HealthCert Blog

At the 2017 Scientific Meeting of the Australians College of Dermatologists, the Australasian Psoriasis Collaborative presented practical and evidence-based advice on the management of psoriasis. This included a discussion about using methotrexate in psoriasis treatment, the risk of malignancy associated with psoriasis, and the interplay of psoriasis and family planning.

The Collaborative reported that, when treating the condition with methotrexate, liver function tests only need to be performed every three to six months after the initial period, and that the best test to predict liver irritation is body mass index and abdominal girth rather than a liver function test. A test dose is of little value and above a methotrexate dose of 25mg it is best to split the dose. Methotrexate has a short half-life unless polyglutamated which takes five to six months, after which the maximal effect is seen. The Collaborative also reported it is worthwhile to test for infections such as tuberculosis and hepatitis at screening.

The Collaborative stated there is an inherent increased risk of malignancy in patients with psoriasis, with the main risk factor for malignancy related to comorbidities. The risk of non-Hodgkin lymphoma, T-cell lymphoma, solid organ, and non-melanoma skin cancer is increased. The Collaborative recommended that there should be age-appropriate cancer screening.

A third talk discussed psoriasis in those planning a pregnancy or breastfeeding. There are fewer births in patients with psoriasis but no increase in birth defects. Around two-thirds of patients have an improvement in psoriasis during pregnancy, but the condition worsens in 25 percent of patients and there is a post-partum flare in 65 percent. If one parent has the condition, there is a 16 percent chance of the child developing it too, but if both parents are affected then the risk increases to 50 percent. The Collaborative reported that folic acid is recommended if planning a pregnancy and that biologics are being prescribed more frequently by rheumatologists and gastroenterologists due to the greater risk of complications if they are ceased and the underlying disease flares. Stopping biologics in the third trimester should be considered to reduce the risk of immunosuppression of the newborn.

Read more recent research on psoriasis.

Source:
Psoriasis Symposium at the 50th Annual Scientific Meeting of the Australasian College of Dermatologists. Dermatology Practice Review. Issue 5.

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