10 common psoriasis questions for GPs - a GP's perspective

Psoriasis questions

By Dr Susanne Farwer, GP and SAS doctor dermatology, South Yorkshire

Psoriasis is not simply a cosmetic problem; it’s a common and very distressing condition and even people with very mild symptoms are affected every day. The impact of the disease on physical and mental well-being is still underestimated, even among healthcare professionals, and a recent survey showed that 52% of psoriasis patients are dissatisfied with their disease management. There is still a long way to go…

Engaging in an open and honest dialogue with your doctor can make a big difference in the way you are able to manage your psoriasis. It will help to find out what’s best for you and will give your doctor a better sense of who you are and how psoriasis is affecting your health and your daily life. Be proactive and don’t hesitate to ask questions about diagnosis, medications, emotional issues or diet and lifestyle matters. To get the most out of your visit to the doctor be prepared and ask the questions that are important to you.

Dr Susanne Farwer

The FAQs I have encountered in day-to-day practice are summarised and answered below and might aid as a guide for your next appointment.

1. How often should I visit to discuss my psoriasis treatment?

There are no hard and fast rules as to how often you should see your GP. It really depends on the severity and the impact psoriasis has on your life. I personally find face-to-face medication reviews a great opportunity to discuss your current medication and skin care regimen, but also to screen for other health problems such as high blood pressure, mood changes or psoriatic arthritis.

2. Psoriasis is making me feel depressed and anxious, who can help?

Psoriasis affects not only your body but also your emotional well-being and self-image. Talk to your GP if things are getting on top of you. Mental health issues such as depression and generalised anxiety are very common among people with chronic skin disorders, but there are strategies that everyone can learn to overcome these and to lead a happier and more fulfilling life.

Stressed about psoriasis

Your GP can refer you to support groups, counselling or other forms of psychological therapies available on the NHS. Counselling is a form of talking therapy that helps you to address negative thoughts and feelings in a confidential and dependable environment. Other types of therapy such as psychotherapy or cognitive behavioural therapy (CBT) are offered too. Mindfulness-based therapies such as MBSR (mindfulness-based stress reduction) or MBCT (mindfulness-based cognitive therapy) incorporate techniques such as simple meditation and breathing. These have proven quite helpful as additional treatments of psoriasis and effective in preventing repeated bouts of depression. If you want to get started with mindfulness, either as a preventative measure or to tackle any mood issues, there are lots of books, podcasts and apps available to choose from. My personal favourite is the Headspace App which offers wonderful, simple and well-structured meditations that go beyond stress reduction to achieve a more balanced and focused life.

3. I’ve heard psoriasis can cause other conditions, what are they and should I be worried?

In continental Europe psoriasis is now referred to as ‘psoriatic disease complex’ to emphasise the fact that it is more than just a skin condition. Having psoriasis increases your risk of developing other chronic health problems such as heart disease, diabetes, inflammatory bowel disease and mood disorders. Research has also linked psoriasis with a higher risk of lymphoma and skin cancer. Up to one third of affected individuals will also be troubled by psoriatic arthritis. It is therefore vital that you try to adopt a healthy lifestyle to reduce your risk factors for heart attacks and stroke and incorporate regular cancer screening in to your care.

4. Which triggers should I watch out for?

Triggers are things that set off flare ups of psoriasis. Common factors are stress, skin injury such as vigorously scratching or severe sun burn, cold weather, certain medications like blood pressure tablets or throat and skin infections. To get to know your psoriasis it can be helpful to keep a diary to identify your personal triggers and learn ways to reduce them.

5. How likely is it that my children will develop psoriasis too?

Psoriasis is a complex disease and is thought to be an inherited condition as there is a strong familial element to it. About 1 in 3 patients will have a relative with the disease.

Children and psoriasis

However, despite carrying the psoriasis genes people might not develop visible signs of psoriasis. Why is this? Having a genetic predisposition is not enough for skin changes to develop, and this is where environmental factors such as a stressful life event, an infectious episode or a traumatic insult come into play. A parent affected by psoriasis has a 15% chance of passing it down to their child. The risk goes up to 75% if both parents have psoriasis.

6. My psoriasis is improving, does that mean I can stop treatment?

Psoriasis is a chronic relapsing condition that needs good skin care even during times when things are ‘under control’. Creams and ointments such as vitamin D analogues and/or corticosteroids are often used intermittently during times of flare ups for a limited duration. Emollient creams and moisturisers in contrast should be used on a daily basis to hydrate dry skin associated with psoriasis. Apart from making the skin feel and look better, they have anti-inflammatory properties and help to reduce itching, scaling and improve the penetration of other topical treatments. There is also good evidence that if your skin is well moisturised, it is more supple and resistant to cracks and fissures and consequent Koebner Phenomenon. Make friends with your big pump dispenser!

7. Where can I find reliable and trustworthy information about my condition?

Most of you have probably started out researching about psoriasis using Google. However, the sheer amount of information can be quite overwhelming and the quality varies from excellent to dreadful. The Psoriasis Association, the British Association of Dermatologists and NHS Choices offer an abundance of relevant and well researched content. The Cochrane Library is a collection of high-quality, independent evidence to look at the effectiveness of health care interventions and their ‘Plain Language Summaries’ are fantastic and written in a straightforward way and worth checking out.

8. What can I do on my own to care for my psoriasis?

Looking after yourself the best you can and adapting a positive attitude and a healthy lifestyle can go a long way. We now know that obesity has been associated with the development of psoriasis and psoriasis of increased severity. Fat tissue is thought to act like an endocrine organ producing a multitude of chemicals sustaining chronic inflammation. Weight reduction therefore could reduce inflammation and improve severity of psoriasis and response to medical treatment.

Healthy diet

Alcohol abstinence and smoking cessation have also been found to reduce the inflammatory load in the body. Try and get active as exercise not only improves our body composition i.e. lowering your percentage of body fat, but also reduces stress and lifts your spirits.

9. I would like to try some complementary or alternative therapies, what is best for psoriasis?

Complementary and alternative medicine (CAM) use is very popular among people with psoriasis and up to 69% of patients have tried it in one form or the other. It is a very fascinating yet controversial field but the amount of evidence from well-designed, methodological robust trials is constantly growing. The term comprises therapies such as traditional Chinese medicine (TCM), herbal therapies, dietary supplements, nutrition, climatotherapy and mind-body interventions. We will be covering the evidence of CAMs in a future blog post in more depth, but for now I would like to point out that ‘natural’ does not mean safe. The Psoriasis Association has published an excellent summary about the Do’s and Don’ts of CAMs.

10. Are there any apps that I can use to track and monitor my psoriasis symptoms?

We are living in very exciting times and the interface between health and digital technology has initiated a revolution for patients, healthcare professionals and many companies. You have probably heard about the ‘Quantified Self’, utilising mobile phone technology and life logging applications. It’s basically self-knowledge through self-tracking technology such a wearable devices and sensors. I am always amazed by the vast amount of health apps available for people to download, ranging from simple data collection to complex interactive education. Research has shown that in chronic disease management, such as heart disease, smart phone intervention has been effective in improving outcomes. The key factors for success included personalised messages with tailored advice, greater engagement and use of multiple modalities. People tracking their symptoms or lack of them, feel more in control of their condition and seem to be coping better.

MyPso app

I have recently downloaded the free MyPso app which is quite sophisticated yet easy to use. It provides a psoriasis diary to monitor treatment progress, identify triggers and generate a report for your next appointment. Have a play and see if health tracking is right for you.

This content is not intended to advise you about your health. Always seek advice from your doctor or other qualified healthcare professionals.

UK/IE MAT-03422. Date of Prep: May 2016

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