If you or a family member has psoriasis, then you're sure to have many questions about how it's treated and the different types of doctors who will be involved in your care to help you live the healthiest life possible.
Treating the whole person
In recent years, doctors have begun to understand that psoriasis is more than a simple skin condition. Because psoriasis is a condition that involves your immune system and inflammation, doctors now think about treating 'the whole person' rather than just your skin rash.
People who have psoriasis, especially if it is severe, can have an increased risk of other health problems such as heart disease, diabetes, obesity and inflammatory bowel disease. Around 25 per cent of people with psoriasis will have swollen and painful joints, called psoriatic arthritis. Because psoriasis can affect your appearance and quality of life and may not be well-understood by others, it can also increase your risk of depression. These health problems that can be associated with psoriasis are what doctors call 'comorbidities'.
We also know that many people with psoriasis don't necessarily receive the best treatment for their condition and feel unhappy with their treatment, which is a shame, because there are very effective treatments available.
That's why it's so important to have the right types of doctors onboard with you: you want to make sure you have the best people to help you as a whole. Managing psoriasis like this can help to improve your overall wellbeing.
It all begins with your GP
Your GP is your first port of call if you have a rash which you think may be psoriasis, or, if you have already been diagnosed with psoriasis and need to get it under control.
A psoriasis rash is one of the more common rashes that GPs see and this puts them in a good position to diagnose psoriasis.
Your GP will talk to you about your medical history, any medicines you are taking, if you are a smoker and how much alcohol you drink. Because about one-third of people with psoriasis have a family member with the condition, they will also be interested in your family's medical history.
To understand how your psoriasis is affecting you, your GP may also ask if you have been feeling sad or down lately, if your rash is causing you distress, or is affecting your social life or ability to work.
Try to be as open as you can with your GP. Your answers to these questions will help them organise the best treatment and referrals for you.
As well as taking your history, your GP will:
- examine your skin – there is a pattern of psoriasis rashes that most GPs will recognise
- check your nails for signs of nail psoriasis
- check your joints for signs of arthritis – as this also follows a particular pattern when it's associated with arthritis
What happens next?
If your GP is not certain that the problem is psoriasis, they may organise a skin biopsy or refer you to a dermatologist – a doctor who specialises in skin problems – to confirm what the problem is.
If your GP diagnoses psoriasis and it is mild to moderate with no arthritis, your GP will usually prescribe topical treatments – treatments that you apply to your skin. They will make a follow-up appointment with you to review your rash and see how well the treatment has worked. If your rash only partly improves with this first treatment, your GP may add another type of topical treatment.
If you respond well to treatment and don't have other associated health problems, you may want to keep seeing your GP to manage your psoriasis. Your GP can also give you helpful lifestyle advice on managing psoriasis triggers so you can help to prevent flare-ups.
If your psoriasis is not manageable with topical treatment, severe or is having a big impact on your life, your GP will usually refer you to a dermatologist – a doctor who specialises in skin problems. Severe psoriasis often needs treatment with ultraviolet light (phototherapy) or prescription medicines that you take by mouth or by injection (systemic treatments). These specialised treatments are usually given and supervised by a dermatologist.
If you have signs of psoriatic arthritis, it is important for your GP or dermatologist to refer you to a rheumatologist – a doctor who specialises in joint problems. A rheumatologist can diagnose psoriatic arthritis and make sure you get the right treatment to help manage your symptoms and prevent future problems. It is especially important not to delay seeing a rheumatologist – the earlier psoriatic arthritis is treated, the better.
If you have been feeling sad or down, or your rash is causing you distress, your GP may refer you to a healthcare professional that specialises in mood – like a counsellor, psychologist or psychiatrist. They can provide emotional support which can be a vital part of living well with psoriasis.
The doctors involved in your ongoing care will depend on the type and severity of your psoriasis and how you respond to treatment. Even if you need to see a specialist, such as a dermatologist and rheumatologist, your GP will remain an important part of your treatment team: monitoring your condition, keeping a close eye on your overall health, acting as the central coordinator of your treatment and providing referrals when you need them.
Ask your GP about your risk factors for other health problems such as heart disease, inflammatory bowel disease or diabetes. Ask them if you are at increased risk because of your psoriasis, what you can do to reduce your risk and if you need to be referred to a specialist to help manage these.
Keep your GP as your first point of contact when you have any concerns about your psoriasis or general health and lean on them for extra support whenever you need it.
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