[If a nurse started the appointment] I ask them all those things again when I appear on-camera, but in deeper detail. I want to learn about when they first noticed it, how quickly it’s been growing, what sorts of symptoms they have, does it hurt, family history of anything similar, any other medical conditions, were they sick prior to this happening? There are certain types of psoriasis that are triggered by illnesses or new medications.
Then I ask them to put something on that is easy to disrobe so that they can reveal [the affected] areas. It’s hard for us to completely do a physical exam, but I’ll have them touch [the area] and describe how thick it feels. Does it feel much thicker than the surrounding skin? Then we probe for other symptoms. Are you having joint pain? Because there’s something called psoriatic arthritis, which can be really destructive to the joints. Then, if it’s not clear-cut psoriasis, I think about any other conditions that might be in that differential diagnosis and I try to “tease” them out as well.
I want [my patients] to be comforted by the fact that psoriasis is exceedingly common. It’s really one of the top 10 conditions that we see and train on. Any board-certified dermatologist will not be surprised by psoriasis and we’ll be able to give you a good treatment plan [virtually]. If you have a complex [case], you may want to see a specialist. The National Psoriasis Foundation can help guide you to a physician who has made psoriasis a big part of their practice.
Treating the Other Effects of Psoriasis
There are things that we can do to significantly improve your comfort and your quality of life. Sometimes psoriasis can be asymptomatic in terms of not itching or hurting, so [some patients] feel like it’s vanity. It is absolutely not vanity. We understand how much it affects you socially. Whether it is work or in your romantic life, having to explain to others that it is not contagious. You cannot catch it; having to explain why when you take off your jacket and there are flakes leftover…
A dermatologist can guide you on how to have those conversations in your personal life to make your life better. All of these things matter, because they affect your quality of life. There are higher levels of depression in psoriasis patients. There are higher levels of heart disease, higher levels of obesity. It can affect so many systems, so having the right diagnosis is important. It’s not “just a skin thing.” It is a full-systemic condition. Treating it early can prolong your life, so having your dermatologist diagnose it and making sure you have the other doctors in line to also assess and help you treat any other conditions we know that are associated with psoriasis is really important. Treating psoriasis is absolutely not vanity. We always call ourselves “skinvestigators.” Your skin tells us what’s going on inside your body. We need to take that information and make sure we do the best with it to keep ourselves safe and healthy. — As told to Kirbie Johnson
This story is part of Survivor’s Guide, a series on navigating the impact of psoriasis through beauty and self-care.
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