Ask the Expert
Available Questions
Recent questions submitted to Ask the Expert by your colleagues are listed below, along with the answers provided by a member of our expert panel. Each question/answer is available for CME credit.
- January 31, 2011
- Treatment options for a patient who is breastfeeding
I have a 37-year-old female patient who has moderate psoriasis with scalp and face involvement. She was being treated with UVB two to three times per week and calcipotriene until she became pregnant, at which point she continued with UVB therapy alone. She is now 2 months postpartum and wants to “recover” from pregnancy as quickly as possible, including getting back to her prepregnancy clearance. My patient is breastfeeding and says she plans to continue until her son reaches 1 year. She is having issues with phototherapy since it requires frequent visits. What can I offer her?
Answered by: Melodie Young, MSN, RN, A/GNP-C
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Release date: January 2011
Expiration date: January 31, 2012
- January 31, 2011
- Treatment suggestion for a patient taking lithium for bipolar disease
I have a patient with serious bipolar psychosis. She was doing well with lithium treatment, but when she is on appropriate lithium levels her psoriasis symptoms worsen. She is a young woman. No other treatment is effective for her psychosis, but she is unwilling to have even minor psoriatic plaques. I was considering a treatment for psoriasis, but I am not sure if this has been done in this type of patient.
Answered by: Jerry Bagel, MD
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Release date: January 2011
Expiration date: January 31, 2012
- January 31, 2011
- Surgery in a patient receiving adalimumab for psoriatic arthritis
My patient is a 72-year-old man with psoriatic arthritis who is taking adalimumab. He informed me that he is scheduled for bypass surgery in 3 weeks. Should he stop adalimumab? If so when? And when can he start again?
Answered by: Neil J. Korman, MD, PhD
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Release date: January 2011
Expiration date: January 31, 2012
- July 14, 2010
- Anti-TNF therapy in a patient with congestive heart failure
I have a 65-year-old male patient who has had moderate to severe plaque psoriasis for about 35 years. He has used topical steroid creams and systemic nonbiologic therapies with little to no success. He is currently taking an injectable anti–tumor necrosis factor (TNF) agent and is happy with the results. He is overweight and a heavy smoker. While shoveling snow this winter, he became out of breath and went to the emergency room and was diagnosed with congestive heart failure. Should the biologic therapy be continued? What are the best treatment options for this patient now?
Answered by: Steven C. Shapiro, MD
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Release date: July 2010
Expiration date: July 31, 2011
- July 14, 2010
- Managing a psoriasis flare in a patient with Crohn’s disease
What is the best treatment for a patient with Crohn's disease who was also recently diagnosed with psoriasis? The patient is already taking biologic therapy for Crohn’s disease.
Answered by: David J. Cohen, MD
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Release date: July 2010
Expiration date: July 31, 2011
- January 29, 2010
- Treatment options for palmar psoriasis
What is the recommended treatment for severe disabling palmar psoriasis (differential diagnosis includes hand eczema) in a patient with coronary artery disease, obesity, and recent placement of a defibrillator?
Answered by: Jeffrey M. Weinberg, MD
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Release date: January 2010
Expiration date: January 31, 2011
- November 11, 2009
- Biologic psoriasis treatment and cardiovascular risk reduction
For biologic agents used to treat severe psoriasis, what are the underlying mechanisms of action that reduce cardiovascular risks?
Answered by: David J. Cohen, MD
Release date: November 2009
Expiration date: November 30, 2010No longer available for CME credit
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- October 7, 2009
- Possible effects of gastric bypass surgery on psoriasis in an obese patient
What recommendations do you have for the treatment of an obese patient with psoriasis and psoriatic arthritis who is considering gastric bypass surgery? Will it improve the psoriatic disease? Are there any risks related to the psoriatic disease?
Answered by: David J. Cohen, MD
Release date: October 2009
Expiration date: October 31, 2010No longer available for CME credit
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- September 9, 2009
- Treatment of a patient with long-standing psoriasis that is unresponsive to acitretin
I have a 50-year-old patient who has had psoriasis since he was 30. Two months ago he developed erythroderma and was treated with acitretin 25 mg daily for 1 month. His erythroderma cleared, so the acitretin was reduced to 10 mg daily. The patient’s psoriasis returned, so I resumed the 25-mg dose of acitretin. All lab analysis is OK (liver, kidney). His response has not been satisfactory, what should I try next for this patient? We live in Tunisia.
Answered by: Jeffrey M. Weinberg, MD
Release date: September 2009
Expiration date: September 30, 2010No longer available for CME credit
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- August 12, 2009
- Use of infliximab in a patient who will receive a silicone breast implant
I have a 36-year-old patient with psoriasis who has been receiving infliximab every 8 weeks for 2 years. Her psoriasis cleared after the induction phase. She intends to undergo an abdominal lipoaspiration and to receive silicone breast implants. I said that she needs discontinue infliximab 2 months before the lipoaspiration and recommended against the implants, but she is very insistent. The patient wants to continue the use of infliximab after the breast silicone implant. Is there a contraindication to silicone breast implants in patients taking biologics, specifically infliximab?
Answered by: Linda Stein Gold, MD
Release date: August 2009
Expiration date: August 31, 2010No longer available for CME credit
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- July 15, 2009
- Animal models of psoriasis
Are there any good animal models to test new drugs for psoriasis?
Answered by: Steven C. Shapiro, MD
Release date: July 2009
Expiration date: July 31, 2010No longer available for CME credit
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- June 24, 2009
- Tuberculosis testing, vaccinations, and the American Academy of Dermatology and National Psoriasis Foundation recommendations
What are the recommendations for patients who were tested for tuberculosis prior to onset of biologic therapy but did not receive all the immunizations listed in the current American Academy of Dermatology published guidelines?
Answered by: Steven C. Shapiro, MD
Release date: June 2009
Expiration date: June 30, 2010No longer available for CME credit
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- June 10, 2009
- Calculating Nail Psoriasis Severity Index (NAPSI)
How can I calculate Nail Psoriasis Severity Index (NAPSI)?
Answered by: Neil J. Korman, MD, PhD
Release date: June 2009
Expiration date: June 30, 2010No longer available for CME credit
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- May 27, 2009
- Methotrexate and pregnancy
What are the recommendations regarding treatment with methotrexate and pregnancy in a female patient?
Answered by: David J. Cohen, MD
Release date: May 2009
Expiration date: May 31, 2010No longer available for CME credit
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- April 30, 2009
- Deficiency of p40 and its role in psoriasis and immune response
Centocor has identified a cohort of patients who are deficient in p40. They have increased bacterial infections, no increased viral infections, and no cases of psoriasis. The gene(s) that code for p40 are important for bacterial infections including tuberculosis, as well as interleukin (IL)-12 and IL-23 production. In light of the importance of p40 in the pathophysiology of psoriasis, can one conclude that the Th1 and Th17 pathways are the only 2 pathways that are abnormal in psoriasis? Also, why are viral infections not increased in patients with this genetic defect?
Answered by: Jeffrey M. Weinberg, MD
Release date: April 2009
Expiration date: April 30, 2010No longer available for CME credit
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- March 24, 2009
- Biologic treatment of adolescents
Are there any biologic agents that can be used in an adolescent (12-year-old) patient with severe psoriasis that is not responding to topical treatments or phototherapy?
Answered by: Neil J. Korman, MD, PhD
Release date: March 2009
Expiration date: March 31, 2010No longer available for CME credit
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- March 19, 2009
- Biologics and tuberculosis
A patient who has been on infliximab for 14 months had a positive PPD. I discontinued the infliximab. Is there a biologic agent that I can safely use in this patient?
Answered by: Steven C. Shapiro, MD
Release date: March 2009
Expiration date: March 31, 2010No longer available for CME credit
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- March 18, 2009
- Peripheral edema and adalimumab
A patient developed marked peripheral edema after the first dose of adalimumab. Is this a recognised adverse reaction and what are the mechanisms involved?
Answered by: Jeffrey M. Weinberg, MD
Release date: March 2009
Expiration date: March 31, 2010No longer available for CME credit
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- March 18, 2009
- PPD testing in patients on anti-TNF agents
What is the recommended protocol for tuberculosis testing in patients who will be placed on an anti–tumor necrosis factor (TNF) agent?
Answered by: David J. Cohen, MD
Release date: March 2009
Expiration date: March 31, 2010No longer available for CME credit
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