Putting On-Treatment Remission Into Practice: A Patient-Defined Target in Psoriasis

In "Putting On-Treatment Remission Into Practice: A Patient-Defined Target in Psoriasis," the panel returns to remission and grounds it in what patients actually live with.

Dr. Han starts by qualifying the 0% BSA goal. Clear skin with swollen, painful joints is not remission by any human standard. He frames the real target as a life free of psoriatic disease, where a patient functions normally and does not have to think about it. He points to DLQI items that reveal how disease shapes what people wear and whether they go out.

Dr. Han highlights skin of color patients, describing Hispanic patients cleared for two years who still have post-inflammatory hyperpigmentation and still will not wear shorts. He reframes early, effective treatment as appropriate rather than aggressive. He argues clinicians talk too little with patients about realistic steps, which drives poor compliance and the shopping bags full of expired creams that arrive at second opinions.

Dr. Wright defines remission through the patient's lived experience rather than her measures. In New York, a patient who always wore black suddenly not wearing black tells her the skin is bad without a word. A patient who cannot get to dinner, the theater, or down to the floor with grandchildren signals disease interfering with existence. She ties this to depression and social context.

Dr. Wright describes herself as treating to a target of zero, so function is restored. She acknowledges ACR50 and MDA are useful for trials, but real-world MDA tops out near 40 to 60%, and only 5 of 7 domains. She wants the specific domain bothering a patient gone. Her patients name tangible milestones: dancing at a granddaughter's wedding, walking down the aisle, holding a baby.

Our next episode, "The Patient Who Is Better but Not Clear: Shared Decisions in Psoriasis," features Dr. Han and Dr. Wright on the patient who is better but not clear, and how shared decision-making guides the next step.