Dr Steven R. Feldman on Managing Psoriasis in Patients With Metabolic Syndrome

Steven R. Feldman, MD, PhD, professor of dermatology, Wake Forest School of Medicine, discusses the challenges clinicians face when managing psoriasis in patients who also have metabolic syndrome.

Transcript

What are some of the challenges clinicians face when managing psoriasis in patients who also have metabolic syndrome?

Psoriasis is challenging whether you have metabolic syndrome or not. There’s the challenge of making the right diagnosis. That’s not hard; we recognize psoriasis when we see it. Prescribing the right therapy can be difficult. There are so many variations of psoriasis, so many different treatments available—creams, ultraviolet light treatments, a variety of oral and injectable medicines. We have to choose from among those.

When you have a patient who has metabolic syndrome, it complicates the decisions, perhaps, a little bit, or if not complicate it, at least leads you in certain pathways as to what to use. For example, metabolic syndrome may be associated with central obesity. Those patients may have a fatty liver, and therefore, you may want to steer away from a drug like methotrexate and move towards an injectable medicine.