Chair, Department of Dermatology
Eastern Virginia Medical School
Physicians go into medicine for as many diverse reasons as there are specialties to choose from. In the case of Dr. Abby Van Voorhees, Chair of the Department of Dermatology at EVMS, it was because her mother was diagnosed with breast cancer while she was in college. She wasn’t planning to go into medicine, but rather to pursue her love of the sciences. But when she saw the treatment her mother was receiving, she had an epiphany: “I knew I could do a lot better than what I was seeing happen.”
She earned her medical degree at Yale, where she met Dr. Irwin Braverman, a Professor of Dermatology who developed a now iconic course incorporating Victorian paintings to help students improve their diagnostic and observational skills. “He became my mentor,” Dr. Van Voorhees says. “We had very few treatments in those days to take care of patients with psoriasis. It’s a terribly disabling disease, but even with such scarce resources, he was masterful. I learned so much from him, and knew I wanted to make dermatology my focus.”
Her studies with Dr. Braverman were a contributing factor to her decision to specialize in treating patients with psoriasis, particularly those at the more severe end of the disease spectrum. “I really liked caring for these patients,” she says, “and it’s been nothing short of revolutionary in terms of what we can do now for patients with the ever more precise biologics that are available today.”
She still remembers the standard of care for such patients during her years in and just out of medical school: a treatment she describes as left over from the 1920s, in which patients would submit to tar baths, coupled with tar applications to their skin for 23 hours daily in combination with ultraviolet light therapy. “The truth is, it can be highly effective,” Dr. Van Voorhees notes, “but it requires patients to essentially devote a month of their life to their skin, and your average working person would have a hard time making that commitment.” But as recently as a year ago, she successfully used the method for a patient who wasn’t an appropriate candidate for biologics.
Fortunately, for most patients – even the most severe – there are at least 10 therapies she can prescribe, individually or tailored to each patient’s case, and more are being developed. “These drugs are getting increasingly more exact. We now have IL17 inhibitors and soon we’ll have IL23 inhibitors, which means they’re getting more effective all the time, without suppressing the entire immune system.”
Not content merely to treat these patients, Dr. Van Voorhees has lectured and published extensively on various aspects of caring for them and the many sequelae of their disease, including an overlay of depression that can accompany it. In addition, she says, “we’re discovering that patients with psoriasis have increased risk of heart disease, diabetes, stroke – and they die younger than the average person. We’re thinking it’s a result of the amount of systemic inflammation they have in their whole body, and we’re coming to view the skin as almost like a weather vane, a sign of all the inflammation that’s inside their body.”
Much of her own research has lately concentrated on education about the importance of knowing these patients are at risk, because “if physicians don’t know that, they can’t possibly think to screen for it. Since psoriasis is a disease that affects people when they’re teenagers, in many ways, the dermatologist is in the best position to serve as that early warning detection system.” She explains: “If I have patients I can identify as being at risk when they’re 18, think of the impact it could have if they’d start making changes to their lifestyle at that point, rather than at 60, when heart disease is discovered. So a lot of my work has been in educating people about the associated co-morbid diseases that travel with psoriasis.”
As chair of the National Psoriasis Foundation’s Medical Board, she’s working with a team that is developing a treat-to-target – establishing guidelines to determine the point at which a patient’s psoriasis can be considered in good control. “Along the way, we’ve created a lot of best practice standards for managing patients to minimize their risk of sequelae in the future,” Dr. Van Voorhees says. “We’re just working on that effort right now, so it’s very exciting. This will be the first time that will be in the dermatology literature.”
Dr. Van Voorhees has held editorial positions on a number of national dermatology publications, including Practical Dermatology and The Journal of Psoriasis and Psoriatic Arthritis. As editor of Dermatology World, the magazine of the American Academy of Dermatology, she has written a great deal about all of the different sides of dermatology – the surgical side of the house, the medical and cosmetic sides.
In medical school, she discovered “an overwhelming kind of inner compass that said what’s right for a patient will always be right.” That’s still true, to this day, any time decisions are being made about a patient’s treatment. “If it’s in the best interest of the patient, it’s always right,” Dr. Van Voorhees says. “The idea of ‘patient first’ has been a very recharging and inspiring motivation.”