Managing patients with psoriasis—particularly those with moderate to severe disease—can be a challenging task, especially when patients struggle for months or even years to successfully treat and cope with the condition. In addition to the negative impact psoriasis often imposes on patients' lives due to its manifestation on the skin, clinical research has reinforced a correlation between psoriasis and the development of other serious co-morbid diseases, including obesity, cardiovascular disease, diabetes and depression.1 As reinforced by Dr. Jerry Bagel in the May issue (see PracticalDermatology.com), monitoring risks and presentation of symptoms related to these associated conditions is increasingly important among the psoriasis patient population.

Psoriasis & Obesity
Recent research has shown a link between psoriasis and obesity.2 Researchers with the Utah Psoriasis Initiative (UPI) previously reported that psoriasis had a causal effect on obesity, most likely due to patients' physical and emotional well-being as well as unhealthy behaviors, such as a lack of regular physical activity and overeating. In the same study, data indicated that not only was body mass index (BMI) increased for those with psoriasis when compared with the general population, but BMI trended higher in patients with more severe psoriasis than in those with mild cases.

I'd venture to say that many of us have treated psoriasis patients who have fallen into a vicious cycle of flare-ups and weight gain, with emotional distress being the end result. In my own practice, approximately one-third of my patients with psoriasis psoriasis are either overweight or obese. Many have stated they would like to lose weight by exercising at the gym but are embarrassed to do so because of the visible psoriatic plaques on their skin. Patients realize that losing weight is imperative for their overall health but fail to initiate an exercise program because they are depressed about their psoriasis. Consequently eating, drinking, and smoking excessively are some of the defense mechanisms that patients utilize to cope with their condition. However, I have noticed that many of my patients who have attained substantial clearance of their psoriasis through a successful treatment modality were able to lose a significant amount of weight afterwards. This most likely is due to the fact that their self-esteem and confidence were elevated, which lead to an increased motivation to loss weight.

Studies also indicate psoriasis patients have an increased risk for cardiovascular disease3 and diabetes, 4 diseases that may be preventable and/or manageable through proper diet and exercise. So while we carefully monitor for treatment side effects and adverse events, how closely are we evaluating other important factors, like body weight and eating habits, or level and frequency of exercise and physical activity? With what we know about our patients through both research and day-to-day clinical interactions, these are lifestyle areas we should be discussing with them during examinations, motivating them to adopt or maintain a healthier way of living.

Fit in Your Skin: A New Patient Offering
This year, I partnered with the National Psoriasis Foundation (NPF) and Centocor Ortho Biotech, Inc. on the launch of a first-of-its-kind exercise and diet program for the psoriasis community called Fit in Your Skin. While it seems there is a plethora of weight loss and diet plans available these days, Fit in Your Skin is different because the unique health resource was designed specifically for people living with psoriasis. Through an online portal, Fit in Your Skin (www.fitinyourskin.com) provides education and support to patients looking to eat healthier, exercise more regularly and manage their overall emotional well-being. It's been self-reported by a sizeable percentage of individuals with psoriasis that they avoid public places, like fitness centers, due to embarrassment over their physical symptoms. To that end, the program's sponsors enlisted the help of certified and nationally-recognized fitness trainer, Jackie Warner, to create a 30- minute, beginner-level routine that may be done in the home and modified based on comfort level and/or disease limitations. Reinforcing its focus on psoriasis patients, the program's exercise DVD and nutrition segment feature psoriasis patients who've empowered themselves to get healthier and inspire others to get fit, inside and out.

What I like about this program is its simplified approach in explaining the role that physical and emotional health plays in effectively managing psoriasis. In addition, treatment options are broadly addressed with the goal of encouraging an open dialogue with a dermatologist.

Seeing the Value of Fit in Your Skin
It's rewarding to recommend an exercise program to my psoriasis patients that takes into account their physical limitations, such as restricted mobility or plaques on the hands or feet. Patients who do sign up to receive the free exercise DVD will find that the routine can be performed at any fitness level and allows for a general progression when they find their athleticism increasing over time. Conversations on the National Psoriasis Foundation's message boards and social media platforms alike speak to the ease of incorporating the fundamentals of Fit in Your Skin into daily life.

Several of my psoriatic patients are actively following the program. They are grateful that this is a unique video tailored to fit their needs and have questioned why something like this has not come out sooner. One of my female patients who adhered to the instructions in the Fit in Your Skin video lost almost 20 pounds in the first six weeks. In addition, her stress level has been considerably reduced and she is better able to cope with her job and daily routines. Another patient was appreciative that the video was easy to follow and can be performed at one's own pace. The video has certainly created awareness of the necessity to stay fit, eat a balanced diet and minimize stress levels as much as possible in many of my patients.

It's clear that overall health and wellness is an area in which our patients are looking for more guidance. I believe that the availability of Fit in Your Skin is a significant advancement in addressing the full spectrum of health with a chronic condition like psoriasis. If you haven't done so already, I encourage you to visit www.fitinyourskin.com, review the materials and consider recommending the program to your patients.

Through my involvement in this campaign, I'm committed to helping my psoriasis patients grasp the full impact of their disease so they are motivated into action to adopt, and live, a healthy lifestyle. If nothing else, perhaps Fit in Your Skin may be just the “conversation starter” you need to engage in dialogue with your patients about how a healthy lifestyle works in tandem with appropriate treatment to improve their overall health.