Past AAD president: PCPs need to recognize seriousness of psoriasis

Mark Lebwohl

Primary care physicians may not understand the seriousness of psoriasis, a condition that affects approximately 7.4 million adults in the United States, according to a former president of the American Academy of Dermatology.

“With all the things PCPs have to do and take care of, it’s easy to overlook psoriasis,” Mark Lebwohl, MD, FAAD, told Healio Family Medicine. “But PCPs need to take this condition seriously and do what they can to help their patients with psoriasis.”

The National Psoriasis Foundation states that although the condition can develop at any age, it most often affects those between the ages of 15 and 35 years. Risk factors and triggers for the condition include smoking, obesity, stress, viral and bacterial infections, and family history, according to the Mayo Clinic, which also states that patients with psoriasis are at greater risk for other conditions, such as kidney disease, conjunctivitis, emotional problems and Parkinson’s disease.

In conjunction with World Psoriasis Day on Oct. 29, Healio Family Medicine asked Lebwohl, who is chair of the Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai in New York City, to discuss psoriasis’s warning signs, its complications, treatment options, and more. – by Janel Miller

Question: Do you think PCPs underestimate the seriousness of psoriasis?

Answer: With so many other things that PCPs need to take care of during limited office visits with patients, PCPs sometimes overlook psoriasis. In addition, some PCPs wrongly think of psoriasis as ‘only’ a skin disease. Heart disease and diabetes are just some of the conditions that a patient with psoriasis is at risk for, so it’s important for PCPs to take this condition seriously.

Q: What are some of the condition’s warning signs?

A: The most obvious signs are scaling and plaque formation in the elbows and knees, as well as flaking of skin on the scalp that isn’t dandruff. PCPs need to pay attention to this flaking and scaling at the early stage to avoid the comorbidities of psoriasis. Patients with severe psoriasis (ie, extensive scaling and plaque formation) should be referred to a dermatologist.

Q: How would you recommend PCPs frame their discussions with patients with psoriasis ?

A : These clinicians need to advise their patients to watch their weight and, if the patient has diabetes and/or hypertension, to keep these conditions under control. These patients also need to be encouraged to maintain a heart-healthy lifestyle like eating nutritious foods and avoiding smoking. PCPs also need to ask these patients if their joints hurt as this may be a sign of psoriatic arthritis, a condition that affects up to one-third of patients with psoriasis. Clinicians should never say to a patient that psoriasis is ‘nothing’ or ‘not important’ — even if the PCP feels that way, the patient likely will not.

Q: What kind of treatments are available for patients with psoriasis?

A: The treatments we have now — topical therapies, ultraviolet light therapies, biologic medications and oral medications — are superb and can help clear the vast majority of psoriasis cases. There is no excuse for patients with psoriasis to not get treatment.

References:

International Federation of Psoriasis Associations. World Psoriasis Day. https://ifpa-pso.com/our-actions/world-psoriasis-day/. Accessed Oct. 20, 2017.

Mayo Clinic. Psoriasis and Symptoms. https://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/dxc-20317579. Accessed Oct. 20, 2017.

National Psoriasis Foundation. About Psoriasis. https://www.psoriasis.org/about-psoriasis. Accessed Oct. 20, 2017.

Rachakonda TD et al. J Am Acad Dermatol. 2014;doi:10.1016/j.jaad.2013.11.013.

Disclosure: Lebwohl reports being an investigator for most of the companies developing therapies for psoriasis and that his employer, Mount Sinai, receives research funds for studies related to these therapies’ development.