Wednesday, July 10, 2024

How Do Doctors Diagnose Psoriasis

What Does Psoriasis Look And Feel Like

Diagnosing Psoriasis

There are five main types of psoriasis. Your doctor will diagnose which type you have and work out a treatment plan with you.

Plaque psoriasis is the most common type of psoriasis affecting about 90 per cent of people with the condition.

It’s recognised by its telltale plaques: patches of thick, red skin that are covered with silvery white scales. Plaques can come in all shapes and sizes, and their edges usually have a clear border separating them from the skin around them. They are often itchy and can crack and bleed.

Plaque psoriasis most commonly affects the front of elbows and knees, the scalp and the lower back.

Delays In Getting Diagnosed With Psoriatic Arthritis Are All Too Common Knowing What To Expect May Help Speed Up The Process

If your shoes are feeling tighter than usual or youre having difficulty or pain opening jars, a type of autoimmune disorder called psoriatic arthritis could be to blame. PsA is an inflammatory arthritis linked to psoriasis . It is characterized by pain, stiffness, and swelling in the joints although these general arthritis symptoms can take on specific characteristics when they are caused by psoriatic arthritis

As with many conditions, early diagnosis and prompt treatment are important. If you put off seeing the doctor, there are two major concerns with a delayed psoriatic arthritis diagnosis, says Bharat Kumar, MD, Associate Rheumatology Fellowship Program Director at University of Iowa Health Care and member of the American College of Rheumatology.

First, he explains, disease activity may worsen and cause lasting joint damage. Second, PsA is linked to a higher rate of heart disease, so the sooner youre diagnosed the quicker you can address cardiovascular factors like high cholesterol and hypertension. Rheumatologists are eager to see anyone with psoriasis who is also experiencing joint pain, Dr. Kumar says.

What Is Cdc Doing About Psoriasis

In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.

CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.

  • Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
  • Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
  • Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.

Who is at risk for psoriasis?

Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.

Can I get psoriasis from someone who has it?

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Physical Exam And Medical History

Your healthcare provider will want to know all about your symptoms and medical history. Questions he or she may ask include:

  • What symptoms are you experiencing?
  • When did your symptoms begin?
  • What causes your symptoms to improve? To worsen?
  • How do your symptoms affect your life?
  • Do you have any other medical conditions?

Psoriasis, an inflammatory skin condition characterized by rough red patches of skin with silvery-white flakes, is closely related to psoriatic arthritis. In fact, about 85% of people with psoriatic arthritis develop before joint .

Your provider will also ask you about your familys health. Approximately 40% of people with psoriatic arthritis have a family member with psoriasis or arthritis.

During your physical exam, your healthcare provider will focus on any areas giving you trouble, such as your joints. He or she may ask you to move in a particular manner to assess your range of motion and ease of movement. Your provider will also conduct a head-to-toe exam. Psoriatic plaquesthe rough skin patches associated with and psoriatic arthritissometimes hide in difficult-to-see areas, such as behind the ear, in the belly button, and between the buttocks.

Your provider may order some laboratory tests. If so, a technician will draw blood from you, and the sample will be sent to a lab for analysis. Blood tests used to check for psoriatic arthritis include:

How To Prepare And What To Expect

Psoriatic arthritis: Tests, diagnosis, and treatment

A key part of the preparation for a visit with a dermatologist is to track and record all symptoms. Doing this allows for a thorough discussion, which will help the dermatologist create an effective treatment plan.

Symptom tracking is particularly important for psoriasis, which can alternate between flare-ups of varying duration and periods of remission that can last for 112 months.

The person should note:

  • Intensity: People can use a scale of 110 to rate the intensity of each symptom.
  • Location: The dermatologist will want to know what part of the body each symptom affects.
  • Duration: It is important to note how long each symptom lasts.
  • Variation: People should record how any symptoms change over time.

Other preparations may include:

  • writing the names and dosages of all prescription and over-the-counter medications and dietary supplements
  • checking the medical history of family members
  • gathering lab results from tests that another doctor has ordered to bring along
  • avoiding wearing makeup, moisturizer, and nail polish

A person may also find it helpful to bring a pen and notebook to the consultation to write down instructions or any unfamiliar terms.

The ideal frequency of appointments will vary among individuals. It will depend on several factors, including:

  • the severity of the psoriasis
  • the frequency of flare-ups
  • the development of any other health conditions

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Otc Medicine For Psoriasis: What To Know

People with mild psoriasis may benefit from over-the-counter medicine, which they can get without a prescription. Some OTC medicines contain active ingredients, such as hydrocortisone or coal tar. OTC moisturizers may also benefit those with mild or severe psoriasis.

Psoriasis is a chronic immune disorder that causes skin rashes, which can vary in color from red or violet to dark brown or gray. These rashes may be itchy or painful and may feature silvery scales.

This article explores OTC medicines and other products for treating and easing psoriasis symptoms. It also looks at the various types of psoriasis, including its causes, diagnosis, and treatments.

A doctor or dermatologist will decide how to treat psoriasis according to the severity and location of the affected area. Treatments for mild psoriasis may include OTC and nonprescription medicine people may benefit from the sole or combined use of these various options.

How Is Psoriasis Diagnosed And Treated

Psoriasis often has a typical appearance that a primary care doctor can recognize, but it can be confused with other skin diseases , so a dermatologist is often the best doctor to diagnose it. The treatment of psoriasis usually depends on how much skin is affected, how bad the disease is , or the location . Treatments range from creams and ointments applied to the affected areas to ultraviolet light therapy to drugs . Many people who have psoriasis also have serious health conditions such as diabetes, heart disease, and depression. Some people with psoriasis also have an inflammatory condition which affects their joints, called psoriatic arthritis.

Psoriatic arthritis has many of the same symptoms as other types of arthritis, so a rheumatologist is often the best doctor to diagnose it. The treatment of psoriatic arthritis usually involves the use of drugs .

Psoriatic disease may be treated with drugs or a combination of drugs and creams or ointments.

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Questions To Ask Your Doctor

  • How long does treatment last?
  • Will I have to be on medicine for the rest of my life?
  • Should I make any changes to my skin care routine?
  • Are there any skin products or foods that I should avoid?
  • If symptoms get worse, when should I call the doctor?
  • If I have psoriasis, will my children get it?
  • Is there a support group that you recommend?

What Are The Symptoms Of Psoriasis

How is Psoriasis diagnosed? – Dr. Suresh G

The following are the most common symptoms of psoriasis. Psoriasis comes in several forms and severities. Symptoms may include:

  • Plaque psoriasis. This type of psoriasis is the most common. Symptoms may include patches of red, raised skin on the trunk, arms, legs, knees, elbows, genitals, and scalp. Nails may also thicken, become pitted, and separate from the nail beds.

  • Guttate psoriasis. This type of psoriasis affects mostly children. Symptoms may include many small spots of red, raised skin. A sore throat usually proceeds the onset of this type of psoriasis.

  • Pustular psoriasis. Symptoms may include small pustules all over the body or just on the palms, soles, and other small areas.

The symptoms of psoriasis may look like other skin conditions. Always talk with your healthcare provider for a diagnosis.

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What Is The Treatment For Psoriasis

Psoriasis is not currently curable. However, it can go into remission, producing an entirely normal skin surface. Ongoing research is actively making progress on finding better treatments and a possible cure in the future.

There are many effective psoriasis treatment choices. The best treatment is individually determined by the treating doctor and depends, in part, on the type of disease, the severity, and amount of skin involved and the type of insurance coverage.

  • For mild disease that involves only small areas of the body , topical treatments , such as creams, lotions, and sprays, may be very effective and safe to use. Occasionally, a small local injection of steroids directly into a tough or resistant isolated psoriatic plaque may be helpful.
  • For moderate to severe psoriasis that involves much larger areas of the body , topical products may not be effective or practical to apply. This may require ultraviolet light treatments or systemic medicines. Internal medications usually have greater risks. Because topical therapy has no effect on psoriatic arthritis, systemic medications are generally required to stop the progression to permanent joint destruction.

Psoriasis shampoo

Oral medications for psoriasis

Oral medications include methotrexate , acitretin , cyclosporine , , and others. Oral prednisone is generally not used in psoriasis and may cause a disease flare-up if administered.

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How To Find A Dermatologist

People who think that they might have psoriasis may wish to schedule an appointment with their primary care doctor, who can likely refer them to a dermatologist. Alternatively, they can visit the NPFs Patient Navigation Center.

Once a person has obtained the names of some local dermatologists, the American Academy of Dermatology Association recommends visiting each of the doctors websites to check whether they are board certified.

In the United States, a qualified dermatologist will have certification from the American Board of Dermatology, the American Osteopathic Board of Dermatology, or the Royal College of Physicians and Surgeons of Canada. Some dermatologists with these credentials may have the initials FAAD after their name, which stands for Fellow of the American Academy of Dermatology.

The AAD provides this search tool to find dermatologists in a certain area.

Before making an appointment, a person may also wish to check with their insurance provider whether the dermatologist is in their network and whether their insurance plan covers the visit.

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Does Your Insurance Cover It

Insurance coverage is a practical matter you should consider when considering a doctor.

Remember, you dont have to rush to choose a dermatologist. Psoriasis is a chronic condition, and treating it can be a process. Thats why its important to find a doctor who will listen to you, and partner with you, to develop a treatment plan thats right for you.

Evaluation And Differential Diagnosis

How Does Your Doctor Diagnose Lupus?

Less common variants of psoriasis include inverse psoriasis, pustular psoriasis, guttate psoriasis, erythrodermic psoriasis, and annular psoriasis .6). These variants can be differentiated from the common plaque type by morphology. Differential diagnoses include atopic dermatitis, contact dermatitis, lichen planus, secondary syphilis, mycosis fungoides, tinea corporis, and pityriasis rosea . Careful observation often yields the diagnosis. For more atypical presentations, a skin biopsy might be helpful.

Differential diagnoses and distinguishing clinical features

Atopic dermatitis Predominant symptom of pruritus and typical morphology and distribution
Contact dermatitis Patches or plaques with angular corners, geometric outlines, and sharp margins dependent on the nature of the exposure to the irritant or allergen
Lichen planus Violaceous lesions and frequent mucosal involvement
Secondary syphilis Copper-coloured lesions and frequent involvement of palms and soles
Mycosis fungoides Irregularly shaped lesions with asymmetric distribution, peculiar colour, and wrinkling due to epidermal atrophy
Tinea corporis Fewer lesions with annular configuration
Pityriasis rosea Tannish-pink, oval papules and patches with Christmas tree configuration on trunk with sparing of the face and distal extremities

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You Can Have Psoriasis And A Different Kind Of Arthritis That Is Not Psa

People with psoriasis can develop different types of arthritis including rheumatoid arthritis, gout, osteoarthritis, and reactive arthritis so diagnosing PsA involves ruling out those other conditions.

Its often difficult to say in a first visit whether a patient definitely has psoriatic arthritis or another type of arthritis that just co-exists with psoriasis, says Dr. Kumar. PsA can take a long time to diagnose because a patient can delay seeing the doctor, then confirming PsA can require multiple labs and imaging tests.

The good news is that the diagnosis process for psoriatic arthritis is improving. Whereas PsA wasnt even recognized as a distinct condition decades ago , doctors are now better equipped with improved lab tests and imaging studies that help identify this disease so more patients can find relief.

When To See A Dermatologist For Psoriasis

The National Psoriasis Foundation advises that anyone with symptoms that may indicate psoriasis should see a dermatologist. The symptoms of psoriasis may include thick, raised patches of dry, itchy skin.

The NPF adds that it is particularly beneficial to find a dermatologist who has experience in treating psoriasis if any of the following applies:

  • The symptoms are worsening, or a flare-up is occurring.
  • The treatments that a primary care doctor prescribed are not relieving the symptoms.
  • The individual wishes to try a treatment that their primary care doctor is unfamiliar with, such as phototherapy or a biologic medication.

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Psoralen Plus Ultraviolet A

For this treatment, youll first be given a tablet containing compounds called psoralens, or psoralen may be applied directly to the skin. This makes your skin more sensitive to light.

Your skin is then exposed to a wavelength of light called ultraviolet A . This light penetrates your skin more deeply than ultraviolet B light.

This treatment may be used if you have severe psoriasis that has not responded to other treatment.

Side effects include nausea, headaches, burning and itchiness. You may need to wear special glasses for 24 hours after taking the tablet to prevent the development of cataracts.

Long-term use of this treatment is not encouraged, as it can increase your risk of developing skin cancer.

Are There Complications Of Psoriasis

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In some people, psoriasis causes more than itchiness and red skin. It can lead to swollen joints and arthritis. If you have psoriasis, you may be at higher risk of:

  • Use medicated shampoo for scales on your scalp.

Other steps you should take to stay as healthy as possible:

  • Talk to your healthcare provider about lowering your risk for related conditions, such as heart disease, depression and diabetes.
  • Lower your stress with meditation, exercise or seeing a mental health professional.

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What Causes Psoriasis

No one knows the exact cause of psoriasis, but experts believe that itâs a combination of things. Something wrong with the immune system causes inflammation, triggering new skin cells to form too quickly. Normally, skin cells are replaced every 10 to 30 days. With psoriasis, new cells grow every 3 to 4 days. The buildup of old cells being replaced by new ones creates those silver scales.

Psoriasis tends to run in families, but it may be skip generations. For instance, a grandfather and their grandson may be affected, but not the child’s mother.

Things that can trigger an outbreak of psoriasis include:

  • Cuts, scrapes, or surgery
  • Belly button
  • Nails

Your doctor will give you a full physical exam and ask if people in your family have psoriasis.

Lab tests. The doctor might do a biopsy — remove a small piece of skin and test it to make sure you donât have a skin infection. Thereâs no other test to confirm or rule out psoriasis.

Why You Need To Know

Knowing whether your psoriasis is mild, moderate, or severe will help you find the best treatment. It’ll also let your doctor know whether the psoriasis is getting worse and how well your treatment is working.

Your doctor may use the PASI score to measure your progress. For example, if you hear youâre “PASI 75,” that means your PASI score has dropped by 75%.

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