Ronald Prussick

From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis

Background: An urgent need exists in the United States to establish treatment goals in psoriasis. Objective: We aim to establish defined treatment targets toward which clinicians and patients with psoriasis can strive to inform treatment decisions, reduce disease burden, and improve outcomes in practice. Methods: The National Psoriasis Foundation conducted a consensus‐building study among psoriasis experts using the Delphi method. The process consisted of: (1) literature review, (2) pre‐Delphi question selection and input from general dermatologists and patients, and (3) 4 Delphi rounds. Results: A total of 25 psoriasis experts participated in the Delphi process. The most preferred instrument was body surface area (BSA). The most preferred time for evaluating patient response after starting new therapies was at 3 months. The acceptable response at 3 months postinitiation was either BSA 3% or less or BSA improvement 75% or more from baseline. The target response at 3 months postinitiation was BSA 1% or less. During the maintenance period, evaluation every 6 months was most preferred. The target response at every 6 months maintenance evaluation is BSA 1% or less. Limitations: Although BSA is feasible in practice, it does not encompass health‐related quality of life, costs, and risks of side effects. Conclusion: With defined treatment targets, clinicians and patients can regularly evaluate treatment responses and perform benefit‐risk assessments of therapeutic options individualized to the patient.

Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review

Importance Psoriasis is a chronic, inflammatory skin disease and has significant associated morbidity and effect on quality of life. It is important to determine whether dietary interventions help reduce disease severity in patients with psoriatic diseases. Objective To make evidence-based dietary recommendations for adults with psoriasis and/or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation. Evidence Review We used literature from prior systematic reviews as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017, that evaluated the impact of diet on psoriasis. We included observational and interventional studies of patients with psoriasis or psoriatic arthritis. The quality of included studies was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Risk of Bias Tool for interventional studies. We made evidence-based dietary recommendations, which were voted on by the National Psoriasis Foundation Medical Board. Findings We identified 55 studies meeting the inclusion criteria for this review. These studies represent 77 557 unique participants of which 4534 have psoriasis. Based on the literature, we strongly recommend dietary weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis. We weakly recommend a gluten-free diet only in patients who test positive for serologic markers of gluten sensitivity. Based on low-quality data, select foods, nutrients, and dietary patterns may affect psoriasis. For patients with psoriatic arthritis, we weakly recommend vitamin D supplementation and dietary weight reduction with a hypocaloric diet in overweight and obese patients. Dietary interventions should always be used in conjunction with standard medical therapies for psoriasis and psoriatic arthritis. Conclusions and Relevance Adults with psoriasis and/or psoriatic arthritis can supplement their standard medical therapies with dietary interventions to reduce disease severity. These dietary recommendations from the National Psoriasis Foundation Medical Board will help guide clinicians regarding the utility of dietary interventions in adults with psoriatic diseases.

Psoriasis in Solid Organ Transplant Patients: Best Practice Recommendations from the Medical Board of the National Psoriasis Foundation.

Abstract Background: Treatment of solid organ transplant patients who have psoriasis can be a therapeutic challenge. Biologic and systemic drugs used to treat psoriasis can result in an increase in infections or malignancies. Objective: We sought to develop a treatment algorithm for organ transplant recipients (OTR) diagnosed with psoriasis vulgaris. Methods: A systematic literature search for psoriasis treatment in organ transplant patients was performed using MEDLINE and GOOGLE. Results: In mild-to-moderate disease, topical therapy should be a first-line treatment. In moderate-to-severe disease, first-line treatment is acitretin with narrow band ultraviolet light (NBUVB), NBUVB, or acitretin. Second-line treatment is increasing the current antirejection drug dose. Other systemic or biologic therapies should be reserved for more severe or refractory cases. Conclusion: No systematic clinical studies have been done to explore psoriasis treatments among affected solid organ transplant patients who have psoriasis, and only a few case reports are available. The algorithm for best practices was developed based on these reports and on the clinical experience and judgment of the Medical Board of the National Psoriasis Foundation. There remains a need for further research on the management of psoriasis in the organ transplant patient population.

Psoriasis and Psychological Comorbidities

Psoriasis is a common systemic inflammatory disease with multiple known comorbidities. We review the literature focusing on the psychological comorbidities that have been reported. We discuss the impact of psoriasis on stress and sleep disorders in addition to depression. Alcohol abuse and nicotine addiction are prevalent in this population, as are psychological problems in children and teenagers who develop psoriasis early in life. We summarize the proposed pathophysiology and known treatments for these comorbidities.