Q&A: Exploring ‘challenging to treat’ areas of psoriasis
Click Here to Manage Email Alerts
Healio spoke with Linda Stein Gold, MD, director of dermatology clinical research at Henry Ford Health, about the most difficult-to-treat body areas for psoriasis, treatment options, unmet needs in these cases and more.
Healio: What are the most difficult areas of the body to treat for psoriasis?
Stein Gold: Psoriasis involving the palms and soles can be very challenging to treat. This is true especially when patients do not have plaque psoriasis on other areas of the body. Another challenging area is the scalp. This is difficult to treat because topical therapy can be messy, and patients often find topical therapies difficult to use. Nail psoriasis is also challenging, as topical therapy is not generally effective.
Healio: What makes these areas challenging to treat?
Stein Gold: As above for scalp and nails. Psoriasis of the palms and soles often does not respond to treatments that commonly work well in psoriasis that involves the trunk and extremities. Involvement of these areas can be debilitating, and effective control is essential.
Healio: What treatment options are most effective in patients with psoriasis presenting on these areas?
Stein Gold: Scalp psoriasis tends to respond well to systemic therapies, including both oral therapies and biologic therapies. Nail psoriasis also responds well to systemic therapies, especially those therapies that work well for psoriatic arthritis. No one medication is consistently effective for palm and sole disease.
Healio: Can psoriasis presenting in these areas be more aggressive than psoriasis presenting in other places?
Stein Gold: Some areas of psoriasis can commonly be associated with the development of psoriatic arthritis, including psoriasis of the nails and scalp. When we see psoriasis in these areas, we must make sure to ask patients about potential joint involvement.
Healio: Are these types of cases more difficult to treat in patients with skin of color?
Stein Gold: The severity of psoriasis can be more difficult to assess in patients with skin of color. The inflammation, or redness, can be more subtle. Also, these patients are more likely to have dyspigmentation when the psoriasis heals.
Healio: What unmet needs exist in the treatment of these challenging cases of psoriasis?
Stein Gold: We have come such a far way with our treatment options for psoriasis. We have newer options that specifically target the defects in the immune system that we have come to understand are important in the pathophysiology of the disease. We have exceptional topical, oral and biologic medications that allow us to get most of our patients to clear or almost clear skin. Sometimes this involves combination therapy. While every drug does not work in every patient, and some challenging areas can be more difficult to treat, we have the tools to help psoriasis patients better than ever before.