This article offers pearls that are often overlooked, but can make a big impact in the quality of care we provide to our patients with psoriasis. If all four are too difficult to include in your next clinic visit, focus on just one or two that you can you incorporate into your regular care of patients with psoriasis.
1. Psoriatic Arthritis
We all know that 30% of psoriasis patients develop psoriatic arthritis. With the potential for crippling pain and joint deformities, it behooves dermatologists to be keep psoriatic arthritis on our radar. While some dermatologists may not feel comfortable making a diagnosis of psoriatic arthritis or managing it, we can certainly screen for it. A particularly helpful question is, “Do you have pain or stiffness in your joints when you wake up in the morning that lasts 30 minutes or longer?” Another helpful question is, “Do you have pain or stiffness in your joints that gets better with activity and worse with inactivity?” If the patient affirms these questions and they have psoriasis, chances are good they have psoriatic arthritis. You can manage it yourself or refer to rheumatology to ensure the patient gets treated.
2. Genital Involvement
Recent data suggest this is far more common than we used to think (Ryan, et al, PUBMED ID 25824273). Additionally, genital psoriasis can have a huge effect on a patient’s quality of life. Unfortunately, patients usually share this information only if you ask about it first, so be sure to ask. Patients will thank you for thinking of this often ignored area in the management of psoriasis.
3. Think Light!
Most patients with psoriasis will improve with phototherapy. Narrow band UVB (NBUVB) is arguably one of the safest options for moderate-to-severe psoriasis that we have today. Think three treatments per week for about 36 weeks. Approximately 75% of patients will clear up or get to almost clear and stay that way for six months! Additionally, units designed for the whole body or just the scalp are now available for the patient to use in the comfort of their own home.
4. Stay Informed!
The new IL-17 drug Cosentyx® (secukinumab) is now available and has the best PASI scores we’ve seen today among the biologics. In fact, it has changed the landscape from talking about PASI-75 scores to PASI-90 scores. Additionally, other IL-17 drugs are in the pipeline and will soon add to our armamentarium. Do yourself and your patients a great service by staying informed of new drugs and what’s coming down the pipeline. You can do this easily by signing up for the email listserve at of the National Psoriasis Foundation (NPF) (www.psoriasis.org).
