Challenges in Treatment of Plaque Psoriasis

Mark Lebwohl, MD: Patients with psoriasis are often emotionally fragile. There’s a high incidence of depression, an increase in suicides, and a profound impact both on physical functioning and psychological functioning. That’s been shown in many studies over decades. It is very important, therefore, that patients who see you know that you’re going to do everything possible to make their psoriasis better. But even more important than that is that we now have the ability to clear almost anyone. The treatments that we have are going to work.

You have to give patients a realistic sense of how quickly they’re going to work. Some of the drugs work more quickly, and the patients will see a benefit within a few weeks. They have to know that. But some of the other drugs that have advantages like infrequent injections are going to clear the patient a little bit more slowly. But they’re going to get to the same degree of clearing, and then they’ll stay clear for most of their lives. We have a lot of options for patients. We can clear almost anyone. As soon as patients know that, they respond positively, both psychologically and physically.

One of the things that I would like people who view this segment to realize is that we have to use the treatments that are best for our patients, and we have a lot of choices out there. I wouldn’t let an insurance company tell you to use a therapy that might not be the ideal therapy for your patient. The resources are there, both from the pharmaceutical companies that market these medications, who often will even provide the medications for free, or from the American Academy of Dermatology and the National Psoriasis Foundation, who have the means and ability to actually help you get the medication you want for your patient.

Members of the American Academy of Dermatology have an office management site on the website of the academy that has a letter writing tool for prior authorizations. Letters that used to take me 15 minutes or 30 minutes to generate, I actually don’t get involved in anymore. My secretary goes to the website, uses my log-in information, and generates the letter for me if I want a patient to get a particular drug. That takes her about 30 seconds. So we have tools available to help us get the medications we need for our patients, and I would encourage anybody viewing this to use those tools.

Transcript edited for clarity.