Providing Guidance for Patients With Moderate-to-Severe Psoriasis Who are Candidates for Biologic Therapy

Abstract

Psoriasis is a chronic, immune-mediated disease characterized by itchy, scaly, and often painful plaques in the skin. Psoriasis can have significant psychosocial burdens and increased risks for numerous comorbidities, including diabetes, hypertension, and cardiovascular disease, particularly in patients with moderate-to-severe disease. Dermatology nurse practitioners and physician assistants are an important part of the healthcare team, contributing to all aspects of psoriasis management. This review reinforces the unique aspects of care that nurse practitioners and physician assistants provide to patients with psoriasis, such as facilitating conversations about managing disease, setting appropriate expectations, and considering treatment options, including when treatment response or tolerability is suboptimal. The importance of relationship building is stressed. Patient management topics discussed include helpful tips about assessing treatment options, initiating biologic therapy, optimizing patient adherence, and managing comorbidities. Also reviewed are how to deal with common barriers including lack of knowledge about psoriasis or making healthy lifestyle changes, fear of injections or side effect risks, lack of health insurance, and concerns about treatment costs. Overall, by forming meaningful relationships and engaging patients in their psoriasis care, nurse practitioners and physician assistants can help to optimize clinical efficacy outcomes and consistently manage moderate-to-severe psoriasis and its comorbidities over the patient’s life course.

Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor

“…Many providers of dermatology and rheumatology care are increasingly seeking primary care experts who understand the comorbidities and complexities of psoriatic disease to reduce undertreatment of psoriatic disease symptoms and improve collaborative patient care (Lebwohl et al., ). Nurse practitioners may be able to spend more time with patients to identify treatment goals that balance disease severity, comorbidities, and safety concerns with patient quality of life and treatment preferences (Aldredge & Young, ). Having comprehensive knowledge of therapeutic options helps create a collaborative and holistic approach to patient care.…”

Effect of Individualized Guidance on Knowledge and Self-Care Practices of Psoriasis Patients

“…There are several types of psoriasis, and the patient may have more than one type of psoriasis at the same time. It is also possible for one type of psoriasis to develop and become more severe (3) . Psoriasis types include plaque psoriasis which is the most common form of the disease, and it appears as raised, red patches (plaques) covered with silvery scales.…”

The Effects of Moderate-Severe Plaque Psoriasis on Patient Well-Being and Prevention of Flares

“…Psoriasis is a chronic skin condition that is indicated by red, patchy and scaly skin that can be painful when irritated. Patients with psoriasis have an increased risk for more than one chronic disease such as Psoriatic Arthritis, Crohn's Disease, Psychological Disorders, Hypertension, Diabetes, and Heart Disease, which may emerge due to the buildup of plaques along with chronic inflammation (Aldredge, & Young, 2016). Despite the expansion of treatments for moderate-to-severe psoriasis over the last ten years, alleviation of symptoms remains suboptimal.…”