Patrick Burnett, MD, PhD, FAAD, chief medical officer of Arcutis Biotherapeutics, speaks about disease manifestations, comorbidities, and other factors to consider in the management of psoriasis.
Understanding the unique aspects of each patient’s disease course in psoriasis is vital to effectively manage symptoms and create improved outcomes, said Patrick Burnett, MD, PhD, FAAD, chief medical officer of Arcutis Biotherapeutics.
What are some unmet needs in the holistic management of psoriasis?
So, when I hear that word, holistic management, as a dermatologist myself, I take a step back and I say—with this patient that's sitting in front of me, and every patient is unique—what is it that this patient needs? And what are the unique aspects of their disease? So, one area might be if a patient has psoriatic arthritis (PsA). If a patient has PsA, intertriginous disease, and they have typical chronic plaque psoriasis, then regardless of what's on their skin, that's a patient who is really going to need systemic treatment, because that's needed in order to treat their joint disease.
And, thankfully, that's a relatively small proportion of patients who have psoriasis overall, but it's something you certainly wouldn't want to overlook when taking care of that particular patient. Because if you just attack their skin, and get that 100% under control, but you ignore their joint disease, then you're not doing them a favor.
It's the same thing with patients who have intensive itch. If you clear their skin so it looks like they don't have much psoriasis, but they're still very symptomatic or if they have intertriginous disease, and this is something that I think we see very commonly right now, because of the lack of treatments that are appropriate to be used in skinfolds, because that's where steroids really have some serious challenges with regard to atrophy or local tolerability. If you attack the patient's normal elbow, knee psoriasis, but you don't address their intertriginous disease, then you're not really treating that patient.
As a doctor, you're kind of making yourself feel a little bit better. And the patient might look better when they come into the clinic, but if you're not getting it where it's impacting their quality of life, then I think you aren't really treating the whole patient.
So, I would say, in that aspect understanding some of these subgroups of patients with psoriasis that have either, in addition to knee and elbow chronic plaque psoriasis or other harder to treat forms, that we really need to make sure that we have treatments that can address those as well. And I would add scalp psoriasis to that group because scalp psoriasis is one area where a lot of treatments aren't able to provide efficacy. Those patients oftentimes will kind of prematurely be pushed into a systemic therapy, because they're not being able to be treated with topicals that are existing on the market right now and available to patients.