POLL: Which Specialties Have You Referred Patients To, Ensuring They Receive Multidisciplinary Care Surrounding Their Skin Condition?

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Whether it be to assess mental health and quality of life (QoL) or comorbidity treatment, multidisciplinary care can help both caregivers and patients to understand the scope of their overall health. Here are a few recent studies, Dermatology Times headlines, and interviews highlighting the importance of collaboration with other specialties to best serve patients.

Mental Health and Acne

Researchers in Europe recently developed a 19-item questionnaire to better assess the quality of life and mental health concerns of patients with acne vulgaris. They found that 3 subcategories divided the questions: Socioemotional, Symptoms, and Stigma and Suicidal thoughts. While other QoL assessments existed for patients with acne, the researchers behind this specific questionnaire felt it would assist in further understanding and developing a long-term treatment strategy individualized to patients, especially for more timely issues.¹

“It is well-known that acne produces cosmetic disfigurement and patients suffering from visible skin conditions have an increased risk of depression, anxiety, body dysmorphic disorder, feelings of stigmatization, and self-harm ideation,” the researchers wrote.

While it is important to use questionnaires such as this for research purposes, the researchers noted they hope this is utilized in general practice as well.

Combining Therapies in Psoriasis and Atopic Dermatitis

James Song, MD, director of clinical research at Frontier Dermatology Partners in Seattle, Washington, recently provided Dermatology Times with comprehensive insights into the strategic combination of systemic therapies for treating psoriasis (PsO) and atopic dermatitis (AD). His presentation at the 2024 Fall Clinical Dermatology Conference for PAs and NPs highlighted the multifaceted approach required to enhance treatment efficacy, address comorbidities, improve patient safety, and collaborate with rheumatologists.²

When treating comorbidities, Song’s pearls for combining systemics include: avoiding the use of treatments that target the same pathway; being mindful of the potential for additive or synergistic toxicities, which necessitates more frequent monitoring (e.g., when combining methotrexate with acitretin or cyclosporine with TNF inhibitors); pairing long half-life drugs (biologics) with short half-life drugs (conventional or targeted synthetic DMARDs); and leveraging existing practices from other diseases rather than starting from scratch.

Psoriasis and Cardiovascular Health

Recent studies led by Joel Gelfand, MD, professor of dermatology and epidemiology at the University of Pennsylvania Perelman School of Medicine, shed light on the impact of psoriasis on cardiovascular health. According to Gelfand’s Masterclasses in Dermatology session “Prevention of Major Cardiovascular Events in Psoriasis,” patients with psoriasis face a heightened risk of major cardiovascular events, mortality, and the development of diabetes, with body surface area playing a pivotal role in driving these outcomes.³

Gelfand noted that many psoriasis patients primarily see dermatologists, leading to a gap in necessary screenings for cardiovascular health. To address this gap in care, Gelfand and his team are developing and testing a novel centralized care coordination service in collaboration with the National Psoriasis Foundation.The CP3 study aims to bridge the communication between dermatologists and primary care providers, ensuring that essential screenings for diabetes, blood pressure, and cholesterol are conducted promptly.

The unique approach involves a care coordinator, a shared virtual service provided by the National Psoriasis Foundation. Dermatologists educate patients and, if necessary, refer them to the care coordinator. This professional spends time explaining the connection between skin disease and cardiovascular risk, offering advice on a healthy lifestyle, diet, and exercise. Crucially, the care coordinator communicates findings back to both the dermatologist and the patient's primary care provider, ensuring a comprehensive loop of care.

Questions To Think About

During a recent Dermatology Times Expert Perspectives video series, Michael Cameron, MD, dermatologist at Cameron Dermatology PLLC and assistant clinical professor at Mount Sinai in New York, New York, spoke on important questions to ask yourself when treating patients with comorbidities for their atopic dermatitis.

Cameron said when it comes to keeping these illnesses in mind, ask:

• When you're considering some of these therapies, what is the evidence behind this?
• What referring providers or other specialties are getting involved?
• What kind of screening for these comorbidities do you need to do, not only for our legacy systemic options, but also for our newer systemic therapies like JAK inhibitors?

Cameron applauded guidelines surrounding JAK inhibitors: “I think the guidelines do a really good job of making sure you treat the whole patient, not just their eczema.”

References

1. Chernyshov PV, Sampogna F, Raimondi G, et al. Development of the acne-specific quality of life questionnaire quality of life relevance-acne. JAAD Int.2024;16:9-17. Published 2024 Mar 25. doi:10.1016/j.jdin.2024.03.007
2. Song EJ. Combining Systemics in Psoriasis and Atopic Dermatitis. Presented at: 2024 Fall Clinical Dermatology Conference; May 31-June 2, 2024; Scottsdale, AZ.
3. Gelfand J. Prevention of Major Cardiovascular Events in Psoriasis. Presented at: Masterclasses in Dermatology February 16-19, 2024; Puerto Rico.