Current considerations for clinical practice
Translating what is known about psoriasis and comorbidities to clinical care, Dr. Gelfand said that dermatologists need to be aware of the existing relationships and the potential consequences on physical and emotional health and integrate the information into their management decisions. He noted that in addition to data associating psoriasis with cardiovascular disease, there is strong evidence linking psoriasis with metabolic syndrome, diabetes, psoriatic arthritis, mood disorders, Crohn’s disease and T cell lymphoma. In addition, evidence is emerging to show higher rates of sleep apnea, nonalcoholic steatohepatitis, chronic obstructive pulmonary disease, renal disease, peptic ulcer disease, and sexual dysfunction among patients with psoriasis.
Outlining specific recommendations for care, Dr. Gelfand said dermatologists should educate psoriasis patients about the connection between their skin disease and cardiovascular risk and either personally screen these patients for cardiovascular risk factors according to US Preventative Health Task Force guidelines or refer them back to their primary care physician for this evaluation.
Recognizing that certain diseases are more prevalent in patients with psoriasis and considering potential effects of immune modulating treatments on those comorbidities, Dr. Gelfand also recommended that psoriasis patients be referred for age-appropriate cancer screening, kept current with recommended vaccinations, particularly influenza and pneumonia, and screened for mood disorders.
He also discussed a personalized medicine approach to selection of biologic therapies for patients with psoriasis that takes into account the potential to benefit or adversely impact comorbidities.
For more information on psoriasis and comorbid diseases, readers can refer to two articles authored by Dr. Gelfand and colleagues and published in the March 2017 issue of the Journal of the American Academy of Dermatology: Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol. 2017;76(3):393-403. Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol. 2017;76(3):377-390.
Disclosures: Dr. Gelfand served as a consultant for Coherus (DSMB), Dermira, Janssen Biologics, Merck (DSMB), Novartis Corp, Regeneron, Dr Reddy’s labs, Sanofi and Pfizer Inc., receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Janssen, Novartis Corp, Regeneron, Sanofi, Celgene, and Pfizer Inc.; and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Abbvie. Dr. Gelfand is a co-patent holder of resiquimod for treatment of cutaneous T cell lymphoma.