Psoriasis Treatment Tips

Pediatric Psoriasis Comorbidities
The comorbidities related to pediatric psoriasis are numerous and include opportunities for prevention and early intervention, according to Kelly M. Cordoro, MD, associate professor of dermatology and pediatrics at the University of California, San Francisco. Dr Cordoro told attendees of her talk1 on the topic at the recent 2017 American Academy of Dermatology Annual Meeting in Orlando, FL, that obesity has the most data in pediatric psoriasis. Arthritis and metabolic syndrome are also comorbidities.

This population may be at risk for lymphoma and cardiovascular disease. Other issues include psychiatric and emotional comorbidities, such as anxiety, depression, bipolar disorder, eating disorders, social isolation, risky behavior (drugs, alcohol), poor quality of life, and poor caregiver quality of life. 

To treat pediatric patients with psoriasis appropriately, Dr Cordoro noted dermatologists can:
• Remain vigilant at each visit
     – Identify those at greatest risk, including those who are overweight and obese and those with severe disease
• Educate patients and caregivers about weight loss/lifestyle interventions
     – Prevention is the best strategy
     – Involve the entire family
     – Refer to obesity/nutrition experts
 
She advised that the following are recommended for all patients with psoriasis aged 2 to 21 annually:
• Blood pressure
• Body mass index
• Arthritis screen
     – Joint pain/swelling/inflammation
     – Joint stiffness after rest or sleep
     – Limp
• Mood disorders screen
     – Anxiety, depression, substance abuse
• Additional screening for diabetes mellitus, dyslipidemia, fatty liver as indicated based on weight and other risk factors
• Involve primary care practitioner (PCP). Psoriasis comorbidity screening recommendations do not depart from American Academy of Pediatrics age-based recommendations.

In addition, she noted that the dermatologist’s role includes awareness and recognition of the risks and consequences of psoriasis, including the physical, psychological, emotional, and social factors as well as high risk behaviors, substance abuse. Routine assessment of the impact that the disease is having on quality of life is needed with the physician, patient, and caregiver perspectives. Finally, early and proactive identification of comorbidities must be effectively communicated with the PCP and other specialists. This includes timely support and effective treatment, she said. 

Reference
1. Cordoro KM. What’s new, what do I need to do? Pediatric psoriasis comorbidities. Presented at: 2017 American Academy of Dermatology Annual Meeting; March 3-7, 2017; Orlando, FL.

Counseling Patients

Steven R. Feldman, MD, PhD, chief medical editor of The Dermatologist and professor of Dermatology, Pathology, and Public Health Sciences, Wake Forest University School of Medicine, in Winston-Salem, NC, offered observations on counseling patients with psoriasis. “While there might seem to the doctor that one drug is better, patients have specific preferences (related to safety, efficacy, or convenience issues) that may differ from those of the doctor,” he said. He noted that dermatologists can discuss patient preferences with their patients and also provide them with National Psoriasis Foundation educational brochures that describe the various treatment options. “This is good medicine and documents that patients are informed of the risks, benefits, and alternatives of treatment,” Dr Feldman added.

Consider Generational Differences

It is important to keep in mind generational differences, according to Benjamin Barankin, MD, FRCPC, in practice in Toronto, ON, Canada. “For example, an older married patient with children (eg, a 55 year old) may be more interested in safety and can be more patient regarding treatment time and results, while a young man with new onset psoriasis wants results now and likely more willing to take on more risk,” he said.