August 23, 2016
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PCPs should be aware of potential psoriasis risks, treatment options

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Psoriasis can be visually, physically, and emotionally jarring for those with the disease. According to the National Psoriasis Foundation, approximately 7.5 million people in the United States live with the disease, which is a common issue seen by primary care physicians.

 “We used to think that psoriasis was a condition that was solely limited to the skin. However, in the last 5 to 10 years, what has become apparent is that the skin findings are really a sign of the inflammation that exists in the body,” Abby Van Voorhees, MD, chair of the medical board at the National Psoriasis Foundation and chair of dermatology at Eastern Virginia Medical School in Norfolk, told Healio.com/Internal-Medicine.

Abby van Voorhees, MD

Abby Van Voorhees

According to Van Voorhees, psoriasis is associated with a higher risk for comorbid conditions such as cardiovascular disease and diabetes. Psoriasis also increases the incidence of metabolic syndrome, hypertension, elevated lipids, obesity, and major adverse cardiac events such as stroke and sudden death, she said.

“We’ve come to think the risk of heart disease in patients who have severe psoriasis as equivalent to that of patients with diabetes. These risks are real,” Van Voorhees said. “PCPs should view the psoriasis as an opportunity of understanding who may be at an increased risk for these systemic findings.”

With early intervention, PCPs can identify high-risk patients and potentially prevent some of these comorbid conditions, she said.

Psoriasis may lead to significant physical, emotional, and psychological effects. According to Van Voorhees, patients with psoriasis are frequently shunned from participating in numerous physical activities such as going to the gym or swimming.

“As you might imagine, it leads people to feel really badly about themselves,” Van Voorhees said.

“When we do quality of life scorings, both in terms of physical and emotional findings, we find that patients with psoriasis score among the worst of all diseases.”

Physically and psychologically, patients with psoriasis scored second only to those with severe congestive heart failure and depression as their primary diagnosis, respectively, she said.

The stigma psoriasis patients endure can be excruciating, Van Voorhees said. However, even though psoriasis is not a curable disease, it is highly treatable.

“Knowing how successful treatments can be is really important for a PCP to tell his or her psoriasis patients,” said Van Voorhees.

Telling patients to “just use a cream” is no longer appropriate for a patient with significant disease burden, Van Voorhees said. Instead, she suggested that patients with moderate-to-severe psoriasis be prescribed systemic therapy, either with a more traditional therapy such as methotrexate or a newer therapy such as a biologic agent or a small molecule therapy. It is especially important for PCPs to understand that these medications have the potential to clear or almost clear their patients’ skin, said Van Voorhees.

She stressed the importance of PCPs prescribing the correct medications for patients who have a significant skin burden, or referring those patients to a dermatologist who will prescribe those medications, so that the patient can begin to heal physically and emotionally.

“In the last 10 or 15 years, we’ve had an explosion of treatment options for patients with psoriasis,” according to Van Voorhees. “With each new development, we’re able to target the immune system even more effectively and in doing so, it seems that we achieve higher and higher results for our patients.”

If a patient is unresponsive to one medication, a medication from a different category can be used, she said, and as a result, treatment success rates are much greater.

“I think that’s what is so exciting in what’s happening in the psoriasis space right now,” said Van Voorhees. – by Alaina Tedesco

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