Moderate to Severe Plaque Psoriasis in Children and in Adults with High-Impact Site Involvement Transcript

0:23 EPISODE INTRODUCTION by moderator Kaitlin: My name is Kaitlin, and I'll be your moderator for today's episode, where we're focusing on the impact of plaque psoriasis on children living with the disease and in adults with plaques in high-impact sites, two areas where patients face significant challenges. This episode contains information about studies and a product offered by Johnson & Johnson. I'm here today with Dr Candrice Heath, a dermatologist board-certified in pediatrics, dermatology, and pediatric dermatology, and Carolyn, an NPF volunteer and active mom of two who has been living with plaque psoriasis since childhood. Today, we will hear about their experiences, which could be of interest for parents of children who may be unsure how to help with moderate to severe plaque psoriasis, as well as the physical impacts of plaque psoriasis, and when to consider treating an immune-mediated disease like plaque psoriasis with a biologic.  

1:22 Kaitlin: TREMFYA® (guselkumab) is a prescription medicine used to treat adults and children 6 years and older who also weigh at least 88 lbs or 40 kilograms with moderate to severe plaque psoriasis, who may benefit from taking injections or pills, which are called systemic therapy, or phototherapy, which is treatment using ultraviolet or UV light. In 2 medical studies, 7 out of 10 patients saw at least 90% clearer skin at 16 weeks. Results may vary. TREMFYA® is also prescription medication used to treat adults and children 6 years and older who also weigh at least 88 lbs or 40 kilograms with active psoriatic arthritis. In two medical studies, more than 5 out of 10 adults treated with TREMFYA® had at least a 20% improvement in active PsA symptoms (joint pain, stiffness, swelling) at 24 weeks compared to placebo. Results may vary.   

2:25 Kaitlin: TREMFYA® is not for everyone. Only your healthcare provider can decide if it's right for you. Do not use if you're allergic to TREMFYA®. TREMFYA® is a prescription medication that may cause serious side effects, including serious allergic reactions, infections, and liver problems. TREMFYA® affects your immune system. It may increase your risk of infections and lower your ability to fight them. Please read the Important Safety Information and the Medication Guide for TREMFYA® to learn more about these and other risks for TREMFYA®. Discuss any questions you have with your healthcare provider. 

3:03 Q1 Kaitlin: Welcome, Dr Heath and Carolyn. It's a pleasure to have you on Psoriasis Uncovered. To start, let's help our listeners learn a bit more about you. Please introduce yourselves. Dr Heath, let's start with you. 

3:16 Q1 Dr Heath: Thank you. I am pleased to be joining you on today's episode. My name is Dr Candrice Heath and I'm a triple board-certified dermatologist specializing in both adults and pediatric care at Howard University in Washington, DC, and I'm very deeply passionate about clinical research and dedicated to addressing the unique needs of all of my patients, with a particular focus on really supporting vulnerable groups such as children and people with skin of color. Thanks for having me. 

3:48 Q1 Carolyn: It's great for me to be here, too. My name is Carolyn. I'm a National Psoriasis Foundation volunteer, and I have been living with plaque psoriasis since around the age of 11, when I began to see odd patches on my skin, and my arms and my legs, and my scalp. So, like many people living with plaque psoriasis, I had a lot of misdiagnoses, treatment trials and errors. Then, when I was around 30 years old, I started to develop symptoms of active psoriatic arthritis. And being a patient advocate allows me to share my personal experiences to empower others living with psoriatic disease to advocate for their own care. As a part-time teacher, I'm also passionate about knowledge-sharing, so I'm always eager to offer valuable patient perspectives to the healthcare community, and I look forward to sharing my story with everyone listening. 

4:36 Q2 Kaitlin: Thank you both, and we're so happy to have you here today. Like you, Carolyn, I first started experiencing symptoms of plaque psoriasis as a child, and I really struggled to balance being a kid while living with the disease. It can be very difficult. Carolyn, can you tell us about your own journey growing up with psoriasis? How were you first diagnosed, and what was that initial experience like for you? 

4:58 Q2 Carolyn: Yeah, of course. I totally understand. As I mentioned earlier, I first saw plaques of psoriasis around 11 years old, when I started getting itchy, scaly plaques around my elbows, my shins, my knees. And then, they got progressively worse over time, until I reached a point where they were beginning to cover a large part of my body when I was in my 20s. Back in middle school and high school, I wasn't doing much to help manage the symptoms, mainly because I couldn't get the right diagnosis. I was told it was things like rainworm or scabies, but never plaque psoriasis. And as a result, I was prescribed antibiotics or told to use soaps and lotions that didn't actually treat the underlying cause of my disease. As you can imagine, having a highly visible disease that makes you look different from the other kids around you is very tough. Kids would often ask me what kind of bug bites I had – my plaques, that's what they thought they were – or if they were contagious. And since I was misdiagnosed with ringworm and scabies, which are contagious, I actually would avoid close contact with other children. You can imagine how devastating that is for a young kid. I felt like a bother to others. So when I was finally diagnosed correctly with plaque psoriasis, I was relieved to be able to finally have an answer that when other kids asked me about my skin, I could know that it was absolutely not contagious, and having that clarity was a turning point in managing my chronic disease. 

6:17 Q3 Kaitlin: Thank you. I went through a very similar experience. Dr Heath, you specialize in pediatric dermatology. Can you tell us more about plaque psoriasis in children and adolescents and if you have encountered similar stories to Carolyn's in your practice?  

6:31 Q3 Dr Heath: Unfortunately, Carolyn's story is very similar to what I hear often in my practice. Psoriasis affects a lot of people. It affects 8 million people in the United States, and about one in three of those living with psoriasis began to see symptoms when they were just children. This can be especially difficult, because plaque psoriasis can cause children and teens to feel isolated, and it can disrupt their childhood, creating challenges. This can really take a toll not only on the kids, but on the parents as well, who of course want to see their children's skin get better, but really kind of struggle to get the answers that they need, or sometimes are just unsure about what treatment approach might be best for their child. And as Carolyn shared, it's not always easy to get those answers because of a delayed diagnosis. Sometimes we see pediatric psoriasis get confused with conditions, that can look similar at first, like eczema or diaper rash. And as a result, a lot of children may initially be prescribed treatment options that don't truly address the root cause of the disease. Even though plaque psoriasis appears on the skin's surface, it's actually triggered by an overactive immune system, which causes the skin to produce new cells too quickly, resulting in those thick, scaly plaques that we see on the skin. And that's why biologics can be very helpful in treating moderate to severe plaque psoriasis. With these advances in therapies, we can target the inflammatory pathways and help reduce the appearance of plaques and relieve the symptoms. 

8:14 Q4 Kaitlin: As someone who had a difficult treatment journey in childhood using painful products like hot oil and tar on my skin, I completely understand the desire to find other treatment options. Carolyn, what advice would you give parents who are navigating this now with their children?  

8:30 Q4 Carolyn: Yeah, of course. So after having gone through this in my own childhood and as a parent myself now, my advice to parents would be to continually push for answers and don't be afraid to ask why. If something isn't working and your child isn't seeing improvement, discuss it with your child's dermatologist or primary care physician. It's important to push for the best care possible. Similar to your story that you were sharing, even after I had received a diagnosis of plaque psoriasis, some of my initial treatments were not sustainable or in some cases even correct, just due to lack of awareness around plaque psoriasis at the time. For example, the plaques on my toenails were not being treated as psoriasis at first, they were being treated as fungus, and so my toenails were even shaved down so that the medication could get closer to my skin. And not only was this painful, but it was worsening the condition of my plaque psoriasis there. So because of that, I have learned to speak up when my treatment regimen is not doing enough for me. It's OK to look for alternative options if you're not getting results and if topicals are not working. I wouldn't hesitate to consider other treatment options, including biologics. 

9:37 Q4A Kaitlin: And Dr Heath, can you shed light on how you address these concerns with your pediatric patients and their parents? 

9:43 Q4A Dr Heath: I agree. It's important that parents really keep an open dialogue with me, and their feelings and even their children's feelings and expectations about the treatment plan. Because, you know, really, truly there's no one-size-fits-all approach to managing the disease. And individual treatment plans really vary widely based on several factors, such as the severity of the psoriasis or the location of the plaques, and even the age of the patient. Initial lines of therapy like topicals work for some patients. But I've also seen this approach come with practical adherence challenges for kids due to their schedule and everything that goes on with them. And that's why I make sure to thoroughly review all of the treatment options with families facing this chronic disease, including more advanced options like biologics. I explain that they can safely and effectively treat moderate to severe plaque psoriasis from the inside out, and then we align on the best path forward together. The good news is, we do have a number of tools in our toolbox, and treatment options are continuing to expand. And in fact, the FDA recently approved TREMFYA®, a biologic therapy also known as guselkumab, for the treatment of children 6 years and older, who also weigh at least 88 lbs, which is 40 kilograms, with moderate to severe plaque psoriasis. The data that supported this approval came from a phase 3 study called PROTOSTAR, which found that over 50% of the children treated with TREMFYA® saw at least 90% clearer skin at Week 16 compared to 16% in the placebo group. There were no new safety signals seen in the children who were in the study, and the safety data were consistent with the known safety profile of TREMFYA®. I have prescribed TREMFYA® to my adult patients for years, and I'm happy that I can now offer it to my pediatric patients 6 years of age and older, weighing at least 88 lbs or 40 kilograms, and their families as a way to help address moderate to severe plaque psoriasis from the inside out.  

12:05 Q5 Kaitlin: Thank you, Dr Heath, for sharing that exciting development. Carolyn, having faced plaque psoriasis since childhood, what has been the most challenging aspect of living with the disease? Can you share how you have learned to cope with it? 

12:19 Q5 Carolyn: Yeah, so my biggest challenge has been finding a treatment that could address all the places that plaque psoriasis appears on my body and provide skin clearance, especially in the harder-to-treat areas like my scalp. Until recently, my plaque psoriasis has always been front and center in my mind. I would always have to make concessions and adjust my lifestyle to fit my psoriasis. For example, in high school, I had plaque psoriasis on my scalp. Treatment options for scalp psoriasis were more limited at the time, and I was using creams and shampoos that sort of helped but weren't convenient. The combination of putting creams in my hair while going through puberty when your skin is already greasy was just not fun at all. So having scalp psoriasis also caused flakes on my shirt that looked like dandruff, and I would wear lighter colored shirts to help camouflage them. Something as simple as choosing what color shirt to wear each day was becoming really stressful. I was nearly covered in plaques around my 20s, and I was trying to manage everything. The plaques on high-impact sites like my scalp, toenails, and bikini area were challenging to treat because of their location, and it was impacting me physically. When I would work out, sweating and wiping my brows became very painful, and joint pain was forcing me to change how and when I exercised. As an active person who loves exercising, you can imagine how difficult all of this was, and so I needed something to change. I started experiencing joint pain around age 28, but it wasn't until I was in my 30s that I really spoke to my doctor and learned that it was active psoriatic arthritis. My doctor considered my active psoriatic arthritis symptoms and my skin plaques and prescribed a biologic. While people do respond differently to treatments, once I was on a biologic, I saw significant improvement in my active psoriatic arthritis symptoms, as well as skin clearance. I was able to get back to some of my daily activities, which I am so grateful for. I'm currently on TREMFYA® and it's working really well for me. In fact, this year my family visited our 50th state together, which was a bucket list item, and we were so excited to be able to accomplish it.