Here are the top reasons people living with psoriasis should check in with their dermatologist.
1. Your Symptoms Aren’t Improving, Even With Treatment
It’s essential to give any new treatment time to work, although exactly how long depends on the drug you’re taking. “Drugs that work the slowest are also some of the best,” says Mark Lebwohl, MD, chairman of the dermatology department at the Icahn School of Medicine at Mount Sinai Hospital in New York and past chairman of the Psoriasis Task Force of the American Academy of Dermatology (AAD). Some biologic drugs used to treat psoriasis, for example, may take up to three months to work, he notes. “If you don’t see some benefits at three months, it’s not working,” Dr. Lebwohl explains. When it comes to topical treatments, such as a corticosteroid, you should typically expect to see some benefits after four weeks. If you’ve been following your treatment plan as prescribed without results, talk to your doctor about whether it may be time to make an adjustment.
2. You Experience New or Worsening Symptoms
If you’re faithfully sticking to a treatment that has been working but you begin to experience new or worsening symptoms, reach out to your dermatologist. It may be a sign that your treatment has stopped working. “[Some] people simply seem to get used to therapies,” says Lebwohl. In other words, drugs can become less effective for people over time. The good news is, with many treatment options available, your doctor will in all likelihood be able to prescribe a new therapy that works for you.
3. Your Symptoms Are Impacting Your Life
If your psoriasis symptoms are getting in the way of your daily activities, you don’t have to just accept it. The many available treatment options help guarantee you can find a new solution that works. There’s also one more — perhaps even more pressing — reason to talk to your dermatologist. The symptoms you’re experiencing may be a sign of other health issues, such as systemic inflammation, that can be addressed with the right treatment. “There’s a price you pay that you might not be aware of when you have inflammation. It’s linked to heart disease, for example,” says Lebwohl. “Think about the future. Are you damaging your joints or increasing your risk of heart disease? It’s not just about the fact that you have skin lesions.”
4. You Notice Changes in Your Nails or Scalp
Nail changes are common in people with psoriasis, according to the AAD. These include:
Dents (known as pits)CrumblingWhite, brown, or yellow discolorationBlood or other buildup under your nailsYour nail bed lifting up from your finger
If you’ve just started a new treatment and your nails aren’t getting better, however, that doesn’t mean a drug won’t work. It can take up to three months before you notice improvements in your symptoms — and it takes an additional six months for the white part of the fingernail bed to fully grow out (12 months for toenails). “The nails lag behind the skin, so you can predict if your nails will clear,” says Lebwohl. That said, if you’ve given your treatment time to work and you notice your nails aren’t getting better or are getting worse, talk to your dermatologist. He or she may recommend injections with the drug methotrexate or corticosteroids directly into the affected nails. These can help, although “we try to avoid them because they hurt,” says Lebwohl. You should also call your dermatologist if you develop symptoms of scalp psoriasis, which include dandruff-like flaking, silvery-white scales, and itching. Scalp psoriasis can be difficult to treat, according to the National Psoriasis Foundation (NPF), but there are many options available. Your dermatologist can help you develop a treatment plan that works for you.
5. You Have Joint Pain
Psoriatic arthritis is a chronic inflammatory disease of the joints that affects roughly a third of people with psoriasis, according to the NPF. It causes symptoms such as joint pain, swelling, and stiffness. It’s essential to talk to your dermatologist if you experience these symptoms. “Some psoriasis drugs work well and some don’t for psoriatic arthritis, so you absolutely need to report these symptoms to your dermatologist,” says Lebwohl. Developing psoriatic arthritis “may warrant changing your drug or adding something to your treatment,” he notes.
6. You Have Signs of a Skin Infection
Skin infections, including yeast infections, are a common side effect of some but not all psoriasis drugs. “You simply have to treat it,” says Lebwohl. Usually, that can be done fairly easily with the right medication to treat the infection. It’s also important for your dermatologist to rule out any other skin infections that aren’t related to psoriasis. MRSA (methicillin-resistant Staphylococcus aureus), for example, is a type of bacterial infection that causes a red, swollen, painful bump or infected area on the skin and may be accompanied by a fever, according to the Centers for Disease Control and Prevention (CDC). It’s one of the most common skin infections in the United States and it’s contagious, tends to recur, and can lead to serious complications such as pneumonia, Lebwohl notes.
7. You Have New Health Problems
New health problems could signal a psoriasis complication or related health condition. In addition to psoriatic arthritis, psoriasis can increase your risk of other conditions, including:
Eye infectionsType 2 diabetesHigh blood pressureIrritable bowel diseases, including Crohn’s disease and ulcerative colitis
“Your dermatologist does need to know about major health changes,” Lebwohl says. “If a patient has health problems in an organ other than the skin, they have to tell us, because it definitely impacts the treatment we select.”
8. You Want to Try a Natural Remedy or New Treatment
While herbal or other natural remedies might seem harmless, you should always talk to your dermatologist before trying them, Lebwohl advises. When tested in the lab, some supplements have been shown to contain steroids that “can have many side effects when used long-term and can lead to psoriasis flares,” he says. Others can interfere with certain medications, he adds. And although it can wait until your next scheduled appointment, also keep your dermatologist in the loop on any new medicine another doctor prescribes to you, says Lebwohl. He or she can monitor you for potential drug interactions or side effects.
9. You Have Pressing Health Questions
It’s normal for questions to come up between appointments. If you have a pressing concern only your dermatologist can answer, it’s perfectly fine to pick up the phone — or at least it should be. For example, “when COVID-19 first came up, people were worried if they should stay on their medicine or if it would make them more susceptible or the outcome worse,” says Lebwohl. A dermatologist can offer reassurance and answers based on the latest research. If your dermatologist generally isn’t available to answer important health questions, you may want to consider a switch. The AAD offers a search tool to help you find a dermatologist who specializes in psoriasis.
10. You’re Planning to Get Vaccinated
Traveling to certain places in the world often requires getting certain vaccinations, and then there are more routine shots such as the annual flu shot and, more recently, the COVID-19 vaccine. Before you finalize your plans and schedule your shot, it’s worth talking to the dermatologist treating your psoriasis. “Many drugs we use specifically state that you shouldn’t use live vaccines because of the concern that they might either reduce the response to the medication or might even make you get sick when you get vaccinated,” notes Lebwohl. While the COVID-19 vaccine is recommended by the NPF for all people with psoriasis, including those on systemic treatments, you should also check in with your psoriasis care provider before getting vaccinated, he says.
