In this episode of MD Newsline, Dr. Collette Honore, a board-certified dermatologist, discusses the evolving landscape of psoriasis diagnosis and treatment. Drawing on years of clinical experience, she shares practical insights into identifying psoriasis across diverse skin tones, selecting appropriate biologic therapies, managing treatment resistance, and addressing complex cases involving psoriatic arthritis, metabolic syndrome, inflammatory bowel disease, and severe disease variants.

Dr. Honoré also highlights the importance of health equity in dermatology, the unique challenges of diagnosing psoriasis in skin of color, and the need for clinicians to listen closely to patients while tailoring treatment plans to individual needs and lifestyles.

Dr. Honoré explains why psoriasis can present differently in patients with skin of color and emphasizes the importance of careful examination rather than relying solely on textbook descriptions. She discusses common diagnostic pitfalls and the value of skin biopsies when the diagnosis is uncertain.

Patients with skin of color often experience delayed diagnosis and undertreatment. Dr. Honoré shares strategies for improving recognition of psoriasis in diverse populations and ensuring equitable access to effective therapies.

Selecting a biologic requires consideration of disease severity, body surface area involvement, lifestyle factors, comorbidities, and patient preferences. Dr. Honoré reviews the role of IL-17 inhibitors, IL-23 inhibitors, TNF inhibitors, and other treatment options in modern psoriasis management.

Certain psoriasis presentations can significantly affect quality of life despite limited body surface area involvement. Dr. Honoré discusses biologic therapies that have demonstrated effectiveness in difficult-to-treat areas, including the scalp, nails, palms, soles, and genital regions.

Psoriasis is more than a skin disease. Dr. Honoré highlights the importance of screening for psoriatic arthritis, metabolic syndrome, cardiovascular disease, and inflammatory bowel disease when developing treatment plans.

When patients lose response to therapy, clinicians must determine whether to optimize treatment, combine therapies, or switch biologic classes. Dr. Honoré explains her approach to managing primary and secondary treatment failure while minimizing the risk of antibody formation.

Regular follow-up and laboratory monitoring remain critical for patients receiving methotrexate and biologic therapies. Dr. Honoré discusses practical monitoring schedules and how she balances safety with long-term treatment success.

From erythrodermic psoriasis to pustular disease and severe palmoplantar involvement, Dr. Honoré shares real-world experiences managing complex patients and explains when hospitalization becomes necessary.

Dr. Honoré concludes with actionable recommendations for clinicians, including the importance of comprehensive patient histories, awareness of medication triggers, recognition of psoriasis in children, and early intervention to prevent long-term complications.

Dr. Honoré emphasizes that successful psoriasis management requires individualized care, careful attention to comorbidities, and a willingness to adapt treatment strategies over time. By improving diagnostic accuracy, embracing newer biologic therapies, and addressing disparities in care, clinicians can significantly improve outcomes and quality of life for patients living with psoriasis.

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