Facial dermatitis is challenging to treat due to the delicate nature of facial skin, and conventional therapies like corticosteroids and calcineurin inhibitors have notable drawbacks, including skin atrophy, high costs, and irritation. Black tea, known for its anti-inflammatory properties, has been traditionally used by German-speaking dermatologists for this condition, though formal studies were lacking. A 2019 study from the University of Lübeck investigated black tea dressings in 22 patients with facial dermatitis, showing a significant reduction in disease severity within three days, with continued improvement through day six and no major side effects. The treatment involved applying gauze compresses soaked in a cooled second infusion of black tea five times daily, followed by an emollient. These promising findings suggest black tea dressings as a safe, cost-effective alternative, warranting further research, which we explored in an interview with Dr. Peter Lio.

In this podcast Dr. Marc-Andre Cornier, Manuel Valdebran and Victoria Palmer discuss the role of inflammation in insulin resistance, its effects on glucose variability, hyperinsulinemia, and the correlation with cardiovascular disease. Here are the key points discussed:

Participant Backgrounds

- Dr. Marc-Andre Cornier: Director of the Division of Endocrinology at MUSC with a background in cardiometabolic diseases, fuel metabolism, obesity, and diabetes.

- Victoria Palmer: Soon-to-be Dermatology resident, collaborated on the manuscript discussing cardiovascular risks and inflammation in psoriasis patients.

- Manuel Valdebran: Dermatologist at MUSC

-Discussion Points

1. Role of Inflammation in Insulin Resistance:

- Inflammation may contribute to insulin resistance and vice versa.

- Genetic and environmental factors contribute to insulin resistance, with inflammation playing a significant role.

2. Insulin Resistance and Hyperinsulinemia:

- Insulin resistance often leads to compensatory hyperinsulinemia.

- Chronic inflammatory disorders like psoriasis and rheumatoid arthritis are linked to increased cardiovascular risk and insulin resistance.

3. Glucose Variability:

- Patients may have normal fasting glucose and A1C levels but show other signs like elevated BMI and triglycerides.

- Glucose variability can trigger hyperinsulinemia and inflammation.

4. Screening for Insulin Resistance:

- Indicators: Physical signs like acanthosis nigricans, elevated BMI, triglycerides, and low HDL.

- Screening Recommendations: Regular screening for fasting glucose, A1C, and other metabolic markers, especially in patients with chronic inflammatory conditions.

- Age Recommendations: General screening for diabetes starts at age 35, earlier if there are additional risk factors.

5. Diet and Exercise:

- Exercise: Improves insulin sensitivity, and lowers glucose levels. Even moderate activity is beneficial.

- Diet: In general, focus on weight loss. A Mediterranean diet rich in whole foods, lean meats, and low in processed foods is recommended.

- Overall Health: Weight loss is crucial, but a balanced diet also promotes long-term cardiovascular and metabolic health.

Conclusion

The podcast emphasizes the complex interplay between inflammation, insulin resistance, and cardiovascular health. Early screening and lifestyle modifications, including diet and exercise, are crucial in managing these conditions and improving patient outcomes.

In this discussion, Dr. Manuel Valdebran, Dr. Victoria Palmer and Dr. Ashley Waring delve into the association between cardiovascular disease and psoriasis, with a focus on preventive cardiology. Dr. Waring, an assistant professor of medicine specializing in preventive cardiology and clinical lipidology, shares insights into her clinics at the Medical University of South Carolina. She emphasizes the importance of preventing cardiovascular events before they occur, particularly in younger patients identified as at risk due to factors like family history, high cholesterol, and hypertension.

The conversation then shifts to risk stratification guidelines and screening methods for patients with inflammatory skin diseases such as psoriasis. Dr. Victoria Palmer, an internal medicine resident, discusses the use of the Framingham scoring criteria and the consideration of factors like body surface area and systemic treatments in determining cardiovascular risk. Dr. Waring highlights the need for a more comprehensive approach, taking into account conditions like psoriasis and rheumatoid arthritis, which are often overlooked in risk assessment.

Later in the discussion, the focus turns to preventive measures and patient education. Dr. Waring mentions the challenges of identifying cardiovascular risk in younger patients with mildly elevated LDL cholesterol and the potential role of tools such as the coronary artery calcium (CAC) score. The conversation concludes with a discussion on resources for patient education, including lipid clinics, lifestyle modification programs, and online materials provided by organizations like the National Lipid Association. The doctors also touch upon emerging topics in preventive cardiology, such as the role of lipoprotein (a) and ApoB in risk assessment. Overall, the discussion underscores the importance of early intervention, patient education, and a multidisciplinary approach in preventing cardiovascular disease, especially in patients with chronic inflammatory conditions like psoriasis.

In this episode we will chat with Dr. Victoria Palmer. Victoria discusses her interest in psoriasis, her experiences, and her recent publication in the International Journal of Dermatology on the link between psoriasis and cardiovascular disease. The interview covers recommendations for screening and addressing cardiovascular conditions in patients with psoriasis, emphasizing the importance of a holistic approach, lifestyle modifications, and potential barriers to implementing these changes. The discussion also touches on genetic and environmental risk factors, dietary considerations, and the bidirectional relationship between psoriasis and vitamin D levels. Additionally, the conversation highlights the challenges faced by underserved populations in accessing healthy food and resources. Victoria expresses satisfaction with the increased awareness of the connection between psoriasis and cardiovascular health.