Ronald B. Prussick, MD, FRCPC, FAAD, is the medical director of Washington Dermatology Center in Rockville, MD, and a clinical associate professor of dermatology at George Washington University in Washington, DC. His specialties include laser treatments and psoriasis. He joined The Dermatologist prior his session on comorbidities in psoriasis which will be presented at the 2022 AAD annual meeting.

Can you give us a preview into what will be covered during your session at the 2022 AAD annual meeting?
There's a paper¹ that I discuss in my talk that had 101 patients with psoriasis come into a clinic so that they conducted personality and depression scores on them. What they found was those patients who developed psoriasis at an early age, such as 20 or younger, had a much higher risk of having personality disorders, depression, or anxiety.

In my practice I’m pretty aggressively treating younger patients, because of the long-term impact that psoriasis has on them, so I think that's also one of the important things I’ll cover.

I also monitor vitamin D levels because of the patient’s risk of having osteoporosis and pathologic fractures. I encourage my colleagues to just keep in mind that using long-term topical steroids can have an impact on their bones in addition to affecting the systemic inflammation. It's been shown that TNF-alpha and IL-6 can affect vitamin D mineralization so reducing their systemic inflammation can potentially help with that. are all the important things so just remember that comorbidities should impact your decision making, when you're when you're treating your patients.

What are the tips and insights you’d like to share with your colleagues regarding comorbidities in psoriasis?
Well, I think the important point is to make sure that part of the discussion with your patients is the comorbidities and the systemic inflammation. The worst their psoriasis is the higher the risk of these comorbidities, but even the patients with mild psoriasis have higher risk of comorbidities.

I think that patients just need to understand that that their lifestyle changes can affect their disease. Sometimes it’s a little frustrating for patients to hear that they have risks of other things when they come in with psoriasis, but I know that, over the many years I’ve been practicing, that I have a lot of success stories of patients that, once they understood how their diet and their weight affected their disease and the risks, they really did make changes. It's really empowering for patients to have that opportunity to do that.

It's also important for providers to understand that psoriatic arthritis can appear, even if you have mild disease or only one plaque of psoriasis, make sure you're asking the questions. You have to ask more than do your joints hurt. You must ask, “Do you have morning stiffness? Is it more than an hour?”, then there's definitely systemic inflammation going on.

If they've ever had a finger or toe that swelled, if their feet hurt when they walk, if they have sore tender elbows or lower back stiffness, those are all important questions to ask every time the patients come in even if they have mild disease. These are all the important tips to remember that comorbidities should impact your decision making when you're treating your patients.

Reference
Remröd C, Sjöström K, Svensson Å. Pruritus in psoriasis: a study of personality traits, depression and anxiety. Acta Derm Venereol. 2015;95(4):439-443. doi:10.2340/00015555-1975