Dr. Heather Woolery-Lloyd recaps her lecture on What's New in Skin of Color on Thursday, November 9, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.
In this video
Dr. Song explains that as a dermatologist, "you can't make your decision about treatment until you find out if the patient has arthritis or not," since so many current psoriasis treatments address both the joints and the skin. Her first pearl is to screen for it: she likes the PEST questionnaire — five easy questions patients can fill out themselves, or that she runs through mentally during the encounter to gauge how suspicious she is. Her second pearl is to ask at every visit, because roughly 75% of psoriasis patients present with skin signs before joint pain, and many don't realize their skin inflammation can affect their joints. Her third pearl is a quick, targeted joint exam — checking the lateral epicondyle and the Achilles tendon for pain at the tendon insertion, or simply asking whether back pain wakes the patient in the middle of the night.
Asked about a drug she's excited about, Dr. Song points to the next generation of oral medications. She highlights SOTIC2 (deucravacitinib) as the second oral option and notes new oral IL-23 inhibitors on the horizon — more choices for patients who are still "afraid of a needle."
- Treatment decisions in psoriasis hinge on knowing whether the patient has arthritis, since many therapies treat both skin and joints.
- Screen with the PEST questionnaire — five quick questions patients can complete or the provider can run through mentally.
- Ask about joints at every visit: about 75% of psoriasis patients show skin signs before joint pain, and many don't connect the two.
- On exam, check the lateral epicondyle and Achilles tendon insertion for pain, or simply ask about back pain that wakes the patient at night.
- The next wave of options is oral: deucravacitinib (SOTIC2) and emerging oral IL-23 inhibitors give needle-averse patients more choices.
