Who Do You See For Psoriasis

Understand Your Health Care Team

Your health care team may change depending on your needs over the course of your condition. Understanding their roles can help you navigate your care.

• Pharmacist

• This includes a family doctor or nurse practitioner.
• This is the first health care professional you get in touch with when you have a new, non-emergency health concern.
• In Canada, visits with primary health care providers are generally publicly funded, meaning you do not have to pay for the visits out of your pocket.
• Consulting a primary health care provider via telemedicine is generally not publicly funded at the time, meaning you or your private insurance plan may need to cover the cost.

• Diagnoses and provides treatment for a variety of health concerns.
• Provides referral to specialists if needed to help with a specific condition.
• Supports management for chronic illnesses.
• Prescribes medications.
• Provides routine check-up visits and screening tests.

• A registered nurse with additional education and experience.
• Can provide most services that family doctors are able to, but with some exceptions .
• If needed, they can always consult with a physician or connect you to a physician or other health care providers who can help you.

• Medical specialist physicians who have completed five-year residency training in prevention, recognition, and treatment of diseases of the skin, hair and nails.
• Generally, you can consult a dermatologist only if you have a referral from a primary care provider.

How Do Dermatologists Treat Psoriasis

If you have psoriasis, a dermatologist can create a treatment plan to meet your individual needs. To create this plan, your dermatologist will consider the:

• Type of psoriasis you have

• Places psoriasis appears on your body

• Severity of the psoriasis

• Impact psoriasis has on your life

• Other medical conditions you have

Your treatment plan may include medication you apply to your skin, advice to help you care for your skin, and tips to help prevent flare-ups. To control psoriasis, some people also need light treatments or medication that works throughout the body.

You can find out about the different treatments for psoriasis at: Medications and light treatments for psoriasis

Your dermatologist will want to see you for follow-up appointments. These appointments can be very helpful because your dermatologist can:

• Find out how well the treatment plan is working for you

• Modify your treatment plan if necessary

• Watch for signs of psoriatic arthritis, a disease that you want to catch early

• Assess your risk of developing other diseases that are more common in people with psoriasis

• Help you set realistic expectations for managing your psoriasis

A dermatologist can also answer questions you have about treating psoriasis. Common questions that patients ask include:

ReferencesBergstrom KG and Kimball AB. 100 questions and answers about psoriasis. Sudbury, MA: Jones and Bartlett Publishers 2005.

All content solely developed by the American Academy of Dermatology

What Nail Psoriasis Looks Like

Nail psoriasis causes changes to your fingernails and toenails

This fingernail shows 3 signs of nail psoriasis: Crumbling, roughness, and blood under the nail .

Common signs of nail psoriasis

This nail also has 3 signs of nail psoriasis: Tiny dents in the nail , white discoloration, and lifting .

Most people who have plaque psoriasis develop nail psoriasis

Discoloration , nail lifting from the finger, and a thin line of blood are common signs of nail psoriasis.

Nail psoriasis usually begins years after psoriasis first appears on the skin

This patients nail has 3 common signs of nail psoriasis: Grooves, blood beneath the nail , and lifting of the nail from the finger.

Nail psoriasis can be mild

If you have psoriasis, ridges and a thin line of blood beneath the nail can be signs of nail psoriasis.

Improvement from treatment happens slowly

Nails grow slowly, so it will take 6 months or longer to clear debris, a common sign of nail psoriasis, beneath the nail.

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What Causes Psoriasis Of The Skin

Doctors dont know exactly what causes psoriasis. However, researchers think its caused by abnormally fast-growing and shedding skin cells. The skin cells multiply quickly, causing the skin to shed every three to four days.

Psoriasis isnt contagious, but it is hereditary, which means that parents can pass it down to their children through their genes. Psoriasis is often recurrent, meaning people will have it multiple times. Some people have severe psoriasis, while others have only mild psoriasis.

Things A Dermatologist Wants You To Know About Psoriasis

Its a chronic skin problem with no cure, but heres what experts, and especially sufferers, want you to understand about the condition.

Psoriasis isnt just about looks, and its not contagious. And although this rash consisting of red, scaly and patchy spots is one of the more common skin diseases dermatologists see, public misunderstanding persists, says Michigan Medicine dermatologist Frank Wang, M.D.

Wang, who also directs Michigan Medicines Dermatology Treatment Center, an outpatient clinical program utilizing intensive topical therapies for psoriasis and other inflammatory skin disorders, says its important to be aware that psoriasis impacts both physical and emotional health.

Its a condition to be taken seriously, Wang says. The way patients may be treated by others who are not familiar with psoriasis can really impact their self-esteem and emotional wellbeing.

Here, Wang addresses the five facts more people should know about the condition, which has been a longtime research focus for Michigan Medicine dermatologists.

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Questions For Your Doctor

Consider these questions for your dermatologist. A dermatologist will not be able to answer all of these questions on your first visit, so consider preparing your most urgent questions.

• What kind of psoriasis do I have?
• Do I have psoriatic arthritis?
• If I dont have arthritis now, am I likely to develop it?
• What severity is my psoriasis?
• Will severity or type change over my lifetime?
• What can trigger a flare of my psoriasis?
• What kind of things can I do for fast relief of a flare?
• What are some things I should do or avoid to help the symptoms Im experiencing?
• What are some symptoms of conditions associated with psoriasis that I should watch out for?
• Should I let you know if my symptoms change?
• How often should I come for checkup?
• What should my daily skin care routine include?
• What is the most important thing that I should be aware of regarding my condition?
• How do I easily explain to people what psoriasis is?

What Else Should I Know

Making healthy choices can help with psoriasis. Here are some things you can do:

• If you smoke, quit. Smoking can trigger outbreaks of psoriasis in some people.
• Avoid alcohol. It can make psoriasis treatments less effective.
• Eat healthy foods. Eating a lot of fruits and vegetables can help fend off diseases that might trigger psoriasis.
• Stay at a healthy weight. This decreases the risk of inverse psoriasis.
• Keep skin clean and well moisturized. Bathing daily with bath salts or oils and then applying moisturizer can help ease the symptoms of psoriasis.

People who have psoriasis may feel self-conscious about how it looks. That’s one reason why some people turn to a therapist or join a support group of people who understand what they might be going through.

The key to psoriasis treatment is keeping up on whatever your doctor prescribes. If that means applying an ointment twice a day, then find a way to remind yourself to do it so you don’t forget. Psoriasis is one of those things that you need to stay focused on treating, even when you’re feeling OK.

Whether your psoriasis is mild or severe, learn all you can about it. Talk to your doctor or check websites like:

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How Do Dermatologists Diagnose Psoriasis

To diagnose psoriasis, a dermatologist will examine your skin, nails, and scalp for signs of this condition. Your dermatologist will also ask if you have any:

• Symptoms, such as itchy skin

• Joint problems, such as pain and swelling or stiffness when you wake up

• Blood relatives who have psoriasis

• Recent changes in your life, such as an illness or increased stress

Sometimes, a dermatologist also removes a bit of skin. By looking at the removed skin under a microscope, a doctor can confirm whether you have psoriasis.

Understanding psoriasis is key

Alexa Boer Kimball, MD, MPH100 Questions and Answers about Psoriasis

Which Specialists Will I Need

That will depend on your situation. For example, if your psoriasis is mild and doesn’t affect your life very much, you may need only your primary doctor. If you have a flare or your symptoms are getting worse, you may want to bring in a dermatologist.

If you start to feel stiffness, pain, or tenderness in your joints, it might be time to add a rheumatologist or a physical therapist to the mix. If your psoriasis starts to take a toll on your mental health, a psychologist or psychiatrist should join the roster.

Your psoriasis doctor can help build your team as you need to expand it. Make sure everyone you see for your psoriasis knows about everyone else, so they can work together to give you the treatment you need.

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What Treatments Are Available For Nail Psoriasis

There are many treatments for nail psoriasis. Your treatment plan may include one or more of the following.Treatment you apply to the nails: This can be helpful for mild or early nail psoriasis. Nails grow slowly, so youll need to apply these treatments for several months, often once or twice a day. Because nail psoriasis can be stubborn, you may need to use more than one treatment. Sometimes, two medicines are combined to give you a faster response.

Treatment that you apply to your nails includes the follow.

• A potent or very potent corticosteroid: This can be helpful for most signs and symptoms of nail psoriasis. Its safe to use this medicine once or twice a day for up to nine months.

• Calcipotriol: In one study, researchers found this to be as effective as a potent corticosteroid at treating the buildup beneath the nail.

• Tazarotene: This treatment can be especially helpful for treating pitting, a separating nail, and discoloration.

If you need stronger treatment, your dermatologist may recommend treatment given in a dermatologist office or clinic. This treatment may include one of the following.

Psoriasis medicine that can help clear the skin and nails includes:

• A biologic

People With Psoriasis Have An Increased Risk Of Developing 13 Different Types Of Cancer

Several studies have determined that psoriasisa skin condition that results in scaly red patches on your bodyis a risk factor for many cancers. The most recent research on the topic was a 2019 review of 58 studies published in JAMA Dermatology, which found that people with psoriasis are 18 percent more likely to develop cancer compared to those who do not have psoriasis. In particular, the study found that people with psoriasis had an elevated risk of developing lymphoma, nonmelanoma skin cancer , esophageal cancer, liver cancer, and pancreatic cancer.

Earlier studies have determined an associated risk with even more cancers, as well. According to one 2013 study published in the British Journal of Dermatology, researchers found that people with psoriasis are also particularly at risk for cancers of the oral cavity, larynx, pharynx, colon, lungs, and kidneys. And another 2013 review of 37 studies published in the Journal of the European Academy of Dermatology and Venereology concluded that psoriasis could increase one’s risk of respiratory tract cancer and urinary tract cancer. And for more symptoms of cancer you may not know, If You’re Sweating at Night, It Could Be a Sign of These Kinds of Cancer.

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For Best Results From Treatment

Treating nail psoriasis can be a challenge. It often takes time to treat. To get results, you need to treat your nails as directed and for as long as directed. Some patients need to try a few treatments to find one that works.

The right nail care can help you get the best results from treatment. Youll find out what dermatologists recommend at: 7 easy-to-follow nail care tips that can reduce nail psoriasis

ImagesImages used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol 2013 69:249.

ReferencesCrowley JJ, Weinberg JM, et al. Treatment of nail psoriasis: Best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015 Jan 151:87-94.Dogra A, Arora AK. Nail psoriasis: The journey so far. Indian J Dermatol. 2014 Jul 59:319-33.Lin YK, Chang YC, et al. A Chinese herb, indigo naturalis, extracted in oil used topically to treat psoriatic nails: A randomized clinical trial. JAMA Dermatol. 2015 Jun 151:672-4.Manhart R, Rich P. Nail psoriasis. Clin Exp Rheumatol. 2015 Sep-Oct 33:7-13.van der Velden HMJ, Klaassen KMG, et al. Fingernail psoriasis reconsidered: A case-control study. J Am Acad Dermatol 2013 Aug 69:245-52.

All content solely developed by the American Academy of Dermatology

The American Academy of Dermatology gratefully acknowledges the support from Amgen and .

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What Is A Rheumatologist

A rheumatologist is a doctor who treats conditions related to the bones, joints, and muscles. These often include autoimmune diseases such as gout, lupus, and various forms of arthritis.

Though the precise underlying causes of autoimmune diseases arent fully understood, they are thought to be related to the body attacking its own healthy tissues. Over time, untreated autoimmune diseases can also damage your organs, eyes, and nervous system. The goal of a rheumatologist is to come up with a treatment plan to reduce the damaging inflammation caused by related autoimmune diseases.

Its important to note that while autoimmune diseases, like arthritis, can cause symptoms of the skin, rheumatologists work to treat the underlying inflammation that causes them. This differs from a dermatologist, who can treat the skin problems at the surface level. Rheumatologists use drugs that target inflammation so the body stops attacking healthy tissues. These come in the form of biologics, corticosteroids, and nonsteroidal anti-inflammatory drugs .

How To Prepare And What To Expect

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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How Is Psoriasis Treated

There is no cure for psoriasis but there are many treatments that can help to keep it under control.

Mild psoriasis is usually treated with products applied to the skin. These include:

• moisturisers
• corticosteroid creams or ointments
• vitamin D preparations

You may also receive ultraviolet light therapy. This can slow down the production of skin cells.

If your psoriasis needs stronger treatment, you may be prescribed oral medicines or injected medicines to reduce the immune response. Two new medicines for severe psoriasis are now subsidised for people with psoriasis in Australia, Tremfya and Ilumya.

The best thing you can do to improve the psoriasis is quite smoking and limit how much alcohol you consume.

You can help manage your psoriasis by:

• taking your prescribed treatment regularly to help prevent flare-ups
• reducing stress
• having a healthy lifestyle and eating a healthy diet

Eye Problems Caused By Psoriasis

Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado.

Psoriasis is more than just a skin disease. It can cause joint damage, known as psoriatic arthritis, has been linked to cardiovascular risk including heart attacks, and can also affect the health of your eyes.

Eye problems may be directly related to psoriasis skin flare-ups around the eyes. But psoriasis can also lead to problems within the eye itselfproblems that, when left untreated, can cause permanent damage and vision loss.

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Psoriasis Flares And The Eyes

Although they are relatively rare, psoriasis flare-ups near the eyes can be especially painful and hard to treat. Scales and dryness may cause the edges of the eyelids to curve up or down, which may produce drying of the cornea or allow the eyelashes to actually scrape the cornea.

In such cases, the National Psoriasis Foundation recommends the following:

• Wash the affected lids and lashes with a mixture of water and baby shampoo.
• Use an over-the-counter eyelid cleaner, such as OCuSOFT, to remove stubborn scales.
• Apply a topical medication, such as Elidel or Protopic , around the eyes. These medications are only available by prescription and should be used with your healthcare provider’s supervision.
• Have your intraocular eye pressure tested by tonometry regularly by an ophthalmologist to ensure that these topical treatments aren’t harming your eyes.

Dermatologists will sometimes prescribe low-potency steroids for use on the eyelids. This can help, but, due to the risk of cataract and glaucoma development, you should not continue the use of these steroids beyond the time recommended by your healthcare provider.