Dr Jashin Wu on Comorbidities and Therapeutics in Psoriasis

Jashin J. Wu, MD, FAAD, is a voluntary associate professor at the department of dermatology at University of Miami Miller School of Medicine in Miami, FL.

Dr Wu met with The Dermatologist to discuss biologics and emerging therapeutic options for psoriatic disease, including recent research that physicians should consider when treating patients with psoriasis.

A recent study found that many patients with psoriatic disease aren’t aware of comorbidities in detail. How can physicians bridge that information gap?

 

There is so much information to discuss with your patients. On your first couple of visits, you’ll probably discuss with them the actual disease, what medications you're going to put them on including the potential side effects, and what to expect with the medication in terms of clearing their psoriasis. So, it might be difficult to add on all the comorbidity discussions on top of that on the first couple of visits, but I think once they're stable on their therapies, that's when you can start introducing some of these other discussions.

The exception I would make is psoriatic arthritis, which should be covered on the first visit. It's that important. You could discuss with them if they have any finger swelling, joint swelling, Achilles heel pain, etc. These are questions that you can typically ask them which could help direct which treatment you put them on that could cover both psoriasis and psoriatic arthritis.

I would also potentially ask them about their mood, their depressive symptoms, and their anxiety symptoms, because patients with psoriasis are much more likely to have depression or suicidal thoughts. That might be helpful for patients to address that sooner, rather than later. After that, you can definitely discuss other things such as a screening for high blood pressure, diabetes, and obesity. All these are very important and are more likely to occur in patients with psoriasis as it could increase their morbidity and mortality.

What are the newest therapeutic options being used to treat psoriasis?

The most recent approval would be something like Wynzora (calcipotriene-betamethasone), which is a combination topical agent of a vitamin D analog and a topical steroid and comes in a special formulation. It's actually more effective than the typical agents when they're put together separately.

There’re a few other things that are in the pipeline coming up in the near future. Tapinarof is a new nonsteroidal topical agent that will be approved also later this year and roflumilast, which is a topical phosphodiesterase 4 inhibitor, will also be approved later this year. There will also be exciting new nonsteroidal agents approved for psoriasis, which is definitely a need.

I would like physicians to remember that these are really exciting medications, and they should be trying to use them in the practice for patients that would be good candidates regardless of the potential side effects. These are very effective medications that can help our patients get through this difficult disease.