Dr. Alice Gottlieb is Chair of the Department of Dermatology and Dermatologist-in-Chief at Tufts Medical Center and is the Harvey B. Ansell Professor of Dermatology at Tufts University School of Medicine. She is an internationally recognized expert in psoriatic disease who has helped shape the current concept of psoriasis as an immune mediated disease. Ahead, Dr. Gottlieb shares her thoughts on the rapidly changing biologic landscape and the evolution in thinking regarding the systemic nature of psoriasis and psoriatic arthritis.

How have the recent advances in the systemic realm—particularly the surge of biologic therapies—affected how you understand psoriasis? Are these agents helping clinicians to better understand the systemic nature of the disease?

 According to Dr. Gottlieb, the application of more refined systemic agents has led to new ways of recognizing and approaching psoriasis. “Use of targeted immunotherapies helped us understand the key role that TNF, IL-17, and IL-23 play in the pathogenesis of psoriasis,” she notes. “Funding of research by pharma has not only brought us new drugs but also directly or indirectly funded basic studies on the pathogenesis of psoriasis.” However, the presence of these agents alone does not replace the role of educational programs and scientific inquiry in helping clinicians better understand the systemic nature of psoriasis, notes Dr. Gottlieb.

 

What is the single biggest hurdle that still needs to be cleared with regard to how psoriasis is approached clinically and managed?   

There are many barriers to effective psoriasis care, according to Dr. Gottlieb, and many of them appear to be related. Citing the high cost of treatment, she notes that simple access to appropriate therapies is a challenge for both physicians and patients. One obstacle, says Dr. Gottlieb, is “access to dermatologists willing to accept lower revenues and increased overhead that is associated with taking care of moderate to severe psoriasis patients.” Additionally, she observes, there is a shortage of exposure in training programs to the use of systemic medications. And finally, awareness has proven to be a significant issue in delivering optimum treatment, specifically, “the lack of patient awareness of the multiple aspects of psoriatic disease and the ability to clear psoriasis and greatly improve psoriatic arthritis,” Dr. Gottlieb explains.

Given the increasing variety of therapies available, what does the future hold for patients with psoriasis?

 More access to treatment will not only lead to better outcomes for patients, according to Dr. Gottlieb, but also better overall living: “If they have access to the full repertoire of treatments, the fact that psoriasis and psoriatic arthritis will not impact their quality of life, i.e., clearance of skin disease and no significant musculoskeletal complaints.” n