Q&A: Psoriasis Awareness Month a time to educate, learn

August marks Psoriasis Awareness Month, a time to spread information about the disease and its treatment options, as well as to support those who experience its manifestations.

Psoriasis and psoriatic disease affect millions of people across the world. Healio spoke with Adam Friedman, MD, FAAD, professor and interim chair of dermatology at George Washington University, about the importance of Psoriasis Awareness Month and how patients and physicians can benefit from advanced awareness and action.

Q. Why is it important to draw awareness to psoriasis during this month?

A. There are a lot of misconceptions and misinformation related to psoriasis or any skin condition that is red and flaky. A lot of people will see this rash and assume it is something infectious or contagious, which can be extremely isolating and ostracize those affected.

It is important to not only help those affected to understand what it is, but also to expand awareness so everyone understands what psoriasis is and is not. Importantly, it is a chronic and disabling systemic condition, not just an annoying, temporary skin rash. If everyone understands that, it creates an environment and a community that supports individuals with this chronic inflammatory disease.

We have so many great treatments today having even that knowledge can help family members or friends direct psoriasis suffers to getting the treatment they deserve.

I think it is wonderful we have a whole month to highlight how impactful this condition is and to shed some evidenced based light on the condition for those who have it. Those who suffer from it know how bad it is, but often if you are otherwise well, you take for granted a lot of the things we do on a day-to-day basis that individuals with chronic diseases have to be concerned about.

Clothing choices, activities, social engagement, work, feelings of embarrassment, trying to avoid potentially awkward situations — these are things those with visible diseases deal with. This is why the burden of skin diseases is so tremendous. You have no poker face here; you are literally showing your medical condition to the outside world.

There is this added level of burden when it comes to dermatologic disease. We need to consider that and make people aware of just how impactful these conditions can be.

Adam Friedman

Q. Can you give an overview of what psoriasis is and how it affects the body?

A. Psoriasis is inflammation gone wild. The perpetual inflammation in the skin clinicall resulting inred,thick and scaly plaques. But that inflammation gets kind of bored in the skin and goes everywhere, making it a systemic disease. While we can appreciate it in the skin first (and this is not always the case), that inflammation can be in the joints, leading to psoriatic arthritis, and it can be extraordinarily disabling and destructive.

Even beyond that, several clinical investigators have recently shown that psoriasis is associated with possibly every medical problem you could imagine.

It is certainly more than just a skin disease. It is a multisystem condition that requires a multisystem approach. It can certainly come with an impressive impact on quality of life if not addressed appropriately.

The inflammation that is present in psoriasis also has the ability to cross the blood-brain barrier. We know depression is directly linked with psoriasis. There is actually a biological component to depression due to that chronic inflammation behind the emotional burden of a chronic disease. So let’s be clear, Psoriasis affects everything.

Q. What can physicians do to ensure their patients are well informed about their condition?

A. Prepare to spend time with your patients at that first visit to have a conversation about what they think the disease is and what they think it means.

Share the epidemiology of psoriasis with them. Let them know this is a common condition that affects up to 8 million Americans. Let them know there are national organizations dedicated to this, such as the National Psoriasis Foundation. This also makes the physician’s job a little bit easier because there are so any great resources for them to use and can save you time in the clinic.

B. Because psoriasis can have multiple morphologies and even appear different across different skin types, misunderstanding by the patient and even misdiagnosis by health care practitioner can happen. Often patients will have been misdiagnosed or thought they had something else, so you may have just introduced a new disease name and have to start from scratch.

There is an emotional capital to hearing that it is a common condition with national organizations dedicated to education and research.

That first visit really has to be a fire side chat. Spending the time here is really an investment in making future visits easier because you have already explained the underpinnings of this condition from a biological perspective and the patient will hopefully understand your therapeutic decision making.

Explaining the condition in lay speak is important. A lot of us are good at communicating with medical lexicon, but being able to explain it in the simplest terms is necessary.

Q. How can physicians keep up to date on the newest developments in psoriasis care?

A. In today’s age with there being so many therapeutic options, it can be noisy.

It was not so long ago that you would have to read a journal to get all of the updates, but we now have various resources.

You can sign up for updates that are targeted and specific through medical news outlets and societies and organizations.

Online digital resources are no question the easiest way to access information and have it come to you. Going out to search will take extra time, but setting up email alerts makes it easier to stay in touch and have your finger on the pulse.

Q. What can patients do to ensure they are managing their condition to the best of their ability?

A. The National Psoriasis Foundation has an incredible repository of patients and psoriasis sufferers who can interact via message boards, so signing up with them can help make you feel like you are a part of the solution.

See your dermatologist and learn what your options are. The landscape is rapidly changing in terms of understanding the disease, as well as new therapeutics, both topical and systemic.

Every psoriasis patient should be seeing a dermatologist, plain and simple. Even with mild disease which is defined by what we see on the skin, could just be the tip of the iceberg. We know patients can get psoriatic arthritis and have absolutely no skin disease at all.

There are a lot of flavors to psoriasis, and it is important to see someone who is trained to be able to tease that out, ask the right questions and do the right investigations to make sure the whole picture is being addressed.

There is also a preventive approach in which we can initiate systemic therapy early and actually prevent comorbidities.

You want to prevent that chronic, systemic inflammation that destroys everything. Initiating therapy early on ultimately results in better medical outcomes but also better quality of life.