More than skin deep: Psoriasis has hidden dangers

As we note in this month's cover story about dermatology for the internist, psoriasis is common, affecting about 2% of the general population. It's been known that patients with the condition are more vulnerable to heart attack, and thus their lipid and BP levels should be monitored. But a new study in the Archives of Dermatology suggests even this level of vigilance may not be enough.

Researchers at the University of Miami analyzed the records of 3,236 patients with psoriasis and 2,500 individuals without it, and found that even after age, sex, smoking status and history of hypertension, diabetes and dyslipidemia were controlled for, patients with psoriasis still were significantly more likely to have atherosclerosis, as well as ischemic heart disease, cerebral vascular disease, or PAD. As such, psoriasis carries an independent risk of higher mortality--19.9% vs. 9.9%.

So what's an internist to do with his or her psoriatic patients? Vigilantly screen them for CV risk factors, and consider prescriptive aspirin, the authors said, until more research can be done.

Labels: dermatology, psoriasis

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posted by Jessica Berthold at 3:00 PM   0 Comments

Warts and all

General internists must see a lot of crusty, itchy, oozing patients.

Today's "Essential Dermatology for the Practicing Internist" session was packed to the gills, with audience members consuming all available floor and wall space. Speaker Julia Nunley, ACP Member, even encouraged folks to sit down front in the area before the podium, "like little children at church."

Once settled in, we all enjoyed a pre-lunch earful and eyeful of scaly patches, inflamed sores, engorged pustules--and juicy clinical tidbits. Among them:

--Be sure to tell patients you treat for acne that it can take 2-3 months to clear up, and that the acne may not disappear completely. Many will quit treatment after three weeks if they don't see results.

--When female patients come in with acne, always ask about their menstrual cycles. "You don't want to miss PCOS," Dr. Nunley said. "When I'm checking out faces, I tuck my finger under the chin so I can feel to see if she's shaving. Often she won't tell you."

--Ask older patients with acne about flushing and blushing; you don't want to miss a diagnosis of rosacea.

--www.rosacea.org is a good site for patients to learn about things that can cause rosacea flair-ups. "You won't see this in any dermatology textbook, but rosacea flairs with menses," Dr. Nunley said. "For me personally, it flairs when I fly."

--Sun protection is the single most important treatment for rosacea. People are born with rosacea, and it gets worse with age-- but it can be stemmed if one is careful in the sun.

--Treatment for dandruff (Seborrheic Dermatitis) varies with ethnic background. African- Americans typically wash their scalps once per week, so shampoo treatments are of limited benefit. Ointments (fluocinonide) and oils (fluocinolone) should be used instead. For Asians and Caucasians, solutions (clobetasol) and lotions (triamcinolone) work well.

...and finally, the one that caused some gasps and murmurs to ripple through the crowd..

--HPV can actually live in liquid nitrogen. Never, ever double dip when performing back-to-back cryosurgery on warts.

Labels: dermatology, internal medicine 2009

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posted by Jessica Berthold at 4:30 PM   1 Comments

How do you pick a dermatologist?

So dermatology isn't a specialty particularly known for self-sacrifice and lack of interest in income (it is part of the ROAD, after all), but this New York Times article raises concerns that some dermatology practices are heavily prioritizing cosmetic patients over medical ones. An expert in the article suggests that concerned patients choose a dermatologist who focuses on medical, not cosmetic, problems, but presumably many patients rely on their primary care docs for a referral. Is the balance between cosmetic and medical practice something you think about when recommending a dermatologist? For now, this issue seems to be limited to a few specialties, but what happens if more internists turn to profitable self-pay sidelines (a trend we profiled a little while back)?

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posted by Stacey Butterfield at 11:42 AM   0 Comments