Psoriasis Comorbidities

Psoriasis decreases life span by up to 10 years

Psoriasis is an interesting disorder.  It affects about 2% of the US population.  As I often explain to patients, it is something that some people are genetically inclined to have, just like their hair color and eye color.  It is not some we can permanently cure, and for most it is a lifelong disorder that comes and goes.  BUT…What we knew, or what we thought we knew about psoriasis has changed dramatically in just the past 15-20 years.  Each day it seems we learn more.  Some of the new findings are particularly startling.

Many studies have shown that people who have psoriasis are statistically at a higher risk of having a number of other disorders and risks.  We label these statistical findings as comorbidities.  The official definition of  a comorbidity is “the simultaneous presence of two chronic diseases or conditions in a patient”. Why does this matter?

At the American Academy of Dermatology meeting last spring, I attended a number of scientific lectures which discussed these comorbidities.  At that meeting it was emphasized that it would increasingly be important for us as dermatologist to educate patients regarding these comorbidities and risk factors.  This topic is evolving and advancing daily, but I wanted to try to summarize this topic for my patients.  So, here we go….

Comorbidities with psoriasis…

Obesity – 2x increase risk

Type 2 diabetes -2x

Coronary artery disease –2 x

Arthritis– About 30% of patients who have psoriasis have psoriatic arthritis.  This is a destructive type of arthritis.

High blood pressure  – up to 2x

Inflammatory Bowel Disease –Crohn’s and Ulcerative Çolitis 3.8 to 7.5x

Fatty Liver and other Liver Disease – up to 2x

Depression  – up to 60% of patients with psoriasis

Lymphoma – up to 2x

Metabolic syndrome (includes high blood pressure, elevated blood glucose, elevated lipids, and obesity) – 2x

Increase risk of non-melanoma skin cancer  – 4x

A significant amount of current research is looking for substantial evidence for systemic treatment of psoriasis to reduce these comorbidities and increase life span.

Recommendations for psoriasis patients to reduce risk of illness and death from comorbid disease…

-Yearly physical by PCP

-Yearly Full skin examination

-Yearly set of lab work including Fasting blood glucose, Hemoglobin A1C, Cholesterol, triglycerides, Liver (AST, ALT, GGT) and kidney function tests (BUN and Creatinine)

-Keep up to date on age appropriate malignancy scans.

-Reducing weight by as little as 10% significantly improves cardiovascular risk

-Reducing and limiting alcohol intake

-Stop smoking

-Cardiovascular exercise at least 3-4 times per week.

-Daily Vitamin E 400IU, Fish Oil

-Coffee, black , in moderation

If you have a friend or relative with psoriasis, please share this information with them!

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Do you think my rash is caused by gluten?

Dermatitis Herpetiformes

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At times, patients will come to the office with a rash that seems to correspond with eating foods that contain gluten. The name of the rash caused by a gluten sensitivity is dermatitis herpetiformis (DH).  So you say I have herpes?  No, the name of this rash often causes people to misunderstand and think that they have viral herpes. However, DH is not viral herpes, but rather is given the name dermatitis herpetiformis because of the clustered blisters that are present with the rash.

So what does dermatitis herpetiformis look like and how is it different than viral herpes?

DH commonly presents symmetrically, unlike viral herpes, on the scalp, shoulders, buttocks, elbows and knees. The skin can appear normal or reddened with raised bumps, sometimes fluid filled. The rash of DH is extremely itchy, but not usually painful like viral herpes.

Often the individual itches and scratches the areas of the rash, and once resolved are left with pigmentation that is either darker or lighter in the areas affected.

Sometimes, DH can resemble other skin rashes such as scabies or papular uticaria.

So if it is not a viral herpes infection, what causes dermatitis herpetiformis (DH)?

DH results from the intestines intolerance of a part of gluten that is found in wheat, rye, and barley. When the intestines come in contact with gluten, it causes antibodies to be produced and an autoimmune response that affects the intestines and the skin. In celiac disease, which affects the intestines, patients often have diarrhea, tiredness, and abdominal distention.  In DH, patients have a very itchy rash.

So how does a dermatologist diagnose me with dermatitis herpetiformis?

Often times, your dermatologist can have a probable diagnosis of DH based on presentation of the rash and your symptoms. To confirm the diagnosis, your dermatologist will need to do a skin biopsy.

If the results are positive for DH, your dermatologist or primary care doctor might order some other tests to check your thyroid and for nutritional deficiencies.

Is dermatitis herpetiformis contagious?

DH is not contagious and you can not transmit it to someone else like viral herpes.

 

How will my dermatologist treat dermatitis herpetiformis?

Most dermatologist will prescribe a strict gluten free diet. However, it may take 3 to 12 months for the symptoms to resolve. So sometimes your dermatologist will prescribe the oral medication known as dapsone. Dapsone works well to decrease the inflammation and suppress the disease, but is not a cure for the disease.

So the good news is patients with DH do not have a sexually transmitted infection that they can pass on to others. The bad news is their diet will be affected and gluten free products will become their new best friend.

To learn more check out these links

Dermnetz – Dermatitis Herpetiformis

 

By Aaron Santmyire APRN-BC, DNP

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Phytophotodermatitis

Be careful with those limes!

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Phytophotodermatitis. No, I did not make that word up.  It is a special kind of rash which occurs when someone is exposed to plant material (PHTYO) and then sun (PHOTO) and then develops a rash.

Interesting case a few weeks ago….I saw a girl with a peculiar rash on her skin.  I immediately thought … lime juice.  Sure enough, the little one had been squeezing lemon and lime into a water bottle while playing outside a few days earlier.  We nerdy doctors love solving a difficult case like this!

Phytophotodermatitis can cause a red, even blistering rash, followed by brown discoloration as you can see in the photo.  The rash only occurs where there is exposure to both things.  It will run its course and the discoloration will improve over many weeks.  When there is active red rash a prescription cortisone cream is helpful.

Other common plants that can be associated with this reaction are parsnip, parsley, celery, hogweed, carrot, lemon, lime, bergamot orange, rue and fig. Lime is by far the most common and much more likely to cause a reaction compared to lemon.

To learn more check out these links below.

http://www.dermnetnz.org/topics/phytophotodermatitis/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185147/

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What is this brown discoloration on my neck?

Acanthosis Nigricans

 Is my skin trying to tell me something?acanthois-nigricans

The answer to this question is “yes”! Our skin often provides clues to our internal health or lack thereof. One skin change, known as acanthosis nigricans, is common in those who are obese and/or have diabetes. It can signal our body’s internal resistance to insulin.

What are the symptoms?

Acanthosis nigricans is characterized by a dark and velvety skin discoloration in the folds and creases. In those individuals affected, it is commonly seen in the armpits, groin, and back of the neck, but can also be seen on the knees, knuckles and elbows.  The discoloration is not painful and commonly develops slowly over a period of time. Acanthosis nigricans can have a slight odor to it, can itch, and skin tags are common in these areas.

Although the most common reason for developing this skin condition is insulin resistance and obesity, there are other causes of acanthosis nigricans. Other causes include malignancies, certain medications, and hormonal disorders.

It is important for your dermatologist and primary care physician to work together to find the cause of the condition to rule out possible malignancies that can be fast growing.

So what can I do to prevent this skin condition?

You can’t just scrub it more.  The most common risk factors for developing acanthosis nigricans are obesity, race, and family history. Therefore, prevention is targeted at the modifiable risk factors.

The more overweight you are, the greater your risk of developing acanthosis nigricans. Obesity is a risk factor for Type 2 Diabetes, and those with acanthosis nigricans are much more likely to develop Type 2 Diabetes than the general population.  Weight loss and medication can be used to correct insulin resistance.

The ethnic background that has been noted to have the highest incidence is the Native American population. There is also a hereditary or genetic link, as those with a family member who has acanthosis nigricans are more likely to develop it than those who do not have a family member with it.  We know that individuals can not change their ethnic background or genetics, but they can be aware of their increased risk.

What can my dermatologist do to treat this condition?

Treatment is normally targeted at the underlying cause of the acanthosis nigricans. For instance if a medication is triggering the condition, your doctor would stop the medication if they deemed it possible and non-life threatening.  If you are overweight, a program directed by your physician of healthy diet, exercise, and at times medications can help you lose weight.

If the underlying cause is treated, and the condition remains, your dermatologist can prescribe topical creams, antibacterial soaps to help avoid infection in these areas.

Remember, our skin is an amazing organ that does communicate with us. The question is “are we listening?”

To learn more about Acanthosis Nigricans, check out these links!

American Academy of Dermatology article about Acanthosis Nigricans

Dermnetz  article about Acanthosis Nigricans

By Aaron Santmyire APRN-BC, DNP

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