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An interview with Dr. Lal on common struggles for psoriasis patients, including associated risks and mental health struggles.
Lal currently serves as the director of pediatric dermatology and cosmetic surgery for Affiliated Dermatology Scottsdale, in addition to being the social media chair for the Society for Pediatric Dermatology.
“So, the big thing when I talk about psoriasis, obviously, (is that) arthritis is one of the most common things we see in about 30% of patients with psoriasis,” he said. “But in addition to that, we know psoriasis is associated with other conditions, including depression, obesity, heart disease, atherosclerosis, smoking, any root anything in that metabolic syndrome platform, in addition, inflammatory bowel disease.”
Lal also went into a discussion about inflammatory bowel disease (IBD), a condition which he describes as part of gut microbiome issues.
“And inflammatory bowel disease is really important because it can exclude patients from receiving certain therapies,” he explained. “For example, the IL-17 inhibitors. You know, if you have psoriasis and inflammatory bowel disease, you can't get those types of therapies. So that's a very good question to ask. And at times, if a lot of patients have, you know, on screening, these vague abdominal complaints, sometimes I'll order a fecal calprotectin, which is kind of like a really good screening test to see if someone has any gut issues going on.”
Lal also described some of the bias he believes people have relating to malignancy risk and psoriasis treatments, which he describes as inaccurate.
“These patients have, at some point, probably received phototherapy or had PUVA or, you know, other methods of phototherapy therapy that put you at risk for skin cancer,” he explained. “And so that's why I think that that statistic will change with time as a lot of people are no longer doing those old, you know, treatments for psoriasis, and more people are relying on biologics, I think it was really interesting that in this study, they found that you know, treatment with biologics did not show an increased risk of cancer.”
Lal explained further that chronic disease frequently coincides with depression, a difficulty compounded by the fact that mental health professionals may be difficult to find for patients struggling financially.
"So ultimately, what does this mean for me is, when I have patients with psoriasis, to always ask them about their mood," he said. "I always ask them about symptoms and regarding to depression whenever I see them.
For more information, view Dr. Lal’s full interview with HCPLive above.