Melodie Young, MSN, ANP-c: Managing Comorbid Psoriatic Disease

In recent dermatology meetings such as Maui Derm 2023 NP + PA Summer Conference in Colorado Springs this week, the topics of discussion and data presentation are nearly exclusive to innovation and progress in medicines, diagnostic tools and disease risk detection.

What sometimes gets lost in the fray of discussing the latest and greatest drugs in a chronic disease like psoriasis is the fact that the therapies will only get clinicians so far— treating the whole patient goes beyond just a prescription.

In the second segment of an interview with HCPLive while at the Maui Derm conference this week, Melodie Young, MSN, ANP-c, an NP with Modern Dermatology in Dallas, discussed the intricacies of psoriatic disease care she’s observed in her 30-plus years in practice. Young stressed her history of managing multigenerational psoriatic disease across different family members; long-term disparities between patients diagnosed and treated versus those who were not; and how pharmacotherapy progression has improved treatment capabilities for patients who would have not been so fortunate even a decade prior.

But the one key challenge she’s seen emerge and come to burden psoriatic disease without enough resistance over that time is obesity, a comorbidity factor which she maintains is not restricted to certain US patients; it has become a global exacerbator of disease.

“The first thing I do is look at their medicines when they come into the clinic,” Young said. “I’m not at all surprised to see if there’s something for lipid control, blood pressure control, maybe they have a sleep disorder. They very likely may have glucose intolerance or insulin resistance.”

Young said she also derives much of a patient’s potential struggle with comorbid disease based on her very first impression of them.

“You’re taught to start evaluating a patient the minute you see them get up in the waiting room,” she said. “A patient will get up, and as they’re walking back, I’m already evaluating (if) they have a little gimp, are they stiff when they’re walking? You can see how they’re getting around, then look at their age and realize, ‘This person’s disease is truly ravaging their body.’”

On the subject of non-pharmacologic interventions for psoriatic disease, Young reiterates the 3 pillars of health hold true: a proper diet, adequate exercise, and a healthy sleep schedule make a difference in her patients. If anything, those components of behavioral health give medical intervention the highest opportunity for success.

“It’s very important, because it makes so many other therapies available to you—so many options, because if you have something else wrong with you, it may limit what my choices would be,” Young said.

Young added there are some other obvious facets to behavioral health that play a role in psoriatic disease management—avoiding excessive drinking, and smoking altogether—but some holistic practices by patients may fall in gray area.

“There’s some data out there related to supplements that people would take, but there’s also a lot of opportunities for people being misdirected,” Young said. “And I don’t want people to think that treating psoriasis is so simple that if you stopped eating something, or avoided eating certain foods, or were so incredibly thin that they wouldn’t have psoriasis.”

The key is to establish a healthy lifestyle for individual patients—and to ensure they’re not putting pressure on themselves to cure their disease.

“It's just eat right, get a good night of sleep, take care of yourself, get a physical every year,” Young said. “My goal is to help you enjoy your life.”