Psoriasis
Patient Education

The Team

Physicians who have been involved with the ongoing care of an individual may initially diagnose psoriasis in a patient. Once the diagnosis is confirmed, however, the patient is usually referred to a specialist. Common specialists that a psoriasis patient encounters are listed in this patient education guide and include:

Dermatologists - This doctor is often the patient's regular doctor and may be the first physician to recommend further tests or procedures to be done by a specialist.

Rheumatologists - A surgeon skilled in operating on the breast. Breast surgeons often perform biopsies on a tumor found in the breast. They will also remove the tumor or breast if necessary. Some breast surgeons also do reconstructive surgery.

These physicians are accustomed to diagnosing and treating skin diseases and are therefore the most knowledgeable on up-to-date therapies available.

Alternative care practitioners include:

Acupuncturists - Treat patients by inserting and maneuvering needles into body areas to relieve pain and improve health.

Naturopaths - Educate patients in the use of lifestyle changes, diet, exercise and natural therapies to treat or prevent disease.

Homeopaths - Treat patients based upon the principle that the body can heal itself. Various solutions are administered toward returning health.

Chiropractors - Treat patients from the principle that medical conditions may be treated by putting the musculoskeletal system back into proper alignment.

How to Prepare

Having made your appointment with a healthcare provider, there are certain actions listed in this patient education guide that you need to take in order to maximize the benefit of your psoriasis doctor visit.

• On the day of the exam, shower and wash hair so that skin has no additional contaminants. This cuts down on infection if biopsy takes place.
• Clean nails prior to examination so abnormalities are better visualized
• Bring list of symptoms with a list of when and where they first appeared
• Bring a list of your medications and the dosage you are currently taking. Include supplements.
• Bring list of allergies and past medical history
• Have a list of questions that you would like to discuss with your physician

Questions to Ask Your Doctor About Osteoarthritis

From your initial psoriasis diagnosis throughout your treatment and care, you will have questions about your psoriasis. Ourt patient education gude lists questions to discuss with your doctor so you can make informed decisions about your condition.

Question About My Diagnosis

• What kind of psoriasis do I have? How severe is my psoriasis? Will it get worse?
• Will my symptoms ever go away?
• How can I achieve remission? Will my symptoms return if I am cleared?
• Will I get arthritis?
• What other medical conditions are related to psoriasis that I am at risk for?
• Are there support groups in this area?

Questions About My Treatment

• How can I get rid of my itching?
• What treatments do you recommend for me and why?
• What are the risks and adverse reactions of the treatment?
• Will I be having light therapy? Should I invest in a home light therapy?
• If my psoriasis comes back after clearing up, will the treatment be the same?
• Do I have to stay on the treatment forever or is it for a certain time frame?

Questions About My Lifestyle & Family

• Can I pass this onto my children? Can my children catch this from my flaky skin?
• Do I have to avoid the beach and the sun's rays? Can I participate in outdoor activities?
• Would protective clothing make a difference for my condition?
• Is there a daily skin care routine that I should follow?
• Is there a special diet that would improve my condition? Are there foods that I should avoid?
• Is there an activity that I should avoid to prevent arthritis?
• Are there special vitamins or supplements that would help?
• Are there triggers that would cause worsening of my condition?

Common Tests or Labs to Diagnose Osteoarthritis - Patient Education

When looking for a diagnosis of psoriasis, your physician will do a complete examination of the skin, nails and scalp.

A biopsy (taking a small skin sample) may be taken to rule out conditions that look similar in appearance. In particular, your doctor will look to exclude:

• Ringworm (tinea corporis)- fungal red scaly circle rash
• Lichen planus-dry itchy bumps on arms or legs, inflammatory
• Pityriasis rosea- starts with one large spot on torso (herald patch) which branches out but confined to 6-8 weeks
• Seborrheic dermatitis- itchy, scaly, greasy, reddened areas of skin
• Dandruff - flaky white cells of the scalp

While there are no blood tests or radiological tests used to diagnose psoriasis, blood will be drawn for screening and monitoring the liver, kidneys and blood while on various oral medications for psoriasis.

Your doctor may screen your blood for the following:

• HIV
• Hepatitis B and C
• Tuberculosis

As you take oral medications to treat psoriasis, your doctor will monitor your blood for the following:

• Triglycerides
• Cholesterol and lipid panel
• Complete blood count
• Liver and Kidney enzymes

Common Treatments

Topical treatment is available for symptomatic relief and oral medications are available, as well, to address the problems associated with psoriasis. Read more in this patient education guide.

External Treatments

Treatment	Preparation	How the Medication Works
Topical steroids	Preparations: sprays liquids creams gels ointments	Decreases inflammation Decreases itch and redness
Immunomodulators	Tacrolimus Pimecrolimus	Symptomatic relief Does not promote skin thinning
Vitamin D analogues	Calcipotriene creams	Enhances effect of topical steroids Does not thin out skin as in steroid use
Bath salts	High salt preparations, like Dead Sea Salt or Epsom Salt	Softens skin patches Exfoliates skin
Coal Tar	Preparations include shampoos bath gels creams	Decreases psoriatic flakes Decreases itch and redness
Moisturizers	Creams with salicylic acid preparations, urea, lactate and glycolate	Moistens skin Decreases scales

Phototherapy (Light Therapy)

Routine daily exposure to sunshine in short increments may be helpful to mild psoriasis. In addition, there are three types of light therapy:

• Psoralen and Ultraviolet A Therapy (PUVA) - Uses timed artificial-light in conjunction with a photosensitizing drug (psoralen) in pill or lotion form. Done 2-3 times/week in a medical office.
• Ultraviolet B Therapy (UVB) - Specific wavelength of artificial light treatment given 2-3 times/week. Exposure time is increased slowly by 15-60 seconds per week
• Narrow Band Ultraviolet B Therapy - Similar to UVB treatment, but uses a different frequency. Occasionally Narrow band UVB treatments are combined with tar treatments (Goeckerman therapy).

Medications for Psoriasis Treatment

If topical treatments and light therapies are unsuccessful, your physician may add medications to your regime.

Drug Class	How the Medication Works
Antimetabolite	Treats rheumatoid arthritis Helps generalized psoriasis in small doses
Retinoid	Effective in treating pustular and erythrodermic psoriasis Also used in combination with Psoralen to decrease amount of UV treatments needed
Immunosuppressant	Helps severe, widespread psoriasis Rapid improvement seen
Biologics (injectables)	Adjusts the immune system (hyperactive in psoriasis) Inhibits protein action causing skin overproduction