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Rural Psoriasis Care

Addressing the challenges of accessing psoriasis care in rural communities.

Psoriasis is an inflammatory disease that has a substantial impact on a person’s physical, emotional, and social wellbeing. [1] [2] It also carries with it a number of comorbidities that can negatively impact quality of life. [3] Studies have shown that people with psoriasis are at greater risk for conditions like diabetes, cardiovascular disease, psoriatic arthritis, and obesity. [4] [5]

Because of the chronic nature of psoriasis and the tendency for people to have flares followed by remissions, as well as the risk for other related health problems, consistent outpatient care is recommended to adequately manage disease burden. [6] But access to consistent care can be a challenge in some geographic locations with few or no health care providers nearby. Studies show, for example, that areas with higher concentrations of dermatologists tend to be urban settings. [7] [8] Patients in rural settings with fewer dermatologists may be required to travel long distances or experience longer wait times [9] that result in treatment delays, while treatments and treatment outcomes may vary. [10]

If you are living with psoriasis and reside in a rural area with limited or no access to a dermatologist, there are a few ways you can access care, suggests dermatologist Adam Byrd, M.D., who works with medical residents in the rural track as an associate professor at the Department of Dermatology at University of Mississippi Medical Center in Jackson.

“The first thing you should do if you think you have psoriasis is visit your primary care provider, who should be able to start you off with a topical steroid,” Dr. Byrd says.

In some rural areas, primary care providers are accessing technology that allows store-and-forward teleconsultations with dermatologists, often called teledermatology. These programs complement or enhance conventional local care. They provide a way for the primary care provider to submit an individual's information and images for initial assessment by a remote dermatologist, who then sends back a recommendation for treatment and management. Programs such as these have increased the number of people who have access to dermatology care and who receive dermatologist evaluations. [11]

Providers with the University of Mississippi are working to improve this process for primary care providers in rural Mississippi by reducing a 20-minute process to just 5 minutes. They are hoping providers will find a phone app, through which they can take quick pictures of the necessary information, faster and more convenient than the current system. Ultimately, the goal is to increase use of the technology and expand dermatology care to more rural people in need, says Robert Brodell, M.D., chair of the Department of Pathology at the University of Mississippi Medical Center.

“Store-and-forward is a way that we can see a large volume of telederm patients through the primary care doctor who knows the local pharmacy and the local insurance plans. They can help navigate once we educate them on the skin condition,” he says.

This is just one of several initiatives aimed at improving dermatology care in underserved areas of Mississippi by supporting or partnering with primary care providers, Dr. Brodell adds.

“If we hear of anything anyone is doing around the country, we want to try it here to see, in comparison to other things, what works and what doesn’t work,” he says.

The University of Mississippi Medical Center’s Project ECHO (Extension for Community Healthcare Outcomes), for example, is based on a model developed at the University of New Mexico. [12] It is designed to work with and educate primary care providers in rural areas about common dermatologic problems including psoriasis, Dr. Brodell says.

“We have a noon conference that’s run a lot like a dermatology grand rounds conference,” Dr. Brodell explains. “There is a 5-minute presentation on a common dermatologic condition. Then we discuss cases submitted by primary care doctors around the state – patients they’ve seen possibly that week – and we educate. This seems to have a bigger impact on our primary [care provider] colleagues than if you just tried to get people to come to a CME [continuing medical education] conference.”

In addition to working with primary care providers, people living with psoriasis can visit websites like those of the National Psoriasis Foundation and the American Academy of Dermatology for information and to find dermatologists nearby, Dr. Byrd says. If you do have to drive a long distance for an appointment, he recommends communicating that to your provider so he or she can come up with a treatment plan that works with your commute.

Another consideration, Dr. Byrd says, is paying cash, because an initial visit that does not include procedures should be relatively affordable. “If you have an option between driving 150 miles for someone who takes your insurance or 60 miles [for someone who does not], maybe prioritize so that you can get a treatment plan,” he says.

You can also become an advocate. “Reach out to hospitals and ask them to recruit dermatologists, and encourage young students in your community who are thinking about medical school to return and practice locally,” Dr. Byrd says. “Reach out to your local political representatives and have them urge academic centers to expand into rural areas.”

Dr. Byrd says he took similar steps as a medical student from a rural community. He attended medical school with the intent of returning to his hometown of about 6,000 residents to practice dermatology. As he was finishing his residency, Dr. Byrd reached out to Dr. Brodell, who chaired the Department of Dermatology at the University of Mississippi Medical Center at that time, about establishing an office in Louisville, Mississippi. Dr. Brodell immediately agreed.

“I knew we could run an academic office that would be like a private practice in a rural area, and that it would be a great opportunity for the university to serve the whole state of Mississippi,” Dr. Brodell says. Today, Dr. Byrd is a faculty member in the Department of Dermatology at the University of Mississippi Medical Center, and his Louisville office is an extension of the university’s academic and medical dermatology department.

Practicing in a rural area can be challenging, says Dr. Byrd, but this model has many benefits too. He is fully supported by the university’s resources, so his focus can remain on patient care. Dr. Byrd’s office is linked with the university medical records system, billing and receiving are run through the university, and pathology reports are processed by the university as well. In addition, having a rural academic practice allows the university to train residents who will then practice in other rural communities.

Dr. Byrd’s residents and medical students  help care for patients, but the experience also provides opportunities for them to integrate and engage with the rural community. “We have four or five residents a year,” says Dr. Brodell. “We try to pick one who grew up in rural Mississippi and is interested in going back. If they’re chosen to be our rural resident, they spend three months each year with Dr. Byrd.”

Ultimately, there is no one right way to help patients with psoriasis in rural communities, Dr. Brodell says. “There are things you can do right away. But it’s more than the Project ECHO, the store-and-forward telehealth, the satellite rapid access clinic. The real solution to the problem [of expanding access to care] is all of the above,” he says.

Tips for Making Telehealth Psoriasis Visits Successful

Listen to this Psound Bytes™ podcast episode with dermatologist Dr. George Han as he discusses challenges and tips for making telehealth visits with psoriatic disease a successful experience.

Listen now

Heather Onorati


Freelance writer


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2. Jankowiak B, Kowalewska B, Krajewska-Kułak E, et al. Stigmatization and quality of life in patients with psoriasis. Dermatol Ther (Heidelb). 2020; 10(2): 285-296. doi:10.1007/s13555-020-00363-1.

3. Schoenberg E, Wang JV, Keller M. Impact of psoriasis on quality of life: a qualitative study focused on patient perspectives. SKINmed. 2021 Dec 1; 19(6): 438-439. PMID:35022115.

4. Armstrong AW, Schupp C, Bebo B. Psoriasis comorbidities: results from the National Psoriasis Foundation surveys 2003 to 2011. Dermatol. 2012; 225(2): 121-126. doi:10.1159/000342180.

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8. Glazer AM, Rigel DS. Analysis of trends in geographic distribution of US dermatology workforce density. JAMA Dermatol. 2017; 153(5): 472. doi:10.1001/jamadermatol.2016.6032.

9. Kimball AB, Resneck Jr. JS. The US dermatology workforce: a specialty remains in shortage. J Am Acad Dermatol. 2008; 59(5): 741-745. doi:10.1016/j.jaad.2008.06.037.

10. Enos CW, O’Connell KA, Harrison RW, et al. Psoriasis severity, comorbidities, and treatment response differ among geographic regions in the United States. JID Innovations. 2021; 1(2): 100025. doi:10.1016/j.xjidi.2021.100025.

11. Desrosiers AS, Petruzzelli CJ, Bobo JF, et al. Clinical interventions aimed at expanding access to dermatologic care. Dermatol Online J. 2021; 27(3). PMID:33865274.

12. Pearlman RL, Brodell RT, Byrd AC. Enhancing access to rural dermatological care: the time to start is now. JAMA Dermatol. 2022; 158(7): 725. doi:10.1001/jamadermatol.2022.1470.

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