do you think the unmet needs are? What are we missing? We have drugs now that are just average. Their mean PASI [Psoriasis Area and Severity Index] scores are 92% to 95% on some of the IL-17 and IL-23 inhibitors, with the systemic agents or apremilast being something that can be a pill that doesn’t require too much monitoring. That can help improve the disease. What are we missing? What would you like to see besides a cure? I know we’d love to see a cure.
Lakshi M. Aldredge, MSN, ANP-BC, DCNP:I know.
Melodie S. Young, MSN, A/GNP-C: Is there a treatment missing, or do we think it’s more our profession that’s missing the opportunity?
Lakshi M. Aldredge, MSN, ANP-BC, DCNP:It is a professional patient education piece, and that is educating one another as health care professionals about the ramifications of not treating this disease. It’s important to understand the comorbidities associated with this disease and the incredible burden of the disease physically, emotionally, and even monetarily to an individual and their family.
That’s the No. 1 educational gap, and the second most important thing is correcting myths or misconceptions, especially during COVID-19 [coronavirus disease 2019]. Almost all the treatments that we give for psoriasis are perfectly reasonable to continue or initiate during this pandemic. When you think about your whole patient, you talk to them about their concerns and fears, and you give them evidence-based data to show that most of the biologic agents are safe, including some of the oral treatments such as apremilast. It’s perfectly safe to start treatment during this pandemic. Patient education will help demythologize and correct misperceptions, with not only our colleagues but also our patients. It’s important to get them on that pathway of not only clearing their disease but having a healthier, more enjoyable life as well.
Melodie S. Young, MSN, A/GNP-C: A lot of the unmet needs are there because there are gaps in care. There are gaps in access. Some cities have multiple experts in psoriasis and multiple dermatologists. In Texas, as big as it is, you’ve got a lot of rural areas there as well. There’s so much of our country that doesn’t have dermatologists or rheumatologists who are current. I hate to even say current because we’ve had biologic agents for 20 years. They need to be aggressive or involved in treating a patient with psoriatic disease or other chronic skin conditions.
That’s what part of the unmet need is, and that’s another opportunity that we have as NPs [nurse practitioners] and PAs [physician assistants]: being able to do telemedicine for rural areas or places where dermatologists aren’t around. You can hardly do that if it’s basal cell carcinoma that you’re trying to deal with. That patient is going to have to come in and get a biopsy, or you need to get them somewhere to get a biopsy. For psoriasis, it’s awesome. It’s socially acceptable. It’s a standard of care within the medical and dermatology community to use telemedicine to treat and diagnose conditions. Psoriasis can usually be diagnosed by looking. That is exciting, and I would like to see a cure. I would love to see medicines for which we would know what we need to do from the get-go, so we know exactly what’s going to be the best therapy and continue to understand more about the disease and all the different areas that are being affected by it. Maybe patients and providers alike will be totally convinced like you and I are about how we need to treat this.
Lakshi M. Aldredge, MSN, ANP-BC, DCNP:You also have to make sure that vulnerable populations have access to all the treatments. That’s legislation that needs to happen, but that’s the only unmet gap because we now have treatments for patients who are pregnant, those who have hard-to-treat areas, and those who have other comorbidities. We’ve come a long way in being able to offer our patients customized care for their disease. Mel, thank you so much for moderating this and having me.
Melodie S. Young, MSN, A/GNP-C: Absolutely. Thank you for doing this, Lakshi. I hope you have a great day. Thank you for watching this HCPLive® Peers and Perspectives® presentation. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peers and Perspectives® and other great content right in your in-box. Thank you.
Transcript Edited for Clarity