RESUMEN
BACKGROUND: For psoriatic patients who need to receive nonlive or live vaccines, evidence-based recommendations are needed regarding whether to pause or continue systemic therapies for psoriasis and/or psoriatic arthritis. OBJECTIVE: To evaluate literature regarding vaccine efficacy and safety and to generate consensus-based recommendations for adults receiving systemic therapies for psoriasis and/or psoriatic arthritis receiving nonlive or live vaccines. METHODS: Using a modified Delphi process, 22 consensus statements were developed by the National Psoriasis Foundation Medical Board and COVID-19 Task Force, and infectious disease experts. RESULTS: Key recommendations include continuing most oral and biologic therapies without modification for patients receiving nonlive vaccines; consider interruption of methotrexate for nonlive vaccines. For patients receiving live vaccines, discontinue most oral and biologic medications before and after administration of live vaccine. Specific recommendations include discontinuing most biologic therapies, except for abatacept, for 2-3 half-lives before live vaccine administration and deferring next dose 2-4 weeks after live vaccination. LIMITATIONS: Studies regarding infection rates after vaccination are lacking. CONCLUSION: Interruption of antipsoriatic oral and biologic therapies is generally not necessary for patients receiving nonlive vaccines. Temporary interruption of oral and biologic therapies before and after administration of live vaccines is recommended in most cases.
Asunto(s)
Artritis Psoriásica , Productos Biológicos , Consenso , Técnica Delphi , Psoriasis , Humanos , Psoriasis/tratamiento farmacológico , Artritis Psoriásica/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Productos Biológicos/administración & dosificación , Administración Oral , Vacunación/normas , Adulto , COVID-19/prevención & control , Vacunas contra la COVID-19/administración & dosificación , SARS-CoV-2 , Metotrexato/uso terapéutico , Metotrexato/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéuticoRESUMEN
Methotrexate (MTX) is a readily accessible drug, first used in 1948 and employed for a wide variety of indications since then. However, despite widespread off-label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off-label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence- and consensus-based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence- and consensus-based recommendations, each with >70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence- and consensus-based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time-honored medication.
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Dermatitis Atópica , Psoriasis , Humanos , Niño , Metotrexato , Consenso , Psoriasis/tratamiento farmacológico , Dermatitis Atópica/tratamiento farmacológicoRESUMEN
BACKGROUND: Psoriasis is associated with comorbid systemic metabolic disease. OBJECTIVE: To assess possible associations of comorbid obesity, history of diabetes, hypertension, and hyperlipidemia with response to biologic treatment at 6 months among patients in CorEvitas' Psoriasis Registry. METHODS: Participants included 2924 patients initiating biologic therapy (tumour necrosis factor inhibitors [TNFi], interleukin [IL]-17i, IL-12/23i, or IL-23i) with baseline and 6-month follow-up visits available. Logistic regressions resulted in adjusted odd ratios (OR) and 95% confidence intervals (CI) for achievement of response in select outcomes for those with obesity and history of diabetes, hypertension, and hyperlipidemia relative to those without each. RESULTS: Overall, obesity reduced by 25% to 30% odds of achieving PASI75 (OR, 0.75; 95% CI, 0.64-0.88) and PASI90 (OR, 0.70; 95% CI, 0.59-0.81). History of diabetes reduced odds of achieving PASI75 by 31% (OR, 0.69; 95% CI, 0.56-0.85) and PASI90 by 21% (OR, 0.79; 95% CI, 0.63-0.98). Obesity was associated with lower response to TNFi and IL-17i classes. Independent of obesity, diabetes was associated with poorer outcomes when on IL-17i therapy and hypertension, to a lesser extent, when on the TNFi class. No significant associations were found in the hyperlipidemia group. LIMITATIONS: The study assessed only short-term effectiveness and small sample sizes limited the power to detect differences. CONCLUSION: Assessment of comorbid disease burden is important for improved likelihoods of achieving treatment response with biologics.
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Productos Biológicos , Diabetes Mellitus , Hipertensión , Psoriasis , Productos Biológicos/uso terapéutico , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Obesidad/complicaciones , Obesidad/epidemiología , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Psoriasis/epidemiología , Sistema de Registros , Resultado del Tratamiento , Inhibidores del Factor de Necrosis TumoralRESUMEN
BACKGROUND: The National Psoriasis Foundation (NPF) published treatment targets for US patients with plaque psoriasis. However, data are lacking on how well existing therapies help achieve these goals. OBJECTIVE: To examine the ability of an interleukin 17 inhibitor, ixekizumab, in achieving these treatment targets. METHODS: Post hoc analysis was performed on pooled data from 4 phase III clinical trials assessing ixekizumab for plaque psoriasis: the UNCOVER-1, -2, and -3 trials and the IXORA-S trial. Treatment response was evaluated using the NPF-defined acceptable response (affected body surface area [BSA] of 3% or less or BSA improvement of 75% or higher at 12 weeks of treatment) and target response (BSA of 1% or less at 12 weeks and every 6 months thereafter). RESULTS: In the UNCOVER trials (n = 2701), acceptable and target response rates at week 12 were 73.9% and 51.8% with ixekizumab 80 mg every 2 weeks, 35.7% and 14.9% with etanercept 50 mg, and 3.0% and 0.6% with placebo, respectively. In the IXORA-S trial (n = 302), acceptable and target response rates at week 12 were significantly higher with ixekizumab every 2 weeks versus ustekinumab (acceptable response 68.4% vs 38.6%, P < .0001; target response 50.7% vs 24.1%, P < .0001). LIMITATIONS: Data were from controlled studies and may not reflect real-world practice. CONCLUSION: The majority of patients treated with ixekizumab in 4 phase III clinical trials achieved NPF, patient-centered treatment targets.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Psoriasis/tratamiento farmacológico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To update guidance regarding the management of psoriatic disease during the COVID-19 pandemic. STUDY DESIGN: The task force (TF) includes 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation staff. Clinical questions relevant to the psoriatic disease community were informed by inquiries received by the National Psoriasis Foundation. A Delphi process was conducted. RESULTS: The TF updated evidence for the original 22 statements and added 5 new recommendations. The average of the votes was within the category of agreement for all statements, 13 with high consensus and 14 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is variable in quality and/or quantity. CONCLUSIONS: These statements provide guidance for the treatment of patients with psoriatic disease on topics including how the disease and its treatments affect COVID-19 risk, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 (including novel vaccination), and what they should do if they develop COVID-19. The guidance is a living document that is continuously updated by the TF as data emerge.
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Vacunas contra la COVID-19 , COVID-19/prevención & control , Psoriasis/tratamiento farmacológico , Productos Biológicos/uso terapéutico , COVID-19/complicaciones , COVID-19/epidemiología , Toma de Decisiones Conjunta , Medicina Basada en la Evidencia , Humanos , Factores Inmunológicos/uso terapéutico , Pandemias , Psoriasis/complicaciones , Factores de Riesgo , Estados Unidos/epidemiología , Tratamiento Farmacológico de COVID-19RESUMEN
To compare drug survival of ixekizumab to other IL-17 inhibitors (IL-17i) and TNF inhibitors (TNFi) among patients with psoriasis (PsO) in a real-world setting. Participants included adult PsO patients enrolled in the Corrona Psoriasis Registry who initiated ixekizumab, TNFi, or other IL-17i between 16 March 2016 to 10 August 2019 and completed ≥1 follow-up visit. Multivariable adjusted hazard ratios (HR) were calculated to estimate the risk for drug discontinuation in the ixekizumab group relative to the other drugs. Among the 1604 drug initiations, 552 initiated ixekizumab, 450 initiated TNFi, and 602 initiated other IL-17i. Mean age was 51 years, 49% were women, and 52% were obese (BMI > 30). Ixekizumab patients had a higher proportion of patients with PASI >12 at drug initiation (24%) than TNFi (15%) and other IL-17i (19%). Over a median of 11 months of follow-up, 723/1604 (45%) drug discontinuations occurred. Persistence of ixekizumab, TNFi, and other IL-17i at 24-months were 68%, 33%, and 46%, among biologic-naïve patients (n = 543), and 46%, 23%, and 36%, for biologic-experienced patients (n = 1061), respectively. Ixekizumab patients had a 64% lower risk of discontinuation vs TNFi (HR = 0.36; 95% CI 0.27-0.47) and a 31% lower risk vs other IL-17i (HR = 0.69, 95% CI 0.55-0.87) after adjustment for biologic experience and other covariates. HRs were similar when limited to patients with moderate-to-severe PsO (BSA > 3, PASI > 3, and IGA > 1, n = 1076) at initiation. In our study of real-world patients with PsO, initiators of ixekizumab had more prolonged drug survival than both initiators of TNFi and other IL-17i up to 2 years of follow-up.
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Anticuerpos Monoclonales Humanizados , Interleucina-17/antagonistas & inhibidores , Psoriasis , Inhibidores del Factor de Necrosis Tumoral , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Sistema de RegistrosRESUMEN
BACKGROUND: Many patients with psoriasis are bothered by symptoms in highly visible, pruritic areas, such as the scalp. OBJECTIVE: To evaluate the efficacy and safety of apremilast for moderate to severe scalp psoriasis. METHODS: This phase 3b, double-blind, placebo-controlled study randomized adults with moderate to severe scalp psoriasis who had inadequate response/intolerance to at least 1 topical scalp psoriasis therapy (NCT03123471). The primary endpoint was the proportion of patients who achieved Scalp Physician Global Assessment response, defined as score of 0 (clear) or 1 (almost clear), with at least a 2-point reduction, at week 16. Secondary endpoints included at least a 4-point improvement from baseline in Whole Body Itch and Scalp Itch Numeric Rating Scales (NRSs) and mean improvement in Dermatology Life Quality Index (DLQI) at week 16. RESULTS: There were 303 randomized patients (placebo: n = 102; apremilast: n = 201). With apremilast, significantly more patients achieved Scalp Physician Global Assessment (43.3% vs 13.7%), Scalp Itch NRS (47.1% vs 21.1%), and Whole Body Itch NRS (45.5% vs 22.5%) response, and significantly greater DLQI improvement was observed versus placebo (-6.7 vs -3.8; all P < .0001). Common adverse events with apremilast were diarrhea (30.5%), nausea (21.5%), headache (12.0%), and vomiting (5.5%). LIMITATIONS: Patients with mild disease were not enrolled. CONCLUSION: Apremilast showed efficacy for the treatment of moderate to severe scalp psoriasis.
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Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Psoriasis/tratamiento farmacológico , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Talidomida/análogos & derivados , Administración Oral , Antiinflamatorios no Esteroideos/administración & dosificación , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Calidad de Vida , Índice de Severidad de la Enfermedad , Talidomida/administración & dosificación , Talidomida/efectos adversos , Talidomida/uso terapéutico , Resultado del TratamientoRESUMEN
OBJECTIVE: To provide guidance about management of psoriatic disease during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: A task force (TF) of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was convened. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation (NPF) staff. Clinical questions relevant to the psoriatic disease community were informed by questions received by the NPF. A Delphi process was conducted. RESULTS: The TF approved 22 guidance statements. The average of the votes was within the category of agreement for all statements. All guidance statements proposed were recommended, 9 with high consensus and 13 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is limited in quality. CONCLUSION: These statements provide guidance for the management of patients with psoriatic disease on topics ranging from how the disease and its treatments impact COVID-19 risk and outcome, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 and what they should do if they develop COVID-19. The guidance is intended to be a living document that will be updated by the TF as data emerge.
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Infecciones por Coronavirus/epidemiología , Inmunosupresores/efectos adversos , Organizaciones sin Fines de Lucro/normas , Neumonía Viral/epidemiología , Psoriasis/tratamiento farmacológico , Comités Consultivos/normas , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , COVID-19 , Consenso , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/virología , Cuidados Críticos/normas , Técnica Delphi , Dermatología/normas , Epidemiología/normas , Humanos , Infectología/normas , Organizaciones sin Fines de Lucro/organización & administración , Pandemias/prevención & control , Neumonía Viral/inmunología , Neumonía Viral/prevención & control , Neumonía Viral/virología , Psoriasis/complicaciones , Psoriasis/inmunología , Reumatología/normas , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
The National Psoriasis Foundation has emphasized the importance of achieving skin clearance targets throughout the course of treatment. However, patients with psoriasis often stop and restart treatment for reasons such as psychological distress, dissatisfaction with treatment, inconvenience, cost, or comorbidities. Brodalumab is a fully human anti-interleukin-17 receptor A monoclonal antibody efficacious for the treatment of moderate-to-severe plaque psoriasis. This review discusses the efficacy and safety of brodalumab and other biologic therapies in patients with psoriasis who stop and restart treatment. These clinically relevant and important findings can help inform real-world treatment decisions. J Drugs Dermatol. 2020;19(4):384-387. doi:10.36849/JDD.2020.5026.
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Anticuerpos Monoclonales Humanizados/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Satisfacción del Paciente , Psoriasis/tratamiento farmacológico , Receptores de Interleucina-17/inmunología , Anticuerpos Monoclonales Humanizados/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Humanos , Psoriasis/patología , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Herpes zoster (HZ) incidence is linked to immunosuppression. Patients with psoriasis or psoriatic arthritis (PsA) on systemic therapy might be at an increased risk for HZ. OBJECTIVE: To assess HZ risk in patients with psoriasis and PsA by systemic treatment and provide recommendations regarding HZ vaccination. METHODS: A systematic literature search was performed for HZ in patients with psoriasis and PsA. HZ vaccination guidelines were reviewed, and the medical board of the National Psoriasis Foundation made consensus recommendations in psoriasis and PsA patients using graded evidence. RESULTS: In total, 41 studies met inclusion criteria. Systemic corticosteroids (strong, 1), tofacitinib (strong, 1), and combination therapy with biologic and conventional synthetic disease-modifying antirheumatic drugs (weak, 2a) carry increased HZ risk while monotherapy does not. There is insufficient evidence to determine risk with interleukin 12/23, 17, and 23 inhibitors or apremilast (weak, 2a). Recombinant zoster vaccine is recommended for all psoriasis and PsA patients >50 years old and patients <50 years old on tofacitinib, systemic steroids, or combination systemic treatment. Vaccination of patients <50 years old on other systemic therapies may be considered on a case-by-case basis. LIMITATIONS: There was significant heterogeneity between studies. CONCLUSION: HZ risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all psoriasis and PsA patients >50 years old and younger patients at increased risk.
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Artritis Psoriásica/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Vacuna contra el Herpes Zóster/administración & dosificación , Herpes Zóster/prevención & control , Psoriasis/tratamiento farmacológico , Psoriasis/inmunología , Adulto , Antirreumáticos/uso terapéutico , Artritis Psoriásica/epidemiología , Artritis Psoriásica/inmunología , Femenino , Herpes Zóster/epidemiología , Herpes Zóster/inmunología , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pronóstico , Psoriasis/epidemiología , Medición de Riesgo , Sociedades Médicas , Resultado del Tratamiento , Estados Unidos , Vacunación/métodosRESUMEN
BACKGROUND: There are limited data about the impact of narrowband ultraviolet B phototherapy on patient-reported measures of health-related quality of life. OBJECTIVE: To evaluate the impact of adalimumab and phototherapy on health-related quality of life. METHODS: We examined patient-reported outcomes from a multicenter, randomized, placebo-controlled trial (ClinicalTrials.gov no. NCT01553058). The Dermatology Life Quality Index and EQ-5D-3L were evaluated every 4 weeks. RESULTS: We enrolled 97 patients: 30.9% were female, mean age was 43.5 years (standard deviation, 14.0), and median Psoriasis Area and Severity Index score was 16.7 (interquartile range, 13.9-21.6). At week 12, patients being treated with adalimumab (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.02-8.17) and phototherapy (OR, 8.83; 95% CI, 2.47-31.57) were more likely to achieve the minimal clinically important difference in the Dermatology Life Quality Index compared with those receiving placebo. There were higher odds of achieving the minimal clinically important difference for the EQ-5D-3L Index score when comparing phototherapy versus placebo (OR, 9.78; 95% CI, 2.99-31.95) and phototherapy versus adalimumab (OR, 4.07; 95% CI, 1.42-11.70). LIMITATIONS: Small sample size, secondary analysis, generalizability. CONCLUSION: Phototherapy and adalimumab both improve skin-related quality of life and overall health-related quality of life compared with placebo in patients with psoriasis; however, patients treated with phototherapy achieved more improvement in overall health-related quality of life compared with patients treated with adalimumab.
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Adalimumab/uso terapéutico , Antiinflamatorios/uso terapéutico , Psoriasis/terapia , Calidad de Vida , Terapia Ultravioleta , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diferencia Mínima Clínicamente Importante , Medición de Resultados Informados por el Paciente , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: There is a significant association between psoriasis and inflammatory bowel disease (IBD). Many treatments for psoriasis and psoriatic arthritis are also used for IBD. OBJECTIVE: To assess therapeutic options for patients with psoriasis and concurrent IBD. METHODS: A systematic literature search was performed for clinical studies of biologic and systemic psoriasis medications in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease, for the period from January 1, 1947, to February 14, 2017. Randomized, controlled, double-blinded studies were selected if available. If not, the next highest level of available evidence was selected. RESULTS: Of the 2282 articles identified, 132 were selected. Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative; colitis, and Crohn's disease. Ustekinumab has demonstrated efficacy in psoriasis, psoriatic arthritis, and Crohn's disease. Certolizumab has demonstrated efficacy in psoriatic arthritis and Crohn's disease. Etanercept, secukinumab, brodalumab, and ixekizumab have demonstrated efficacy in psoriasis and psoriatic arthritis but may exacerbate or induce IBD. Guselkumab has demonstrated efficacy in psoriasis. LIMITATIONS: There are no known clinical trials of treatment specifically for concurrent psoriasis and IBD. CONCLUSIONS: Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease; other agents have demonstrated efficacy for some, but not all, of these indications.
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Fármacos Dermatológicos/uso terapéutico , Fármacos Gastrointestinales/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Psoriasis/complicaciones , Psoriasis/terapia , Acitretina/uso terapéutico , Adalimumab/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Certolizumab Pegol/uso terapéutico , Ciclosporina/uso terapéutico , Etanercept/uso terapéutico , Humanos , Infliximab/uso terapéutico , Talidomida/análogos & derivados , Talidomida/uso terapéutico , Ustekinumab/uso terapéuticoRESUMEN
Given the change in our population to one that is more racially and ethnically diverse, the topic of diversity in dermatology residency programs has gained attention. In a field that has become highly competitive, diversity is lagging behind. What are the reasons for this? The existing diversity among medical school matriculants is reflective of the applicant pool, and although modest, there has been an increase in applications and acceptances from minority populations. However, these proportions do not carry through to the population applying to dermatology residency. Making sense of this and planning how to recruit a more diverse applicant pool will improve the quality and cultural competency of future dermatologists.
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Diversidad Cultural , Dermatología/educación , Dermatología/estadística & datos numéricos , Internado y Residencia/estadística & datos numéricos , HumanosRESUMEN
Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.
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Enfermedades Cardiovasculares/epidemiología , Neoplasias/epidemiología , Psoriasis/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Humanos , Infecciones/epidemiología , Enfermedades Inflamatorias del Intestino/epidemiología , Hepatopatías/epidemiología , Trastornos del Humor/epidemiología , Obesidad/epidemiología , Prevalencia , Insuficiencia Renal Crónica/epidemiologíaRESUMEN
As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.