The last time you saw your dermatologist for your psoriasis, were you satisfied by the information you got? If not, there’s a chance you just weren’t asking the right kinds of questions. But how are you supposed to know what to ask?
With that in mind, we asked Dr. Doris Day, a board certified dermatologist based in New York, what top questions she wishes psoriasis patients asked her during their appointments. Keep reading to find out what she had to say.
1. How did I get psoriasis?
No one knows exactly what causes psoriasis, but it’s a lifelong disorder known to also have a genetic component. What we do know is it’s an autoimmune condition where the immune system is mistakenly triggered, which speeds up the growth cycle of skin cells.
A normal skin cell matures and sheds off the body's surface in 28 to 30 days, but a psoriatic skin cell takes only three to four days to mature and move to the surface. Instead of naturally maturing and shedding, the cells pile up and can form thick red plaques that are often itchy and unsightly.
Psoriasis can be limited to a few spots or can involve moderate to large areas of the skin. The severity of psoriasis can vary from person to person and in the same person from one time to another. Mild psoriasis is considered to involve less than 3 percent of the body’s surface area. Moderate psoriasis typically involves 3 to 10 percent. And severe psoriasis is greater than 10 percent.
There’s also an emotional component to the severity grading, where even someone with less body surface coverage may be considered to have moderate or severe psoriasis if the condition has a greater impact on their quality of life.
2. What is the significance of my family history of psoriasis or other medical conditions, such as lymphoma?
Having a family history of psoriasis does increase your risk, but is in no way a guarantee of it. It’s important for your dermatologist to have as thorough an understanding as possible about you, and also know your family history of psoriasis and other medical conditions in order to be able to guide you through your best treatment options.
Those with psoriasis have a slight increased risk of lymphoma over the general population. Your dermatologist may decide some medications are preferable and others should be avoided based on this history.
3. How do my other medical conditions affect, or are affected by, my psoriasis?
Psoriasis has been shown to be a systemic inflammatory condition with similarities to other inflammatory immune disorders. In addition to its effects on the skin, 30 percent of people with psoriasis will also have psoriatic arthritis.
Besides its association with arthritis, psoriasis is also associated with depression, obesity, and atherosclerosis (a buildup of plaque in the arteries). Those with psoriasis may also have an increased prevalence of ischemic heart disease, cerebrovascular disease, peripheral artery disease, and an increased risk of death.
Inflammation could be a biologically plausible explanation for the association between psoriasis and high blood pressure or hypertension, as well as that between psoriasis and diabetes. Research and attention has also been focused on the association between psoriasis, cardiovascular health, and heart attacks or myocardial infarction.
4. What are my treatment options?
No single psoriasis treatment works for everyone, but there are exciting newer, more advanced treatment options that target the underlying cause of psoriasis better than ever before. Some are in the form of a pill, others are injections, and others are available via infusion. It’s important to know what your options are and the risks and benefits of each.
5. Which treatment would you recommend for me?
As much as we want to give you options, your doctor will have a preference of protocol to help you. This will be based on the severity of your psoriasis, the treatments you’ve tried in the past, your medical history, your family history, and your comfort level with different drug delivery options.
It’s hard to predict what will work for a particular individual. However, your doctor will help you find the best treatment or combination of treatments for you. They will let you know what you can expect from the treatments, including how long it will take to see results, side effects, and the need for monitoring during treatment.
6. What are the possible side effects?
There are side effects with every medication. From topical cortisone to phototherapy to immunosuppressant’s to biologics, each one has benefits and risks you need to know before you start. Knowing the side effects of each medication is an important part of your discussion with your doctor.
If you’re starting a biologic it’s important to have a purified protein derivative (PPD) skin test to see if you have been exposed to tuberculosis in the past. The medications don’t cause tuberculosis, but they may lower your immune system’s ability to fight the infection if you’ve been exposed in the past.
7. How long will I need to be on the medication?
There’s no cure, but many different treatments, both topical and systemic, can clear psoriasis for periods of time. People sometimes need to try out different treatments before they find one that works for them.
8. Can any medications I’m taking worsen or interfere with my medications for psoriasis?
Your dermatologist will need to know every medicine you’re taking, both prescription and over-the-counter since there may be drug interactions you need to be aware of.
For example, acetaminophen combined with some biologics may increase your risk for liver failure, so the combination should be avoided as much as possible. And regular blood tests to evaluate liver function are needed.
Also, some medications like aspirin can make psoriasis worse. While other medications, like oral corticosteroids, can lead to a life-threatening case of psoriasis, called pustular psoriasis, even in those who have mild psoriasis. This is because the oral steroid is being tapered down. If you’re prescribed oral steroids by mouth, be sure to tell the doctor you have psoriasis before starting the medication.
9. If I start a biologic, do I need to stop my current regimen for the treatment for my psoriasis?
Take a photo or make a list of your current treatment regimen to bring with you to the office visit so your dermatologist can know how to adapt or adjust your treatment to optimize your results. It also helps to bring in any recent lab work. Your doctor may have you continue topical treatments when you first add a biologic, and then taper off as the new medication takes effect.
10. Why do I need to change or rotate my treatments for my psoriasis?
With psoriasis, we sometimes need to rotate treatments over time since they can become less effective as the body adapts to the treatment. Your dermatologist may then switch to other treatment options, and can rotate back to previous ones since the body loses resistance after a month or so of discontinued use. This is less true of biologics, but it can still happen.
In selecting a biologic or any treatment option, your doctor will review previous treatments and the risks and benefits of each drug available today to help guide you in the decision-making process. It’s helpful to make a list of the treatments you’ve tried, the date you started and stopped them, and how they worked for you.