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