Daily Archives: October 2, 2022

Review

Affiliations Expand

Item in Clipboard

Review

Adriana Rendonet al. Int J Mol Sci. 2019.

Display options

Format Abstract PubMed PMID

Item in Clipboard

Display options

Format AbstractPubMedPMID

Research on psoriasis pathogenesis has largely increased knowledge on skin biology in general. In the past 15 years, breakthroughs in the understanding of the pathogenesis of psoriasis have been translated into targeted and highly effective therapies providing fundamental insights into the pathogenesis of chronic inflammatory diseases with a dominant IL-23/Th17 axis. This review discusses the mechanisms involved in the initiation and development of the disease, as well as the therapeutic options that have arisen from the dissection of the inflammatory psoriatic pathways. Our discussion begins by addressing the inflammatory pathways and key cell types initiating and perpetuating psoriatic inflammation. Next, we describe the role of genetics, associated epigenetic mechanisms, and the interaction of the skin flora in the pathophysiology of psoriasis. Finally, we include a comprehensive review of well-established widely available therapies and novel targeted drugs.

Keywords: chronic skin disease; inflammation; psoriasis.

The authors declare no conflict of interest.

Figure 1

Clinical manifestations of psoriasis. (

Figure 1

Clinical manifestations of psoriasis. ( A , B ) Psoriasis vulgaris presents with

Clinical manifestations of psoriasis. (A,B) Psoriasis vulgaris presents with erythematous scaly plaques on the trunk and extensor surfaces of the limbs. (C) Generalized pustular psoriasis. (D) Pustular psoriasis localized to the soles of the feet. This variant typically affects the palms of the hands as well; hence, psoriasis pustulosa palmoplantaris. (E,F) Inverse psoriasis affects the folds of the skin (i.e., axillary, intergluteal, inframammary, and genital involvement).

Figure 1

Clinical manifestations of psoriasis. (

Figure 1

Clinical manifestations of psoriasis. ( A , B ) Psoriasis vulgaris presents with

Clinical manifestations of psoriasis. (A,B) Psoriasis vulgaris presents with erythematous scaly plaques on the trunk and extensor surfaces of the limbs. (C) Generalized pustular psoriasis. (D) Pustular psoriasis localized to the soles of the feet. This variant typically affects the palms of the hands as well; hence, psoriasis pustulosa palmoplantaris. (E,F) Inverse psoriasis affects the folds of the skin (i.e., axillary, intergluteal, inframammary, and genital involvement).

Erythrodermic psoriasis.

Figure 3

Onycholysis and oil drop changes

Figure 3

Onycholysis and oil drop changes on psoriatic nail involvement.

Onycholysis and oil drop changes on psoriatic nail involvement.

Figure 4

Histopathology of psoriasis. ( A

Figure 4

Histopathology of psoriasis. ( A ) Psoriasis vulgaris characteristically shows acanthosis, parakeratosis, and

Histopathology of psoriasis. (A) Psoriasis vulgaris characteristically shows acanthosis, parakeratosis, and dermal inflammatory infiltrates. (B) In pustular psoriasis, acanthotic changes are accompanied by epidermal predominantly neutrophilic infiltrates, which cause pustule formation.

Figure 5

The pathogenesis of psoriasis.

Figure 5

The pathogenesis of psoriasis.

The pathogenesis of psoriasis.

Boehncke WH, Brembilla NC. Boehncke WH, et al. Clin Rev Allergy Immunol. 2018 Dec;55(3):295-311. doi: 10.1007/s12016-017-8634-3. Clin Rev Allergy Immunol. 2018. PMID: 28780731 Review.

Schleicher SM. Schleicher SM. Clin Podiatr Med Surg. 2016 Jul;33(3):355-66. doi: 10.1016/j.cpm.2016.02.004. Epub 2016 Mar 25. Clin Podiatr Med Surg. 2016. PMID: 27215156 Review.

Ko JM, Qureshi AW. Ko JM, et al. G Ital Dermatol Venereol. 2010 Jun;145(3):393-406. G Ital Dermatol Venereol. 2010. PMID: 20461047 Review.

Blauvelt A, Chiricozzi A. Blauvelt A, et al. Clin Rev Allergy Immunol. 2018 Dec;55(3):379-390. doi: 10.1007/s12016-018-8702-3. Clin Rev Allergy Immunol. 2018. PMID: 30109481 Free PMC article. Review.

Mrowietz U, Reich K. Mrowietz U, et al. Dtsch Arztebl Int. 2009 Jan;106(1-2):11-8, quiz 19. doi: 10.3238/arztebl.2009.0011. Epub 2009 Jan 5. Dtsch Arztebl Int. 2009. PMID: 19564982 Free PMC article. Review.

Lu YW, Chen YJ, Shi N, Yang LH, Wang HM, Dong RJ, Kuang YQ, Li YY. Lu YW, et al. Front Immunol. 2022 Sep 12;13:971071. doi: 10.3389/fimmu.2022.971071. eCollection 2022. Front Immunol. 2022. PMID: 36172384 Free PMC article.

Wang Z, Zhang HM, Guo YR, Li LL. Wang Z, et al. World J Clin Cases. 2022 Jul 26;10(21):7224-7241. doi: 10.12998/wjcc.v10.i21.7224. World J Clin Cases. 2022. PMID: 36158000 Free PMC article.

Andjar I, Esplugues JV, Garca-Martnez P. Andjar I, et al. Pharmaceuticals (Basel). 2022 Sep 3;15(9):1101. doi: 10.3390/ph15091101. Pharmaceuticals (Basel). 2022. PMID: 36145322 Free PMC article. Review.

Olunoiki E, Rehner J, Bischoff M, Koshel E, Vogt T, Reichrath J, Becker SL. Olunoiki E, et al. Life (Basel). 2022 Sep 12;12(9):1420. doi: 10.3390/life12091420. Life (Basel). 2022. PMID: 36143456 Free PMC article. Review.

Nijakowski K, Gruszczyski D, Kolasiska J, Kopaa D, Surdacka A. Nijakowski K, et al. Int J Environ Res Public Health. 2022 Sep 8;19(18):11302. doi: 10.3390/ijerph191811302. Int J Environ Res Public Health. 2022. PMID: 36141573 Free PMC article. Review.

Show all 217 references

Original post:
Psoriasis Pathogenesis and Treatment - PubMed

It sounds plausible: If psoriasis is causing dry, scaly patches on your skin, couldnt drinking more water hydrating from the inside out improve symptoms or prevent a flare?

Dermatologists arent buying it.

Yes, psoriatic skin has hydration issues. Because the skin barrier in psoriasis is abnormal, you can lose water through the skin, saysSteven Feldman, MD, PhD, a dermatologist who specializes in psoriasis treatment at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina. Applying moisturizer to damp skin, he says, is important for hydrating psoriasis plaques.

But drinking water is a different kind of hydrating, Dr. Feldman says. There isnt any evidence that we know of that suggests drinking more water improves psoriasis.

By the way, there isnt much research to indicate that drinking extra water has any impact on skin hydration or appearance in individuals with healthy skin either, according to Mayo Clinic.

Certainly staying hydrated by drinking plenty of water is good for overall health, whether a person has psoriasis or not. Your cells, tissues, and organs need water to function properly its a key component in the regulation of body temperature and the removal of waste from the body, according to the American Academy of Family Physicians.

TheU.S. National Academies of Sciences, Engineering, and Medicine determined that women need about 11.5 cups of fluid a day and men need about 15.5 cups per day. That recommendation covers fluids obtained from water, other beverages, and food about 20 percent of daily fluid intake comes in the form of what you eat, not what you drink. If your urine is colorless or light yellow and you rarely feel thirsty, thats an indication that youre hydrating appropriately.

People with psoriasis can follow the same hydration guidelines as everyone else, says Feldman. They dont need to drink more water because of their condition, and there isnt any evidence that drinking more will improve psoriasis symptoms or prevent flares, he says.

RELATED: Hydration Calendar: How Much Water Do You Need to Drink a Day?

Topical ointments with vitamin D are sometimes used to treat psoriasis, but there isnt strong evidence to indicate that drinks fortified with vitamin D can help with psoriasis symptoms, according to theNational Psoriasis Foundation.

But people with psoriasis often have lower than normal levels of vitamin D, says the Mayo Clinic, a problem that can worsen as hours of daylight wane in the fall and winter. (Skin naturally produces vitamin D in response to sunlight.) Vitamin D is important to overall health for a host of reasons, including helping the body absorb calcium to build bone and maintaining immune function, says the National Institutes of Health.

If you do want to up your vitamin D intake through beverages, milk and orange juice fortified with vitamin D are good sources. Talk with your doctor before taking vitamin D supplements: Too much can be harmful.

Note: For people with psoriasis who are lactose intolerant or otherwise have trouble digesting dairy products, milk can be problematic because it can irritate the gut, worsening inflammation throughout the body. In some cases, people with psoriasis who cut out dairy see an improvement in their skin symptoms, according to Johns Hopkins Medicine.

Currently there isnt any evidence that antioxidants in black, green, or herbal teas will improve psoriasis symptoms, says Feldman.

Although laboratory studies suggest that antioxidants may be beneficial in lowering inflammation, the high amounts that a person would need to consume make it unlikely that antioxidants in ones diet would have any effect on psoriasis, according to a paper published in February 2021 in the journalAntioxidants.

Still, its worth remembering that people with psoriasis are at higher risk of heart disease and stroke. The antioxidants in tea can help reduce inflammation throughout the body, including the cardiovascular system, helping protect the heart and brain.

Drinking too much alcohol isnt a good idea it probably has a direct effect on psoriasis, says Feldman.

There isnt a lot of research on how drinking alcohol may impact psoriasis, but there is evidence to suggest that alcohol consumption may increase the risk of developing psoriasis and may worsen inflammation in people who already have the disease. This appears to be due at least in part to alcohols harmful effect on the gut microbiome.

Another concern is that high-calorie beverages like alcohol, juice, and sugary drinks like soda can contribute to weight gain. Evidence suggests that for people with psoriasis who are overweight or obese, treating the psoriasis and following a healthy and balanced diet that promotes weight loss could lead to fewer flare-ups and less severe disease, according to the American Academy of Dermatology.

Scientists have also linked overconsumption of sugar with chronic inflammation, which can make psoriasis worse.

Some people with psoriasis have a sensitivity to gluten, which is found in some types of alcohol, such as beer.Research suggests that for those who have the sensitivity, avoiding gluten can improve psoriasis symptoms, though it may not help much (if at all) in people without the sensitivity.

When it comes to hydration and psoriasis, you dont need to do anything special, says Feldman. Just make sure youre drinking enough water to support your overall health while limiting sweetened drinks or alcohol, he says.

Excerpt from:
Best and Worst Drinks for Psoriasis - Everyday Health

My skin is perfect, said no one ever. Real talk: By the time you hit adulthood, your skin has gone through growing pains of its own. Between the ages of 12 and 24, 85% of Americans have at least minor acne, according to the American Academy of Dermatology; another 10.7% will have eczema. Got dry skin? Youre among one in three people who deal with it every day, according to recent research.

In other words, weve all got skin issues. And just as no two people are alike, neither are the skin woes we face, meaning there is no one-treatment-fits-all plan. Each chronic skin condition has its own unique set of symptoms, causes and ways of being managed. Take a look at what the experts have to say about these 10 common skin disordersand how to keep your skin healthy now and in the future.

Leave it to the global pandemic to coin a new derm term: We seen a lot of maskne in the last two years, especially at the height of COVID, due to all the mask-wearing and how it affects the skin, saysDr. George Han, MD, PhD, an associate professor and director of research in the department of dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Lenox Hill Hospital in New York City.

Pandemic or not, says Dr. Han, adult acne is on the rise. We have women who never had acne as kids coming in as new patients at 30 years old, he says, adding that the reason for this increase is not clear.

The condition occurs when hair follicles become clogged with oil and dead skin cells, leading to pimples, and to a lesser extent blackheads and whiteheads, according to the Mayo Clinic. Acne can occur on your face, chestand back, among other placesin the case of cystic acne, pimple-like bumps form under the skin surface.

We dont understand exactly why acne happens, however, we know that it is driven by hormones, diet and stress, saysDr. Joshua Zeichner, MD, an associate professor of dermatology and the director of cosmetic and clinical research at Mount Sinai Hospital in New York City.

Over-the-counter topical medications are the first line of defense with acne and can be effective in clearing your skin. Benzoyl peroxide is perhaps the most effective ingredient to treat angry pimples, Dr. Zeichner says. Look for formulations with 2.5% benzoyl peroxide, which studies show to be as effective as higher concentrations but with less skin irritation.

Meanwhile, topical retinoids act like pipe cleaners to keep the pores clear, Dr. Zeichner says. I use them in treating my adult acne patients because they also offer collagen-stimulating benefits to address aging skin. Products containing salicylic acid may also help, he says: This ingredient is a type of beta hydroxy acid that removes excess oil and dead cells from the surface of the skin to help dry out pimples.

If youve given these remedies a try and your acne stubbornly persists, its time to call in the reinforcements. If they are not doing the trick after one to two months, I recommend speaking to a dermatologist for professional recommendations and to consider an oral medication, says Dr. Zeichner. In adult women, we use hormonal therapies like birth control pills or spironolactone to address the hormonal impact on oil glands.

Related: Do Pimple Patches Actually Work?

If youre thinking, I didnt know dry skin was an actual condition, were with you. But theres the dish-soap-dried-out-my-hands dry skin, and then theres the clinical sort. Known as xerosis cutis, clinically dry skin can cause cracking, bleeding, itching and irritation. The condition frequently affects older people and is made worse by dry heat during winter months.

Dry skin can also be caused by another underlying condition, such as eczema or kidney disease, according to the American Academy of Dermatology (AAD). Certain medications can contribute to dry skin as well.

Treatment for dry skin starts with lifestyle changes. Follow these tips from the AAD:

In severe cases, your dermatologist might also prescribe a steroid for short-term use to calm any inflammation thats making itching or cracks in your skin worse.

Unless youve been living under a rock (pun intended), you know all about alopecia as it pertains to Jada Pinkett Smith, the Oscars and that infamous Chris Rock slap. In a nutshell, alopecia refers to hair loss. There are a few types of alopecia; alopecia areata is the most commonan autoimmune condition in which the immune system attacks hair follicles on the face, head and sometimes other areas of the body, causing hair to fall out.

Alopecia can occur in both men and women and people of any race and age, although it typically appears for the first time when people are in their 20s, 30s and 40s, per the National Institutes of Health. About 6.8 million Americans have alopecia areata, with a lifetime occurrence around 2%, according to the National Alopecia Areata Foundation.

Depending on your age, location of hair loss and extent of baldness, your doctor may talk with you about the following options to help stimulate hair growth, per the American Academy of Dermatology:

Other options include wigs, transplants or scalp prosthesis, or going the opposite route and shaving your head.

Related: Best Skincare Routine for Morning and Night

Even the word sounds itchyand with eczema, your skin usually is. We talk about eczema as the itch that rashespeople feel itchy and before their eyes, a rash starts to appear, says Dr. Han. That rash typically looks like tiny red bumps clustered together.

While the condition has no single cause, there is often a family history of asthma and allergies associated with the condition. (The condition itself is tied to genetics: If one of your parents has eczema, your risk of developing it jumps two- to three-fold, according to research in the Journal of Pediatrics.) Other triggers for the condition include smoking, stress, dry skin and hormonal fluctuations, among others.

Eczema is a condition where the skin barrier is not functioning as well as it should be, says Dr. Zeichner. In eczema, the microbiome, or collection of microorganisms that live on the skin surface, is disrupted. This leads to loss of hydration and inflammation in the skin.

Atopic dermatitis is the condition most people mean when they refer to eczemathe terms are used interchangeably. But there are several other types of the condition, according to the Cleveland Clinic, including contact dermatitis (caused by direct skin contact with an irritant); dyshidrotic eczema (blisters on hands and feet); hand eczema (symptoms are limited to your hands); neurodermatitis (patches on skin are thicker); nummular eczema (characterized by larger welts on your skin); and stasis dermatitis (caused by faulty veins that leak fluid).

The goal of treatment is to repair the skin barrier with moisturizers, says Dr. Zeichner. We also want to reduce inflammation in the skin with over-the-counter anti-inflammatories or topical or systemic medication by prescription. Treatments for eczema range from DIY therapies (warm baths, baking soda and thick moisturizers) to medical intervention. Your doctor may talk with you about calcineurin, Janus kinase and PDE4 inhibitors, or biologics, all of which work by blocking certain proteins in the body that turn on skin inflammation.

So that waseczema. The skin condition it is most commonly confused with is psoriasis. If you look at old medical textbooks, youll see that we used to distinguish between the two by saying that eczema means you have itchy skin and psoriasis doesnt itch, says Dr. Han. But in the past few decades that has been turned on its head and we now know psoriasis also itches.

In fact, he says, 80% to 90% of psoriasis patients cite itching as a primary symptom. So what makes psoriasis different than eczema? Mainly, how and where the disease appears on the body. The classic description of a psoriasis lesion is thick scaly skin on top of a plaque, says Dr. Han. It tends to be a red area thats relatively clearly cut off from the surrounding skin. Whereas with eczema, you have small red bumps in red patches on skin.

(scroll to keep reading)

While plaque psoriasis is the most common form of this condition, there are other types of psoriasis, including nail, scalp, guttate, inverse, pustular and erythrodermic psoriasis. In all cases, the psoriasis is caused by skin cell turnover that occurs too quickly. The process usually takes 30 days, but in people with psoriasis, cell turnover happens in three days, says Dr. Han. The dead skin cells pile up, leading to the conditions telltale plaques.

Treatments for psoriasis range from topical creams like retinoids to systemic medications, and which you use depends largely on the severity of your condition. In cases where your symptoms are very mild, you might even try home remedies for psoriasis, including moisturizers that contain salicylic acid to help exfoliate the plaques, essential oils (the benefits of these are questionable), mindfulness techniques and various foods to reduce skin inflammation. (Skip the processed foods, which make inflammation worse, according to research in the Journal of Investigative Dermatology.)

For moderate to severe psoriasis, your doctor will likely talk with you about drugs called biologics, which work by targeting the proteins in your body responsible for causing inflammation in your skin. Biologics are usually given as injections.

Related: Dermatologist-Approved Skincare Routine for Oily Skin

Rosacea can look a lot like acne but typically affects older patients as opposed to teens, says Alok Vij, M.D., a dermatologist at the Cleveland Clinic in Ohio. Rosacea can have a few components: broken blood vessels on the skin surface, pustules like acne but not blackheads and thickening of the sebaceous skin. (Picture W.C. Fields with thick skin on his nose, he suggests.)

So, how is rosacea treated? We start by classifying the severity of the disease, says Dr. Vij. If its mild, well use topical anti-inflammatory creams or antibiotics for pustular rosacea. Laser therapy may help reduce redness from blood vessels and there is some evidence that oral vitamin A therapy is helpful.

Rosacea treatment may take four weeks to see improvement because that's the length of a full skin cycle, he adds. In the meantime, many over-the-counter products and cosmetics can lessen the red appearance.

Unlike most of the common and chronic skin conditions that are marked by increased plaques, bumps or redness, the disorder vitiligo is characterized by whats missing: Namely, skin color. Vitiligo is an autoimmune condition in which your own antibodies attack cells called melanocytes in your body, says Nada Elbuluk, M.D., a clinical associate professor of dermatology at the Keck School of Medicine and director of the USC Skin of Color Center and Pigmentary Disorders Clinic at the University of Southern California in Los Angeles. These cells create melanin, which is what gives skin its color, so once they are affected, those areas of skin develop white patches.

Although scientists are still exploring the causes of vitiligo, the current thinking is that some people are genetically predisposed to the condition. There are two things that need to happen for vitiligo to occur, says Dr. Elbuluk. First, you have the genetics for it, and second, there is some sort of eventmaybe a sunburn or skin scrape or even stressthat triggers the onset of vitiligo.

The psychological impact of vitiligo can be severe: In a review of dozens of studies, a report in the American Journal of Clinical Dermatology found that 62% of people with vitiligo also suffer from depression while 68% struggle with anxiety. People with vitiligo start to self-isolate or feel uncomfortable in social situations, says Dr. Elbuluk. The emotional symptoms of the disease are very concerning.

Treatment for vitiligo varies depending on which parts and how much of the body is affected, and may include phototherapy, laser therapy, topical steroids, oral medication and surgery. Some people, though, may choose not to treat vitiligo at all. Celebrities like model Winnie Harlow have built their career celebrating their unique skin appearance.

If youve ever nicked yourself shaving, only to discover an inflamed red bump in the spot the following day, thats folliculitis. Sometimes referred to as fungal acne, the condition is marked by infected or inflamed bumps on the skin that can look like acne at first, according to the Cleveland Clinic. There are different types of folliculitis, named either for the type of bacteria that has caused the infection or the severity and location of the skin symptoms. (You can develop folliculitis anywhere and everywhere, including your butt, chestand chin.)

Folliculitis is a very common and benign condition that refers to little pimples that occur any place where there are hair follicles on your body, says Dr. Vij. You can get it on your face, thighs, back of armsjust about anywhere. Because symptoms (inflamed bumps) are typically mild, we tend to use fewer aggressive treatments, says Dr. Vij. These might include benzoyl peroxide washes and topical antibiotics, as well as warm compresses and anti-itch creams.

Related: Best Sunscreens for Sensitive Skin

Sweat much? If so, you might be among the one in 20 people in the U.S. who have hyperhidrosis, a skin condition characterized by excessive perspiration (the exact number of folks with hyperhidrosis is unknown and estimates range from one in 50 people to closer to one in 10, per the Cleveland Clinic.

We all sweat sometimesits how our body cools itself, after all. But in people with hyperhidrosis, not only is sweating excessive, it can happen at random times, for no apparent reason, when youre not even stressed. It is disruptive at best and a self-confidence crusher at its worst.

How can you tell the difference between a heavy sweater and one with a clinical disorder? The Cleveland Clinic list these symptoms of hyperhidrosis:

There are two types of hyperhidrosis: focal (also called primary) which results from a genetic mutation and generalized (also called secondary) which results from another condition or medication you may be taking.

Based on the severity of your sweating, your doctor may treat your hyperhidrosis with anything from clinical-grade antiperspirants to iontophoresisthis at-home device zaps your skin with a mild current to temporarily shut down your sweat glands, according to the American Academy of Dermatology. Other treatments include Botox injections, oral medication and even surgery to remove the sweat glands.

Hidradenitis is a condition where cysts, nodules and scars typically develop in areas like the underarms, groin and under the breasts, says Dr. Zeichner. We dont understand exactly why it happens, but we know that it is caused by blockages within sweat glands.

Risk factors for developing the condition (which can appear as bumps and blackheads on the skin surface) include family history, smoking and obesity.

Hidradenitis suppurativa is associated with other severe acne-like conditions, which are collectively known as the follicular occlusion tetrad, Dr. Zeichner says. Hidradenitis suppurativa goes through flares and remissions, but most lesions never completely clear, he adds. While medications can help keep symptoms under control, currently there is no cure.

Lifestyle modifications can help though. These include regular cleaning of the under-skin pimples with surgical-grade, antimicrobial cleansers; a healthy diet and exercise to maintain a proper body weight; and quitting smoking.

In mild cases, topical medications offer some help, says Dr. Zeichner. Cortisone injections to reduce inflammation are useful. Larger abscesses may be drained. In severe cases, plastic surgeons may remove the glands in the affected areas altogether and replace the skin with a graft.

As the disease progresses, systemic medications may be needed as well, including a biologic medication (Humira) that is FDA-approved to address the underlying inflammatory response that makes symptoms worse.

And there you have it: The main chronic skin conditions that can mess with your daily mojo. Theyre more common than most people realizeespecially when you add them all together. So if your skin is itching and you havent visited a patch of poison ivy lately, talk with your dermatologist about whats going on. If you do have one of these chronic skin disorders, treating it early will help you get back to your regularly scheduled life.

Next up: These Top TikTok Skincare Hacks Actually Work

Read more here:
These Are the 10 Most Common Chronic Skin Conditionsand the Most Important Facts to Know About Them - Parade Magazine

Holistic, collaborative, multidisciplinary, and integrated communication between physicians and women of childbearing age is lacking, according to a study published in Springer.1 Medical treatment and family planning, particularly among women of childbearing age with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), should be considered within this patient population. Patient-centered care including reproductive choices should be integrated as a part of routine clinical practice.

The proportion of women being treated with biologics is growing, investigators explained. However, data on treatment recommendation awareness among treating physicians and women who are considering pregnancy and family planning are limited.

An English-language, 55-question survey was developed to identify the current practices of physicians regarding the reproductive health needs of women with RA, PsA, and psoriasis in the Czech Republic, Slovakia, and Hungary. The questionnaire was designed to simultaneously elicit spontaneity of physicians while allowing for the processing of responses, mutual comparison, and overall assessment. The survey obtained information from 120 physicians, including 82 rheumatologists and 38 dermatologists.

Female patients of reproductive age (aged 18 to 45 years) with moderate-to-severe disease encompassed 10-30% of all respondents. Roughly two-thirds of physicians discussed family planning with their patients when making the diagnosis. Rheumatologists collaborated with other specialists more frequently when compared with dermatologists and gynecologist/obstetricians. Pregnancy effects were the top concern for female patients.

Approximately half of the rheumatologists revised treatment 6 months prior to when the patient planned on becoming pregnant (44% [n = 36/81]). However, dermatologists acted much sooner (26% [n = 10/38]), acting 2 to 3 years prior planned parenthood. While rheumatologists selected systemic glucocorticoids as firs-line treatment to counteract pregnancy flares, dermatologists preferred topical corticosteroids.

Although gender alone did not influence treatment choice in 11% of dermatologists and 39% of rheumatologists, all dermatologists and 96% of rheumatologists were influenced by the patients fertility and pregnancy. Disease severity and uncontrolled disease were the main risk factors linked to conception in this patient population. In fact, 53% of dermatologists and 79% of rheumatologists believed that poor disease control was associated with poor pregnancy outcomes. Of the most valuable sources of information as determined by physicians, congresses and interdisciplinary forums were the most highly rated. Patient education and collaboration were noted as key factors in reducing unplanned pregnancies.

A cross-border investigation, from the perspective of both rheumatologist and dermatologist, strengthened the study. However, investigators did not evaluate or categorize the individual physicians level of experience with biologics or reproductive health and instead based data on actual clinic experience. Investigators theorize that those who have had more exposure to this approach would be more willing to utilize it. The lack of formal survey validation, and the fact that the survey was provided in English, further limits the study.

To improve the reproductive health of sexually active women of childbearing age in Central Europe who have chronic inflammatory diseases (CID), rheumatologists and dermatologists must improve their education and work with other specialists, investigators concluded. More timely discussions with women of reproductive age and family planning are needed to educate them about the disease's effects on their childbearing potential and the selection of treatment options based on their reproductive goals. Best practices in patient-centered care must consider each patient's reproductive decisions in their treatment planning to give the best patient-centered care.

Reference:

Olejrov M, Macejov , Gkalpakiotis S, Prochzkov L, Tth Z, Prgr P. Reproductive Healthcare in Women with Rheumatoid Arthritis and Psoriatic Diseases in Routine Clinical Practice: Survey Results of Rheumatologists and Dermatologists [published online ahead of print, 2022 Sep 24]. Rheumatol Ther. 2022;10.1007/s40744-022-00488-z. doi:10.1007/s40744-022-00488-z

Read more:
Survey Addresses Concerns Regarding Reproductive Healthcare Communication in Women with RA, PsA - Rheumatology Network