Psoriasis Treatment Considerations in Military Patients: Unique Patients, Unique Drugs
Psoriasis is a common dermatologic problem with a chronic and sometimes debilitating course. Psoriasis can impair a service member’s ability to perform job-related activities and should certainly be treated; however, use of immunosuppressive treatments can prevent deployment to strategic locations around the world for numerous reasons, such as the need for laboratory monitoring, minimal access to climate-controlled storage, and potential increased risk of exposure to virulent pathogens while on these medications. Similar obstacles can exist for nonmilitary patients who are placed in austere conditions or participate in worldwide travel. Although treatment efficacy, cost, and side-effect profiles are always paramount considerations in deciding on treatment regimens with patients, herein we focus our discussion on a consideration that might be easily overlooked when treating patients in modern society, that being the “logistics” of treatment.
Practice Points
- Establishing goals of treatment with each patient is a critical step in treating the patient rather than the diagnosis.
- A good social history can reveal job-related impact of disease and potential logistical roadblocks to treatment.
- Efficacy must be weighed against the burden of logistical constraints for each patient; potential issues include difficulty complying with follow-up visits, access to laboratory monitoring, exposure to pathogens, and adequacy of medication transport and storage.
Final Considerations
The manifestation of psoriasis is different in every patient, and military service poses additional treatment challenges. For all of our military patients, we recommend an initial period of close follow-up after starting any new systemic agent, which is necessary to ensure the treatment is effective and well tolerated and also that we are good stewards of our resources. Once efficacy is established and side effects remain tolerable, we generally endorse continued treatment without specific travel or work restrictions.
We are cognizant of the unique nature of military service, and all too often we find ourselves trying to practice good medicine in bad places. As military physicians, we serve a population that is eager to do their job and willing to make incredible sacrifices to do so. After considering the wide range of circumstances unique to the military, our responsibility as providers is to do our best to improve service members’ quality of life as they carry out their missions.
