Collaborative Care Across Dermatology & Rheumatology
Next Steps in Derm and the Journal of Drugs in Dermatology, in partnership with the Dermatology Education Foundation (DEF) and Physicians Resources, interviewed
Andrea Nguyen, PA-C, MPAS, of First OC Dermatology in Irvine, CA. Andrea shares her tips for how to improve communication between practitioners in different medical specialties. While continuity can be difficult, especially when practitioners work in different organizations, good communication can happen. Watch as Andrea shares some quick and easy tips for collaborating with rheumatologists in the care of your psoriasis patients.
Andrea Nguyen, PA-C, MPAS, lectured on this and other topics at the recent DERM2022 NP/PA CME conference held July 28-31, 2022.
Further Reading
If you want to read more about considerations in the care of psoriasis, check out the following articles published in the Journal of Drugs in Dermatology:
Unmet Needs in Psoriasis Patients
ABSTRACT
Background: Psoriasis can greatly impact patients’ quality of life. The introduction of new treatments has improved treatment outcomes, but treatment gaps may still exist.
Objective: Identify unmet treatment needs in patients with psoriasis.
Methods: Participants aged 18 years or older, with an Amazon Mechanical Turk account, who reported diagnosis of psoriasis and correctly answered an attention check question were included. Results were analyzed using descriptive and inferential statistics.
Results: Of the 417 participants who met study inclusion criteria, 51.1% were female, and 39.3% were 31-40 years of age; 61.2% reported mild, 25.4% moderate, and 13.4% severe psoriasis. Most (74.8%) were currently under treatment; half (51.6%) were mostly or completely satisfied with treatment, while 24.5% were slightly or not at all satisfied. Respondents were most satisfied with topical (59.5%), followed by oral (46%), and injectable treatments (19.9%). Most (78.7%) slightly or strongly felt there should be more cost-effective options. Gaps in current psoriasis treatment options included more affordable topical and oral treatments that work faster and require less frequent use.
Limitations: The use of an English survey and Amazon Mechanical Turk precludes certain populations from this study. Participants were not asked to provide their current form of psoriasis treatment.
Conclusions: Despite advances in psoriasis treatment, there remains a desire for more effective, faster, longer acting, and less costly, more accessible treatments.
ABSTRACT
Background: Studies have proposed a link between psoriasis and imbalanced gut microbiome. Therefore, the modulation of the gut microbiota with probiotics may improve clinical outcomes, chronic inflammation, and cardiovascular risk factors in patients with psoriasis. Methods: In a randomized double-blind placebo-controlled clinical trial, forty-six patients with psoriasis randomly assigned into probiotic capsules contains multi-strain at least 1.6× 109 CFU/g bacteria or placebo for two months. Psoriasis Area and Severity Index (PASI), blood pressure, quality of life (QOL) pro-inflammatory cytokines (hs-CRP and IL1-β), and lipopolysaccharides (LPS) were measured.
Results: Improvements in QOL was significant in patients taking probiotics supplementation comparing to the placebo group and PASI (-5.06±2.10 vs 0.30±1.80, P=0.049) as well. After the intervention, a considerable reduction in serum LPS levels (-7.21±10.33 vs -2.74±0.97 mmol/L, P=0.010), hs-CRP levels (-1.67±0.95 vs -0.70+ 0.38 mg/L, P=0.013), and IL1- β levels (-1.64±1.10 vs 0.17+ -0.20 mg/L, P=0.043) in the probiotics group.
Conclusion: This study shows that probiotics significantly improved the quality of life and seriousness in psoriatic patients. Moreover, it enhances cardiovascular risk factors and inflammatory/oxidative stress markers.
ABSTRACT
Background: Psoriasis is a chronic, inflammatory skin condition that is growing in prevalence globally. Routinely available options to assess psoriasis severity and progression are limited. More options are needed to monitor disease progression as therapeutic management is based on disease severity.
Objectives: This study evaluates the usage of complete blood count components (CBC) including platelet count, mean platelet volume (MPV), and red cell distribution width (RDW) as hematological markers for assessing psoriasis severity.
Materials and Methods: In this cross-sectional study of 120 patients with psoriasis, disease severity was assessed using the PASI score followed by a blood draw to determine whether correlations existed between each marker and PASI score.
Results: A significant, positive correlation was found between total platelet count and PASI while no such correlation was found in MPV and RDW. When stratifying for age, duration of disease, sex, and body parts involved, we found intriguing relationships and offer potential explanations for their occurrence.
Conclusion: Our findings suggest that hematological parameters MPV, platelet count, and RDW found in the CBC are useful in identifying psoriasis severity to some extent. We foresee the use of RDW, MPV, and platelet count biomarkers as a complement to the PASI score in assessing severity for psoriasis patients, while also as a gauge for likelihood of developing comorbidities such as cardiovascular disease.
