Derm Topics

Applying the Psoriasis Guidelines to Practice

Next Steps in Derm and the Journal of Drugs in Dermatology, in partnership with the Dermatology Education Foundation (DEF) and Physicians Resources,  interviewed Dr. April Armstrong (Professor of Dermatology and Associate Dean for Clinical Research at the Keck School of Medicine at USC) on applying the psoriasis guidelines established by the American Academy of Dermatology and the National Psoriasis Foundation to help guide the clinician community. As Dr. Armstrongs points out, one of the most important aspects of these guidelines is determining when systemic therapy is appropriate for psoriasis patients. Watch as Dr. Armstrong carefully explains the criteria needed to make this clinical decision as well as how she sees these guidelines evolving over time.

Dr. April Armstrong lectured on this and other topics at the recent  DERM2O22 NP/PA CME conference held July 28-31, 2022.

Further Reading

If you want to read more about current and upcoming treatment strategies for psoriasis, check out the following articles published in the Journal of Drugs in Dermatology:

Evolving Concepts in Psoriasis: Special Considerations for Patients With Skin of Color, Skin Barrier Dysfunction, and the Role of Adjunctive Skin Care


Background: Despite considerable advances in our understanding of the pathogenesis and treatment of psoriasis, data pertaining to racial/ethnic variations, effects on barrier function, and the potential role of adjunctive skin care are relatively limited. Knowledge gaps in the clinical presentation, quality-of-life impact, and approach to treating psoriasis in patients with skin color contribute to disparities in care. In addition, small studies suggest that using skincare products can reduce psoriasis symptoms, improve barrier function, and result in higher patient satisfaction, yet patients with psoriasis may underuse skincare products. This manuscript seeks to offer insights into these knowledge gaps and their potential treatment implications.
Methods: A structured literature search followed by a panel discussion and an online review process explored best clinical practices in treating psoriasis patients with skin of color and providing expert guidance for skincare use, including gentle cleansers and moisturizers.
Results: Racial/ethnic differences in genetic factors, clinical presentation, and disease burden in psoriasis have been reported. Under-recognition of these differences contributes to racial/ethnic health disparities for psoriasis patients in the US. Several studies have shown a greater quality-of-life impact with psoriasis among patients with skin of color. Although the published data are limited, some studies have identified differences in skin barrier properties and suggest a role for adjunctive skin care in the management of psoriasis.
Conclusion: Further study is needed to understand racial/ethnic population variations in psoriasis and develop strategies to reduce disparities in care. Addressing alterations in skin barrier function observed in psoriasis may help to improve treatment outcomes and patient satisfaction.

Persistence With Biologic Treatments in Psoriasis: A Structured Literature Review of Studies Using Administrative Database and Clinical Registry Data


Background: Psoriasis is a chronic, autoimmune-mediated inflammatory disorder. Drug persistence is a composite measure of effectiveness, safety, and treatment satisfaction, often estimated using data from administrative databases and clinical registries. Persistence rates calculated from these two data sources appear to be systematically different.
Objective: Review and compare persistence rates of psoriasis-indicated biologics reported in registry and database studies.
Methods: A structured literature search of studies published during 2009-2019 was performed in PubMed and American Academy of Dermatology records to identify research describing persistence with biologic treatments in psoriasis patients. English language retrospective or prospective persistence studies based on database or registry data, and reporting on at least two psoriasis-indicated biologics, of which at least one was ustekinumab, secukinumab, ixekizumab or guselkumab, were included. Single-arm studies, randomized control trials, systematic literature reviews, and studies presenting stratified results only were excluded.
Results: A total of 37 studies (22 registry- and 15 database-derived) comprising 76,000 patients were included. On average, drug persistence collected from registry studies was 18% higher than database studies.
Conclusion: The findings of this study may be used by practitioners to make meaningful comparisons between persistence data derived from registries and databases, and thereby improve clinical decision making.

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