Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities

Publication Date: February 1, 2019
Last Updated: March 14, 2022

Recommendations

Psoriasis and PsA comorbidity

Patients with psoriasis should be informed about the association between psoriasis and PsA. (B)
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PsA should be considered in all patients with cutaneous psoriasis. (B)
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Patients with signs and symptoms suspicious for PsA should be fully evaluated for PsA. Initiate appropriate PsA therapy if comfortable with the diagnosis or otherwise consult with a rheumatologist for assessment and management. (A)
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Psoriasis and cardiovascular disease comorbidity

CV risk assessment (screening for hypertension, diabetes, and hyperlipidemia) with national guidelines is recommended for all patients with psoriasis. (B)
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Clinicians should consider early and more frequent screening for hypertension, diabetes, and hyperlipidemia in psoriasis patients who are candidates for systemic or phototherapy or who have psoriasis involving >10% of the BSA. (B)
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Risk score models should be adapted for patients with psoriasis by introducing a 1.5 multiplication factor when the patient with psoriasis meets either criteria: disease severity of BSA >10% or candidate for systemic or phototherapy. (C)
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CV risk management in psoriasis for hypertension and dyslipidemia should be carried out according to national guidelines. The target for blood pressure and lipid levels are based on risk calculated for psoriasis. Antihypertensives and statins may be used as in the general population. CV risk management should be performed by either a primary care physician or other health care provider experienced in CV risk management or the dermatologist. (C)
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Psoriasis and metabolic syndrome comorbidity

Patients with psoriasis should be informed about their increased risk for metabolic syndrome and have their metabolic syndrome status evaluated according to national guidelines by an appropriate health care professional. (B)
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Patients with moderate-to-severe psoriasis should have their obesity status determined according to national guidelines. Those patients already being monitored for obesity should be encouraged to maintain a healthy lifestyle and keep regularly scheduled follow-up visits with their primary care provider and/ or dermatologist. Bariatric surgery should be considered to improve the comorbidities in psoriasis patients with a body mass index >40 kg/m2 who fail standard weight loss measures. (B)
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Patients with mild, moderate, or severe psoriasis should have their blood pressure checked according to national guidelines. Patients with blood pressure of 140/90 mmHg or greater should be referred to their primary care provider for assessment and treatment. (A)
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All patients with psoriasis should have screening lipid tests performed according to national guidelines by their health care provider, with increased frequency considered for patients with severe disease. If these studies are conducted by the patient’s dermatologist, those with elevated fasting triglycerides and/or high-density lipoprotein cholesterol should be referred to their primary care provider for assessment and management. (B)
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A fasting blood glucose and/or hemoglobin A1C should be performed by a health care provider in patients with psoriasis according to national guidelines. If these studies are conducted by the patient’s dermatologist, those with prediabetes or newonset diabetes should be referred to their primary care provider for further assessment and management. (C)
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Psoriasis and mental health

Patients with psoriasis should be informed about the association of psoriasis and anxiety and depression. (B)
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Patients with psoriasis should be asked about signs and symptoms of anxiety and depression by their dermatologist or primary care provider. (B)
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Psoriasis patients showing signs or symptoms of anxiety, depression, or suicidal ideation should be referred to an appropriate health care professional for further assessment and management. (A)
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Psoriasis-specific therapy is recommended as a measure to improve psoriasisassociated anxiety and depression in individuals with psoriasis. (B)
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Psoriasis and changes in quality of life

Patients with psoriasis should be informed of the association between psoriasis and smoking, as smoking increases the risk for severe disease and the likelihood of cardiovascular comorbidities. (B)
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Patients with psoriasis should be counseled to limit alcohol intake, as it increases the risk for severe disease and is associated with other psoriasis comorbidities. (B)
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Providers should consider the amount of alcohol ingestion in their psoriasis patients when considering treatment options for their patients. (B)
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Patients with psoriasis who have nicotine or alcohol dependency should be referred to expert health professionals for further assistance. (A)
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Psoriasis and inflammatory bowel disease

Patients with psoriasis should be informed about the association of psoriasis and IBD. (B)
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Psoriasis patients found to have concerns for IBD should be referred to their primary care provider or a gastroenterologist for further assessment and management. (A)
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Patients who develop psoriasiform eruptions while on TNFi therapy might respond to other medications that are used to treat psoriasis and continue on their IBD medication. If those measures do not improve the psoriasiform eruption, discontinuation of TNFi therapy might be necessary to achieve skin clearance. (B)
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Interleukin 17 inhibitor therapy should be avoided in patients with IBD. (C)
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Recommendation Grading

Disclaimer

Overview

Title

Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities

Authoring Organizations

Publication Month/Year

February 1, 2019

Last Updated Month/Year

June 9, 2022

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This guideline addresses the management of extracutaneous manifestations of psoriasis in adults, including comorbid conditions, mental health, psychosocial wellness, and quality of life (QoL). 

Target Patient Population

Patients with psoriasis

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Long term care, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Assessment and screening, Management

Diseases/Conditions (MeSH)

D015535 - Arthritis, Psoriatic, D011565 - Psoriasis, D008603 - Mental Health, D003376 - Counseling, D015897 - Comorbidity, D024821 - Metabolic Syndrome

Keywords

obesity, depression, psoriatic arthritis, psoriasis, comorbidities

Methodology

Number of Source Documents
214
Literature Search Start Date
January 1, 1980
Literature Search End Date
December 31, 2017