From the Guidelines
The management of a patient with psoriasis and leukocytosis (elevated white blood cell count of 18) should prioritize investigating the cause of the leukocytosis and selecting a psoriasis treatment that considers the potential impact on white blood cell counts. For the psoriasis treatment, topical therapies are typically first-line for mild to moderate disease, including corticosteroids (such as betamethasone 0.05% cream applied twice daily), vitamin D analogs (calcipotriene 0.005% ointment once daily), or combination products, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1. Some key points to consider in the management of psoriasis with leukocytosis include:
- Investigating the cause of the elevated white blood cell count to determine if it is related to the psoriasis itself, an infection, medication side effect, or another underlying condition.
- Selecting a psoriasis treatment that considers the potential impact on white blood cell counts, such as avoiding certain systemic immunosuppressants that may exacerbate leukocytosis.
- Regular monitoring of complete blood counts during treatment, especially with medications like methotrexate, which can affect white blood cell counts, as outlined in the guidelines of care for the management of psoriasis and psoriatic arthritis: section 4 1.
- Considering lifestyle modifications, including stress reduction, smoking cessation, maintaining a healthy weight, and avoiding trigger factors, to help manage psoriasis symptoms while addressing the underlying causes of leukocytosis. For moderate to severe psoriasis, systemic therapies may be necessary, including methotrexate (starting at 7.5-15 mg weekly), cyclosporine (2.5-5 mg/kg/day), or biologics like TNF inhibitors (etanercept, adalimumab), IL-17 inhibitors (secukinumab, ixekizumab), or IL-23 inhibitors (guselkumab, risankizumab), as suggested by the guidelines of care for the management of psoriasis and psoriatic arthritis: section 1 1. However, the choice of systemic therapy should be guided by the most recent and highest quality evidence, prioritizing the patient's safety and the potential impact on their leukocytosis, as well as their overall morbidity, mortality, and quality of life.
From the Research
Management Approach for Psoriasis with Leukocytosis
The management of psoriasis with leukocytosis (elevated white blood cell count) involves a comprehensive approach that considers the severity of psoriasis, the presence of comorbidities, and the potential risks and benefits of various treatments.
- Assessment of Psoriasis Severity: The severity of psoriasis can be assessed using objective measures such as the Psoriasis Area and Severity Index (PASI), body surface area involved, and Physician's Global Assessment 2.
- Treatment Options: Various treatment options are available for psoriasis, including topical corticosteroids, vitamin D3 analogs, phototherapy, systemic agents such as methotrexate and cyclosporine, and biologic agents 3, 4, 5.
- Phototherapy: Phototherapy, including narrowband ultraviolet B (NB-UVB) and psoralen with ultraviolet A (PUVA), can be effective in managing moderate-to-severe plaque psoriasis 5.
- Systemic Agents: Systemic agents such as cyclosporine can be used to treat severe psoriasis that is resistant to other treatments 6.
- Combination Therapy: Combination therapy, such as the use of acitretin and NB-UVB or PUVA, can be beneficial in achieving faster clearance and reducing the dose of individual agents 3.
- Consideration of Comorbidities: The presence of comorbidities such as diabetes, cardiovascular disease, and psoriatic arthritis should be considered when selecting a treatment approach 4, 2.
Leukocytosis Considerations
The presence of leukocytosis (elevated white blood cell count) in a patient with psoriasis may indicate an increased inflammatory response or the presence of an underlying infection.
- Inflammatory Response: Leukocytosis can be a marker of inflammation, and treatments that reduce inflammation, such as biologic agents, may be beneficial in managing psoriasis with leukocytosis 3.
- Infection Risk: Patients with psoriasis and leukocytosis should be monitored for signs of infection, and treatments that increase the risk of infection, such as immunosuppressive agents, should be used with caution 6.
It is essential to consult with a healthcare professional to determine the best course of treatment for a patient with psoriasis and leukocytosis, as the management approach will depend on individual factors, including the severity of psoriasis, the presence of comorbidities, and the potential risks and benefits of various treatments 3, 4, 5, 2, 6.