Is PRP part of the Psoriatic Continuum

Editor’s Note: August 2015 was Psoriasis Awareness Month. I did just that — I became aware. The result was an article published in the September 2015 issue of On the Road.

The National Psoriasis Foundation (NPF) is the world’s largest nonprofit serving more than 2.1 million people with psoriasis and psoriatic arthritis annually by promoting health education and advocacy initiatives.

When PRP is misdiagnosed, psoriasis is the skin disorder most frequently cited. Fortunately, many of the treatment options are common to both diseases.

Does the sword cut both ways? How many people have been misdiagnosed with psoriasis who should be diagnosed with PRP?

Psoriatic Continuum

There may be other more scientific definitions associated with the term Psoriatic Continuum, but from the perspective of someone well-schooled in Dr. Emmett L. Brown’s space-time continuum (circa 1985, Back to the Future) here’s my version.

Psoriasis comes in several flavors: plaque psoriasis, guttate, inverse, pustular and erythrodermic.

Erythrodermic [eh-REETH-ro-der-mik] psoriasis is a “particularly severe form of psoriasis that leads to widespread, fiery redness over most of the body. It can cause severe itching and pain, and make the skin come off….” Sound familiar?

It is estimated that three percent of the 7.5 million people living with psoriasis in the U.S. have erythrodermic psoriasis.

I am not suggesting that erythrodermic psoriasis and PRP are the same skin malady. What I am suggesting is that PRP may be another form of psoriasis, a more aggressive form. A link between PRP and psoriasis would have a profound impact on the PRP community.

Diagnosis. Whenever erythrodermic psoriasis is considered, PRP should be mentioned in the same breath.

Treatment options. Drugs heretofore unavailable to PRPers could become readily available and covered by insurance. Imagine having unfettered access to Stelara, Cosentyx, Enbrel, Remicade and Humira.

Coping strategies. Much of the advice given to a patient with psoriasis applies to PRP. We can tap into a rich vein of useful information developed by the NPF.

Research. The NPF alone has funded more than $13 million in psoriatic disease research grants and fellowships.

Not so fast…

Each type of psoriasis has its own range of severity, from mild to severe. Glen Misek, fellow PRPer, has suggested an alternate diagram where psoriasis is classified as mild, moderate and severe. He would add erythroderma to the right of severe and then do the same for PRP by adding mild, moderate and severe with erythroderma to the far right (see chart below). What if? What if, indeed.

Glen Misek offers his perspective: 

What if there is a bona fide connection between psoriasis and PRP that puts PRP in the psoriatic continuum? Glen notes that psoriasis can be mild moderate or severe and may or may not involve erythroderma.

“It’s the erythroderma that takes the condition over the top. PRP likewise appears to vary from mild, moderate and severe and can involve erythroderma which, in turn, takes the condition over the top.

“I think the PRP overlap with psoriasis is mostly with plaque that can cover much of the body. Also, triggers for erythroderma and psoriasis can include drug reactions, especially prednisone.

Treatments for the conditions are very similar, especially the use of biologics.

Finally, like PRP, psoriasis treatments are not effective for all patients. So if one does not work, the dermatologist simply moves to another. However, the newer targeted biologics are working for greater percentages of patients. Hence, there is hope for PRP.

Path Forward

The worldwide PRP community should encourage and promote research to confirm whether or not PRP is on the Psoriatic Continuum. Moreover, we should foster an advocacy relationship with the National Psoriasis Foundation.