Phosphodiesterase (PDE) inhibitors including apremilast and crisaborole ointment may provide safer alternatives than traditional steroid-sparing agents for psoriasis and atopic dermatitis. Side effects of apremilast may include GI symptoms, weight loss and depression, and taking apremilast with anti-seizure drugs or rifampin lowers apremilast blood levels, Apremilast is being studied in inflammatory bowel disease, Behcet's disease and pediatric psoriasis, and may have a place in the treatment of hidradenitis suppurativa (HS).
With a long history in dermatology and rheumatology, TNF inhibitors can not only improve psoriasis and psoriatic arthritis, but they also may reduce comorbid cardiovascular risks and work better combined with methotrexate. Low doses of cyclosporine may be effective at treating the psoriasis reaction when topicals have proven ineffective. Aggressively managing TNF-induced reactions can help patients stay on drugs that are working for other challenging diseases.
In skin of color, psoriasis can be tough to spot, and it carries a broader differential diagnosis. Darker-skinned patients may not know that they can develop psoriasis, or the importance of seeking treatment early.
Important recent publications from mainstream medical journals highlight the following: Automobile side windows do not block UV radiation well; An adjuvant herpes zoster vaccine works as well in patients over 70 years old as it did in the 50-plus age group; The American Academy of Ophthalmology recommends hydroxychloroquine and chloroquine dosing based on actual, not ideal, weight.