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Psoriasis with less than 10% body surface area can still be severe

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Melodie S. Young

FORT WORTH, Texas — Patients with psoriasis affecting less than 10% body surface area can be considered severe cases, especially among those with psoriatic arthritis, based on features including location, quality of life and comorbidities, according to a presenter at the Rheumatology Nurses Society Annual Conference.

“They can have a little bit of psoriasis and have comorbidities with the disease, even if they have a small amount of skin demonstrating psoriasis,” Melodie S. Young, MSN, RN, ANP-C, a nurse practitioner at Modern Dermatology-Aesthetics Center in the Baylor Health Care System, told attendees. “It can also still have a massive impact on their quality of life. Even if they have just 1% body surface area — exactly where would it be possible to have 1% body surface area of psoriasis, and not have it impact your life? Your forehead? Hands? Nails? Genitalia? Every 1% can be important, and you always have to think about that in terms of the patient.”

According to Young, although some patients may have a lax attitude regarding a mild case of psoriasis, those with just 1% body surface area of a severe case will react strongly.

Patients with psoriasis affecting less than 10% body surface area can be considered severe cases, especially among those with PsA, based on features including location, quality of life and comorbidities, according to a presenter at the Rheumatology Nurses Society Annual Conference.

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“If they tell you it doesn’t bother them, fine, but most of the time it will be one or two spots, and they will come in and say, ‘I hate it, I want it gone,’” she said. “And that typically opens up the discussion about what can be done to get this under control.”

Regarding treatment, psoriasis therapy does not require a stair-step approach, and most therapies used in dermatology will improve symptoms by at least 75%, Young said. However, in cases of psoriatic arthritis, it would be considered a “great day” if dermatologic treatments improve the patient’s condition by even 50%.

According to Young, psoriasis with psoriatic arthritis requires prompt treatment with systemic and/or biologic therapy, such as TNF inhibitors or disease-modifying antirheumatic drugs.

“If we see any sign of arthritis, or any sign of manifestation at all, we want them to see a rheumatologist and we want them to see a primary care physician,” Young said. “This is because of all of the comorbidities associated with inflammatory diseases, from diabetes, high blood pressure and cholesterol, and obesity.” – by Jason Laday

Reference:

Young MS. Rashes, Bumps and Lesions: What are they saying about our patient? Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.

Disclosure : Young reports research support from Abbvie, Celgene, Galderma, Eli Lilly, Ortho, Janssen, Pfizer, Sun and UCB; as well as consulting or speaking fees from Abbvie, Celgene, Galderma, Janssen, Eli Lilly, Novartis, Ortho, Sanofi/Regeneron and Sun.