Jeffrey Cohen, MD: Mild Versus Severe Psoriasis, Recommended Therapies

During an HCPLive interview, Jeffrey Cohen MD, Yale School of Medicine assistant professor of dermatology, spoke about several other key pieces of information on psoriasis, the impacts of different therapies on comorbidities, and more.

Cohen had presented these points at the American Academy of Dermatology (AAD) 2023 Annual Meeting in New Orleans, LA.

He first discussed more about the effects of various types of therapies on patients with psoriasis and their comorbidities.

“So I think the most important thing to really understand is, in the case of inflammatory bowel disease, interleukin-17 inhibition can worsen that,” Cohen explained. “You really want to stay away from that. In the case of multiple sclerosis, or congestive heart failure, TNF alpha inhibition can worsen that, so you’d really want to stay away from that.”

He added that for a patient that has acute hepatitis B, psoriasis therapies are basically all best to avoid until the person can get some treatment with hepatology.

“And then for many of the others, it's a bit more nuanced,” he said. “But for psoriatic arthritis, many of the medications can be safe. Not all of them have a label for psoriatic arthritis. And so if you are treating a patient with psoriasis and psoriatic arthritis, you may want to use one of the many that are FDA-approved for both joint and skin disease.”

Cohen later spoke more broadly about treating mild-to-moderate psoriasis versus treating severe cases of the condition.

He noted that the medical world is starting to really see that although a patient may have mild-to-moderate psoriasis, instead of moderate-to-severe psoriasis, they can still develop some of the comorbidities that come up in patients with more severe psoriasis.

“And so we have increasingly been thinking about using systemic treatment in those patients. For example, the oral apremilast is now approved for mild, moderate, or severe psoriasis,” he explained. “And more and more studies are coming out using injectable biologics such as secukinumab for mild, moderate or severe psoriasis. And so, in general, someone with milder disease is probably going to start with topicals and you see if you can clear the patient with topicals.”

He added that patients with low body surface area and special sites, palm soles, genitals, though they have low body surface area, still may really benefit from systemic treatment.

For more information from Cohen’s presentation at AAD, view the full interview segment above.