Case 1: A 32-Year-Old Woman’s Battle with Plaque Psoriasis

The first case presented involved a 32-year-old woman diagnosed with plaque psoriasis for a decade. She had additional health challenges, including hypertension and gestational diabetes, which she managed through lifestyle adjustments after pregnancy. Dr. Lewitt highlighted the necessity of tailoring treatment plans that consider both medical and lifestyle factors, asserting that the perceived severity of psoriasis can greatly differ from patient to patient. Questions emphasizing quality of life and treatment goals such as “How does psoriasis affect your daily life?” were identified as crucial for developing patient-oriented strategies.

The panelists discussed various therapeutic options, weighing systemic treatments against topical alternatives. They pointed out the complexities of managing patients like hers, particularly given her history of gestational diabetes and hypertension, as some treatments could adversely affect these conditions. A noteworthy suggestion included the potential use of biologics that require less frequent administration, such as risankizumab (Skyrizi), which can alleviate the stress of regular injections and monitoring.

Ultimately, the patient opted for an IL-23 inhibitor, which necessitated only one injection every three months. Dr. Lewitt confirmed that this regimen has already shown promising results in managing her psoriasis symptoms.

Case 2: Managing Psoriasis Complicated by Psoriatic Arthritis

The next case focused on a 55-year-old man grappling with 15 years of plaque psoriasis that had recently become severe, affecting his palms and soles, as well as causing pain from psoriatic arthritis. Historically resistant to systemic options, he sought treatment due to increasing difficulties in his daily activities.

The discussion centered around oral therapies, with apremilast (Otezla) emerging as a primary candidate due to its ease of use and minimal need for monitoring. However, the panel warned him of potential gastrointestinal side effects, including early-stage nausea and diarrhea. Strategies such as adjusting dosing schedules and incorporating supplements like zinc were suggested to alleviate these symptoms.

Furthermore, combining apremilast with targeted topical treatments was considered to address local flare-ups, allowing the patient to maintain systemic treatment without interruption. They also explored nonsteroidal topicals like roflumilast cream (Zoryve) as a viable option to manage scalp psoriasis, minimizing long-term steroid-related side effects.

Case 3: The Psychological Impact of Pediatric Psoriasis

In a shift towards pediatric care, the discussion turned to a 7-year-old girl diagnosed with psoriasis a year ago. Presenting with visible plaques that covered 3% to 5% of her body surface area, her condition was impacting not only her skin but also her emotional health and social interactions at school. Her parents were deeply concerned about the psychological consequences of her visible symptoms.

The panel initially recommended a conservative approach using topical corticosteroids and roflumilast cream, suitable for children. Given the common fears regarding steroid use, nonsteroidal options were also discussed, aiming for a balanced approach that fits into the family’s daily routine.

As treatment progressed, it was evident that the girl faced mounting emotional distress. The team responded by exploring systemic treatments, including biologics, while remaining cautious about their use in young patients. They stressed the importance of ongoing patient education to manage expectations and emotional welfare regarding the chronic nature of psoriasis.

After several months, the girl displayed significant improvements both physically and emotionally, thanks to a combination of roflumilast cream and well-monitored low-potency corticosteroids which reduced inflammation and improved her quality of life.

Conclusion: The Importance of Personalized Treatment

These insightful cases underscore the need for tailored treatment strategies in psoriasis management. The roundtable emphasized that effective treatments should consider lifestyle, emotional well-being, and patient preferences, as addressing the complete spectrum of a patient’s life is essential to successful outcomes. Dr. Lewitt and the panel’s collaborative approach to managing psoriasis offers a promising outlook for many affected by this complex skin condition. Are you or someone you know impacted by psoriasis? Discover how personalized treatment can transform your journey towards healthier skin!