Assessment of Dermatologists' and Dermatology APPs' Educational Needs and Current Management of Patients with Moderate-to-Severe Plaque Psoriasis: Results of a Case-based Survey

Abstract

Introduction Psoriasis is a chronic systemic immune-mediated disease with skin manifestations that can significantly diminish a patient’s quality of life (QoL). As treatments rapidly evolve, dermatology clinicians may struggle to keep pace with the latest best practices and therapeutic options. A study was designed to assess the clinical practices, barriers, and learning priorities of US-practicing dermatologists and dermatology advanced practice providers (APPs) on assessment and management of patients with moderate-to-severe psoriasis. Gaining a firm understanding of educational gaps and needs of dermatology clinicians enables the development of relevant continuing education programs aimed at optimizing practice behaviors and improving patient outcomes. 

Methods A survey on the management of patients with psoriasis was developed and electronically distributed to dermatologists, dermatology nurse practitioners (NPs), and dermatology physician associates (PAs) currently practicing in the US. The survey utilized a simulated case to gauge current clinician practices, as well as additional questions related to attitudes, barriers to care, and information-seeking preferences. Descriptive statistics were used to summarize results.

Results A total of 225 clinician responses were collected from December 2024 to January 2025; 169 dermatologists and 56 dermatology APPs (13 NPs, 43 PAs). When presented a case of a patient initially presenting with plaque psoriasis (4% body surface area [BSA]), nearly all clinicians would document %BSA and informally assess QoL. 4% of APPs and no dermatologists would incorporate an objective QoL questionnaire into the patient’s assessment. While nearly all clinicians would start this patient with a topical therapy, roughly half of dermatologists and three-fourths of APPs would switch to a biologic if the patient had 12% BSA or psoriasis in a high impact area (eg, scalp/palms). If the patient’s psoriasis was not initially resolved while on topical corticosteroids, clinicians had a lack of consensus on a second-line approach. 38% of clinicians set 10% BSA as the threshold for systemic therapy, though 14% of the sample would wait until the psoriasis is over 20% BSA. Top barriers to care include cost, safety concerns, and lack of tolerability of current medications. Many clinicians also reported that a patient’s inability to use topical and oral medications as prescribed poses a significant barrier. Journal articles, continuing education activities, and regional/local conferences are viewed as the most useful sources of information related to psoriasis; dermatologists ranked journal articles as the most useful source while APPs ranked regional/local conferences as most useful.

Conclusion Based on this study, education should address new and emerging treatments, current treatment guidelines, best practices in QoL assessment, management strategies beyond initial topical therapy, and principal barriers to optimal care. Leveraging clinician-preferred educational resources will enable a targeted approach to facilitating knowledge acquisition and improving clinical practice.