This Patient Perspective highlights the lived experiences of individuals with psoriasis regarding cardiovascular disease (CVD) risk and prevention. Drawing on national survey responses and user feedback from the TEXTME PSO trial, it reveals low awareness of the psoriasis–CVD link but high receptiveness to education, screening and digital support. The findings underscore the need for holistic, patient-centred care that integrates CVD prevention into routine dermatology practice.

Importance Cardiovascular disease (CVD) is the leading cause of mortality in patients with psoriasis, yet structured CVD prevention is not routinely embedded in dermatology care. Objective To evaluate the effectiveness of a text-messaging intervention in improving patient activation and cardiovascular risk factors among patients with psoriasis. Design, Setting, and Participants This single-center, parallel-group randomized clinical trial took place at a tertiary hospital dermatology clinic in Australia from February 2024 to February 2025. Adults with dermatologist-confirmed psoriasis were randomized 1:1 during outpatient dermatology visits between April and July 2024. Data were analyzed from February to April 2025. Intervention A 6-month text-messaging intervention (Tobacco, Exercise, and Diet Messages for Psoriasis [TEXTME PSO]), comprising 4 text messages per week, compared with standard care. Main Outcomes and Measures The primary outcome was score on the 13-item Patient Activation Measure. Secondary outcomes included Mediterranean Diet Score, physical activity, cardiometabolic measures, psoriasis-CVD knowledge, medication adherence, Psoriasis Area and Severity Index, Dermatology Life Quality Index, and user feedback. Analysis of covariance was used to adjust for baseline values under an intention-to-treat framework with multiple imputation. Results Among 111 participants (mean [SD] age, 51.8 [13.2] years; 71 [65.1%] male), the intervention showed a statistically significant improved patient activation at 6 months compared with usual care (adjusted mean difference, 10.8 points; 95% CI, 7.0-14.6 points; P < .001). Statistically significant improvements were also observed in Mediterranean diet adherence (adjusted mean difference, 1.7; 95% CI, 1.0-2.4; P < .001), medication adherence (adjusted mean difference, 1.6; 95% CI, 0.8-2.5; P < .001), and psoriasis-CVD knowledge (adjusted mean difference, 6.6; 95% CI, 4.7-8.4; P < .001). Minutes per week of physical activity increased (adjusted mean difference, 127.9; 95% CI, 21.9-234.0; P = .02), and body mass index, calculated as weight in kilograms divided by height in meters squared, decreased (adjusted mean difference, −1.0; 95% CI, −1.4 to −0.7; P < .001). No statistically significant between-group differences were observed for lipid parameters, hemoglobin A 1c , smoking behavior, dermatology-specific quality of life, or psoriasis severity. Conclusions and Relevance In this randomized clinical trial, a text-messaging intervention improved patient activation and cardiovascular risk behaviors in adults with psoriasis. While biomarker changes were modest or not statistically significant, findings support digital tools as an adjunct to cardiovascular risk in dermatology care. Trial Registration ANZCTR Identifier: ACTRN12624000498594

Importance:Cardiovascular disease (CVD) is the leading cause of mortality in patients with psoriasis, yet structured CVD prevention is not routinely embedded in dermatology care. Objective:To evaluate the effectiveness of a text-messaging intervention in improving patient activation and cardiovascular risk factors among patients with psoriasis. Design, Setting, and Participants:This single-center, parallel-group randomized clinical trial took place at a tertiary hospital dermatology clinic in Australia from February 2024 to February 2025. Adults with dermatologist-confirmed psoriasis were randomized 1:1 during outpatient dermatology visits between April and July 2024. Data were analyzed from February to April 2025. Intervention:A 6-month text-messaging intervention (Tobacco, Exercise, and Diet Messages for Psoriasis [TEXTME PSO]), comprising 4 text messages per week, compared with standard care. Main Outcomes and Measures:The primary outcome was score on the 13-item Patient Activation Measure. Secondary outcomes included Mediterranean Diet Score, physical activity, cardiometabolic measures, psoriasis-CVD knowledge, medication adherence, Psoriasis Area and Severity Index, Dermatology Life Quality Index, and user feedback. Analysis of covariance was used to adjust for baseline values under an intention-to-treat framework with multiple imputation. Results:Among 111 participants (mean [SD] age, 51.8 [13.2] years; 71 [65.1%] male), the intervention showed a statistically significant improved patient activation at 6 months compared with usual care (adjusted mean difference, 10.8 points; 95% CI, 7.0-14.6 points; P < .001). Statistically significant improvements were also observed in Mediterranean diet adherence (adjusted mean difference, 1.7; 95% CI, 1.0-2.4; P < .001), medication adherence (adjusted mean difference, 1.6; 95% CI, 0.8-2.5; P < .001), and psoriasis-CVD knowledge (adjusted mean difference, 6.6; 95% CI, 4.7-8.4; P < .001). Minutes per week of physical activity increased (adjusted mean difference, 127.9; 95% CI, 21.9-234.0; P = .02), and body mass index, calculated as weight in kilograms divided by height in meters squared, decreased (adjusted mean difference, -1.0; 95% CI, -1.4 to -0.7; P < .001). No statistically significant between-group differences were observed for lipid parameters, hemoglobin A1c, smoking behavior, dermatology-specific quality of life, or psoriasis severity. Conclusions and Relevance:In this randomized clinical trial, a text-messaging intervention improved patient activation and cardiovascular risk behaviors in adults with psoriasis. While biomarker changes were modest or not statistically significant, findings support digital tools as an adjunct to cardiovascular risk in dermatology care. Trial Registration:ANZCTR Identifier: ACTRN12624000498594.

BACKGROUND AND STUDY AIMS:Patient perspectives on psoriasis as a systemic disease, with its heightened risk of cardiovascular disease (CVD), are unclear. Approaches to cardiovascular risk factor screening and management vary in this cohort. This study aimed to ascertain knowledge, practice and perceptions of patients with respect to psoriasis and CVD, CV risk factor screening and management. METHODS:This cross-sectional study consisted of a self-administered questionnaire capturing demographic characteristics, knowledge of the association between psoriasis and CVD, and perspectives on cardiovascular risk factor screening and management. This was distributed to psoriasis patients in public and private clinic settings. The survey data was assessed with the use of descriptive statistics. RESULTS:A total of 102 patients with psoriasis were surveyed. The majority of respondents were male 52%, (53/102), 46-60 years old 30.4% (31/102), with longstanding psoriasis (> 20 years), 42.2.% (43/102). Most patients nominated a dermatologist in a public hospital setting as the primary clinician responsible for their psoriasis management 71.6% (73/102). A total of 20.6% (21/102) psoriasis patients surveyed indicated knowledge of the association between CVD and psoriasis, and 22.5% (23/102) agreed that psoriasis was associated with worse CVD outcomes compared to the general population. 63.7% (65/102) indicated they had undergone CV risk factor screening in the last year, with most nominating general practitioners (GPs) 38.4% (38/99), followed by cardiologists 14.1% (14/99), then dermatologists 9.1% (9/99), as the clinician who performed this CV RF screening. A total of 68.6% (70/102) responded they did not currently have a treating cardiologist, while 34.3% (35/102) nominated a Cardiologist as their preferred clinician to facilitate CVD risk factor screening/management, 23.5% (24/102) indicated a preference for a multidisciplinary team, 17.6% (18/102) nominated GPs and 6.9% (7/102) nominated the dermatologist. CONCLUSION:There is a need for improved patient education regarding the relationship between psoriasis and CVD. Heightened awareness around cardiovascular risk may serve as an impetus for patients to seek relevant cardiovascular risk factor screening, management and pursue healthy lifestyle behaviours.

BACKGROUND:Psoriasis is a risk factor for cardiovascular disease (CVD). This risk is independent and incremental to traditional cardiovascular (CV) risk factors, but clinician and patient perspectives on this risk are unclear. This study aims to assess the knowledge, perceptions, and practice of clinicians and patients with respect to psoriasis and CVD. METHODS:This cross-sectional study consisted of a self-administered questionnaire capturing demographic characteristics, knowledge of the association between psoriasis and CVD, and perspectives on CV screening and management. This was distributed to members of relevant Australasian Speciality Medical Colleges, speciality societies, and psoriasis patients in public and private clinic settings. Survey data were assessed using descriptive statistics. Logistic regression was used to investigate the relationship between categorical variables and the outcome variable, for example, to determine factors predictive of clinician knowledge and perceptions. For all analyses, a p-value of less than 0.05 was considered statistically significant. RESULTS:A total of 298 clinicians (dermatologists (86), rheumatologists (56), cardiologists (53), general practitioners (103)) and 102 patients with psoriasis were surveyed. Regarding clinician knowledge of the association between psoriasis and CVD, dermatologists and rheumatologists indicated knowledge of this association (98.8%) (85/86) and 91.1% (51/56) respectively, while only 54.7% (29/53) of cardiologists and 29.1% (30/103) of GPs indicated knowledge of this association. Only 23.5% (24/102) of patients surveyed indicated knowledge of this association. Clinicians with a higher proportion of their caseload including psoriasis patients were significantly more likely to be aware of the association between psoriasis and CVD (OR 3.05 [1.64, 5.68]; p < 0.001). Most clinicians nominated GPs as best placed to facilitate CV risk factor screening and management (dermatologists 80.2% (69/86); rheumatologists 83.9% (47/56); cardiologists 75.5% (40/53); GPs 88.3% (91/103)). Patients preferred specialist input and multidisciplinary care for CVD risk management; 34.3% (35/102) nominated a cardiologist as the preferred clinician, and 23.5% (24/102) indicated preference for a multidisciplinary team. LIMITATIONS:The possibility of sampling and response bias, inherent in the study design, is acknowledged; however, responses are likely representative of clinician and patient sentiments on this issue and in keeping with similar study findings. CONCLUSION:Clinician and patient knowledge of the relationship between psoriasis and CVD needs to be improved. The establishment of a national consensus approach to address this gap in clinical care is needed.

Background: A psoriasis (PSO) diagnosis may pose specific treatment challenges for women of childbearing age (WoCBA) who are considering pregnancy, are pregnant, or have just given birth. Objective: To report perspectives of WoCBA with PSO regarding pregnancy and dermatologists about the disease management of these women in Australia and Japan. Methods: Online surveys were completed by women aged 18 to 45 years who were pregnant within the past 5 years with moderate to severe PSO and dermatologists. Results: In Japan (n = 31) and Australia (n = 27), most WoCBA with PSO did not feel adequately informed about pregnancy planning and had concerns regarding the safety of tumor necrosis factor inhibitors (TNFi) when used during pregnancy. Dermatologists (Australia: n = 40; Japan: n = 97) also had safety concerns around prescribing TNFi during pregnancy, and most were impartial toward or not at all comfortable with prescribing TNFi to women who were pregnant or actively planning pregnancy. Dermatologists felt that more safety data on pregnancy, lactation, and pediatric outcomes 5 years postdelivery would increase their comfort with prescribing TNFi. Limitations: Limitations included small respondent size, a lack of formal validation for questionnaires, recall bias among participants, and generalizability of results to all WoCBA with PSO. Response rates of survey participants were also not collected. Conclusion: Additional safety information can help address concerns about biologic use (including TNFi) in WoCBA, enabling dermatologists to make informed treatment recommendations in such patients.

Chronic inflammatory skin disease is more than skin deep, with several cutaneous disease entities associated with an increased risk of cardiovascular disease. Notably, psoriasis carries a markedly increased risk of cardiovascular disease, along with a significant comorbid burden. There is a need for greater clinician, patient and community awareness around the impact of chronic cutaneous inflammation, with attention to psoriasis in particular, in order to enhance care in this cohort.

Psoriasis is a systemic inflammatory disease with increased cardiometabolic risk including dyslipidaemia and diabetes. Biologic therapy effectively treats the cutaneous inflammatory burden of psoriasis and evolving evidence suggests potential to reduce systemic inflammatory sequalae that can elevate cardiovascular risk. This study aimed to assess the change in cardiometabolic risk markers in a cohort of patients with psoriasis treated with 1 year of continuous biologic treatment. A retrospective review was conducted of patients receiving biologic therapy for chronic plaque psoriasis in a single dermatology centre at a major tertiary hospital in Sydney, Australia. The effect of biologic therapy on psoriasis was assessed using the psoriasis area severity index (PASI). Cardiometabolic risk markers assessed included lipid profile (total cholesterol [TC], low-density lipoprotein [LDL] cholesterol, high-density lipoprotein [HDL] cholesterol and triglycerides [TG]) and haemoglobin A1c (HbA1c). Measurements at baseline and 1 year were compared using paired t tests for analysis of the parameters which approximated normal distribution (TC, LDL, HDL) and Wilcoxon signed-rank test for analysis of those which did not (TG, HbA1c, PASI). Two-tailed P values < 0.05 were considered significant. A total of 200 patients were reviewed, of which 39 had complete data sets. The participants’ ages ranged from 21 to 85 years (mean 51, SD 16.9). Of the 39 participants, 31 (79.5

BACKGROUND/OBECTIVES:Oral retinoids are teratogenic, and pregnancy avoidance is an important part of retinoid prescribing. Australia does not have a standardised pregnancy prevention programme for women using oral retinoids, and the contraception strategies for women who use oral retinoids are not well understood. The objectives were to determine trends in the use of prescription retinoids among Australian reproductive-aged women and whether women dispensed oral retinoids used contraception concomitantly. METHODS:This was a population-based study using Australian Pharmaceutical Benefits (PBS) dispensing claims for a random 10% sample of 15-44-year-old Australian women, 2013 - 2021. We described rates and annual trends in dispensing claims for PBS-listed retinoids and contraceptives. We also estimated concomitant oral retinoid and contraceptive use on the day of each retinoid dispensing and determined if there was a period of contraceptive treatment that overlapped. Estimates were then extrapolated to the national level. RESULTS:There were 1,545,800 retinoid dispensings to reproductive-aged women; 57.1% were oral retinoids. The rate of retinoid dispensing to reproductive-aged women increased annually, from 28 dispensings per 1000 population in 2013 to 41 per 1000 in 2021. The rate of oral retinoid dispensing doubled over the study period, from 14 dispensings per 1000 population in 2013 to 28 per 1000 in 2021, while topical retinoid dispensing did not change. Only 25% of oral retinoid dispensings had evidence of concomitant contraceptive use in 2021. CONCLUSIONS:Rates of oral retinoid dispensing have doubled among reproductive-aged women over the past decade. A large percentage of oral retinoid use does not appear to have concomitant contraception use, posing a risk of teratogenic effects in pregnancies.