AB1610-HPR TREATING PSORIASIS - A TOPICAL GUIDE FOR RHEUMATOLOGISTS
Authors: W. Tuckwell, L. El-Dars, C. Rhys-Dillon
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The COVID-19 pandemic severely affected waiting times in Dermatology and appointments in Primary Care.<sup>[1]</sup> Hence, our patients with psoriatic arthritis (PsA) have been struggling to access treatment for psoriasis flares. As poorly controlled psoriasis is strongly associated with reduced quality of life, we wanted to see if we could address this burden in our Rheumatology clinics.<sup>[2]</sup> Topical treatments are first line in the management of psoriasis.<sup>[3]</sup> <h3>Objectives:</h3> Our aim was to assess the confidence of Rheumatology clinicians in Cwm Taf Morgannwg University Health Board (CTMUHB) when prescribing topical treatments for psoriasis flares in patients with PsA. We then sought to develop a resource to aid clinicians which would offer clear guidance on topical treatments for psoriasis flares as verified by a dermatology consultant. <h3>Methods:</h3> We devised a questionnaire on Google Forms and distributed this by email to all Rheumatology clinicians with prescribing responsibilities in CTMUHB. Clinicians were asked what action they take when a patient presents with poorly controlled psoriasis. Participants also rated their overall confidence from one (no confidence at all) to ten (extremely confident) when prescribing topical treatments for psoriasis, as well as for certain subtypes of psoriasis. The subtypes included were: extensor, flexural, scalp, facial and genital psoriasis. Participants were also asked if an additional resource could improve how they manage their patients with psoriasis. Additionally, descriptive data was collected on desirable features for a prescribing guide. We then reviewed NICE and The Primary Care Dermatology Society psoriasis guidelines to compile a summary of topical treatments for psoriasis flares. This was then peer-reviewed by a dermatology consultant. <h3>Results:</h3> A total of 16 clinicians completed the questionnaire. 2 (12.5%) clinicians answered that they would prescribe topical treatments for poorly controlled psoriasis; 12 (75.0%) answered that they would refer to dermatology. The median value for overall confidence when prescribing topical treatments for psoriasis was 2.5 out of 10. For extensor, flexural, scalp, facial and genital psoriasis, the median confidence values were 2, 2, 3, 1 and 1 respectively. 15 (93.8%) participants responded that they would find an information sheet on prescribing for psoriasis beneficial when treating patients. First line management (87.5%), flowchart layout (75%) and dermatology referral indications (56.3%) were the most requested features for the prescribing guide. <h3>Conclusion:</h3> The results suggest that Rheumatology clinicians have low confidence levels when prescribing topical treatments for psoriasis. Inadequate management of psoriasis could have detrimental effects on the wellbeing of patients with PsA. Participants expressed that a resource would be beneficial to aid their practice and improve patient outcomes. Using the descriptive feedback and the prescribing information, we developed a resource summarising topical treatments for psoriasis flares (Figure 1). This resource has now been distributed across our health board to promote increased confidence when managing psoriasis. This study is part of our ongoing quality improvement work. We will continue to evaluate the confidence of Rheumatology clinicians when seeing patients with flares of psoriasis, with the aim of improving patient outcomes and quality of life will improve. <h3>REFERENCES:</h3> [1] Bhargava S, Negbenebor N, Sadoughifar R, Ahmad S, Kroumpouzos G. Global impact on dermatology practice due to the COVID-19 pandemic. Clin Dermatol. 2021 May-Jun;39(3):479-487. doi: 10.1016/j.clindermatol.2021.01.017. Epub 2021 Feb 2. PMID: 34518007; PMCID: PMC8043816. [2] Feldman SR. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 2020 Jan;82(1):256-257. doi: 10.1016/j.jaad.2018.07.059. PMID: 31837740. [3] Bakshi H, Nagpal M, Singh M, Dhingra GA, Aggarwal G. Treatment of Psoriasis: A Comprehensive Review of Entire Therapies. Curr Drug Saf. 2020;15(2):82-104. doi: 10.2174/1574886315666200128095958. PMID: 31994468. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>