Managing psoriasis: What’s best for your patient?

CASE Tom denied having a personal family history of multiple sclerosis, or any demyelinating disorder. Nor did he have a history of cancer, tuberculosis exposure, CHF, or hepatitis. A purified protein derivative (PPD) was negative, as was his hepatitis panel, and his complete blood count with differential and metabolic panel were within normal limits.

Tom was started on the TNF-inhibitor adalimumab, after undergoing patient education and training and receiving instructions to stop the medication if he developed a major illness or infection. He received a loading dose of 80 mg SC, followed by 40 mg every other week. He tolerated the treatment well and 70% of his cutaneous symptoms cleared after 12 weeks of therapy; his joint pain also was reduced.

Tom is followed regularly in the clinic, with labs every 4 to 6 months. He is maintained on the injections and happy with the results. At each visit, weight loss and decreased beer intake are encouraged, both of which have been shown to reduce psoriasis severity. Although the beta-blockers and ACE inhibitors he takes are known to exacerbate psoriasis, the medications are necessary to treat Tom’s coronary artery disease.

CORRESPONDENCE Elizabeth Uhlenhake, MD, 18100 Oakwood Boulevard, Suite 300, Dearborn, MI 48124; eulenha@neomed.edu