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In Reply: We did not attribute the association between psoriasis and a sedentary lifestyle exclusively to psoriatic arthritis, as Drs Skolnick and Alexander suggest. We quoted the findings by Herron et al¹ that 32% of obese patients with psoriasis reported that arthritis interfered with physical activity, compared with 14% of nonobese participants. That leaves 68% of obese patients with psoriasis who do not report arthritis as interfering with physical activity, and other factors undoubtedly play a role in patients with psoriatic arthritis.

As Skolnick and Alexander point out, the high rates of social stigmatization and anxiety in patients with psoriasis are well documented. Clinicians who care for patients with psoriasis are likely to have observed the tendency for some patients with psoriasis to hide their disease, leading to a sedentary and unhealthy lifestyle.

We agree that dermatologists and other physicians who manage psoriasis need to account for the psychiatric implications . . . [Full Text of this Article]

Mark Lebwohl, MD
Department of Dermatology
Mount Sinai Medical Center
New York, NY

Jeffrey P. Callen, MD
jefca@aol.com
Department of Dermatology
University of Louisville
Louisville, Ky

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