That's Pso Psoriasis: Dermatologist Appointments

3 min read

Dermatology visits are a consistent part of managing life with psoriasis. Place them right next to moisturizing daily and skirting around unsolicited advice. They also have a reputation for being notoriously brief, lasting sometimes for as little as five to 10 minutes.

Straight from those who live it

And if you don’t know how to efficiently and effectively advocate for yourself — in a way so that your dermatologist truly hears you, you're left feeling unheard, unhappy, and overall confused.

We asked our own contributors and advocates here at PlaquePsoriasis.com for some words of wisdom when it comes to managing life with psoriasis, specifically for insight into that tricky doctor-patient relationship.

Our question? What is your advice on making the most out of a dermatologist appointment?

Julie: I am one of those patients who does not see my dermatologist frequently. However, since I also have psoriatic arthritis, I see a rheumatologist regularly. When I see my dermatologist, it is because my psoriasis symptoms are out of control and I cannot manage them on my own.

Many psoriasis sufferers only see a dermatologist and really need to make the most of their appointments. Over the years, I have learned more about how to make the most of any doctor's appointment.

The most important lesson is to remember that this is not a social visit. When the doctor asks how you are, tell her. This is not the time to say "fine" unless you really are fine.
In addition to telling your doctor your symptoms, you want to tell her how you are affected by your symptoms. Saying "I have psoriasis on my scalp" doesn't mean as much as saying "psoriasis on my scalp is so itchy that I stay up scratching my head all night." Be descriptive.

When you have said what you need to say, stop talking. Give the doctor a chance to process. Silence sometimes makes me uncomfortable, but I have to remind myself that I don't have to keep talking. It can dilute the point.

”gemma
Gemma:I approach my dermatology appointments like I approach business meetings. I decide what I want to achieve, and exactly what I need as a minimum to judge the meeting as a success. I will refuse the leave the doctor's office until I have my minimum requirements met!

Usually, these minimum requirements are knowing not only what my new treatment plan involves but also exactly how long I should wait to expect results, what those results should look like, and an exact plan (with timelines) as to what I should do if things don't work out as expected.

It's so hard when a treatment doesn't work and then you have to wait for months to go back to the dermatologist. When I approach my appointments this way, I get direct dial numbers, and personalized email addresses of team members to follow up with if I have less than satisfactory results.

Keeping a diary of more than your skin symptoms can also be really helpful. Recording when you have canceled plans or cried as you tried to get ready for a cocktail party can help your doctor diagnose the mental strain you're under. Depression and the symptoms of mental strain are independent of psoriasis severity. So don't feel like you have to keep your feeling to yourself just because you feel "your skin isn't bad enough."

”catherine
Catherine:My advice for preparing for a dermatology appointment: take photos and make a list of things you want to ask/talk about. The taking photos tip stems from the time that I waited six months for an appointment, only to be sent home with no treatment because my guttate psoriasis had magically disappeared that day. Of course, it returned the following day and I had to wait months to be seen again.

Whilst that doesn’t happen often, I always take photos of my psoriasis between appointments now. This can also help with tracking how the psoriasis is changing over time and whether treatments are having an effect. Also, keep an eye on your nails – psoriatic nail changes are a risk factor for developing psoriatic arthritis. My dermatologist and I actually discussed my nail changes and the possibility of psoriatic arthritis around four years before I was diagnosed with PsA. It’s really important to be aware that psoriasis can affect more than your skin, and your dermatologist should be mindful of this too.

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sho50 Member
My biggest problem with my dermatology appointments is just getting them! There is a critical shortage of dermatologists in my area (far NW Washington) and mine is by far the most sought after. Because of this, her "new patient" wait-list is over a year long. Even for us "regular" patients on her case load, return appointments are often 6 months or more out. She is good at online follow up, but procedures are often too delayed. There are only two other active dermatologists in our area: one is just as busy and the other is not liked, for many reasons. A fourth very good doc (who was hospital based) retired nearly two years ago and has not yet been replaced. Some SOL folks are forced to travel the 100 miles to Seattle to find available dermatologic services. 
1. Clair G Moderator & Contributor
 <inline-mention username="sho50" user-id="7016129"/> Oh my gosh, I am hearing more and more about shortages of specialist appointments in dermatology and rheumatology all over the world. I wish this system was more user-friendly and that the process were smoother for all patients, How has your psoriasis been behaving lately? Are you managing okay? Warmly, Clair ( Team Member)
sho50 Member
 <inline-mention username="Clair G" user-id="3324255"/>Thanks Clair. My psoriasis has been mostly stable and the lesions mostly minor. It's a combination of little clusters of guttate lesions plus a few more typical plaque lesions. Problem areas include the typical scalp (really itchy) and behind my ears, and more minor around my elbows and knees. But oddly, my most chronic flair up area (plaque form) is along the instep of my left foot. Go figure! I usually keep it in reasonable check with daily triamcinalone cream, but when It gets bad with cracking, peeling, pain, and even some bleeding - about every 2 or 3 months - a two week course of clobetasol ointment will effectively knock down the flair up. No need for anyrhing more drastic (yet), like a biologic. I've learned to be really careful with the strong clobetasol steroid, however, because it causes permanent underlying skin thinning. I made the mistake of over-using it years ago on my forearms and they now suffer badly from ugly spontaneous bruising and frequest bleeding. That's bad and there's no fixing it. Another problem, especially on my scalp, is the comorbidity with many actinic keratoses (AKs) and recurring basal cell carcinomas (BCCs). Regretfully, the treatments for the these are pretty much the opposite of what's needed for psoriatic lesions. And, it's very hard to differentiate between AKs and guttate psoriasis (even my dermatologist often can't tell one from the other without microscopic biopsy). This makes scalp treatments really challenging. I've posted about this on this site before hoping to hear about how others cope with the same comorbidity conundrum, but there have been no responses (so far). It's hard to believe that I could be the only person who suffers from both conditions.
1. Clair G Moderator & Contributor
 <inline-mention username="sho50" user-id="7016129"/> Thank you so much for your perspective and for sharing your experience. It is part of what weaves this rich fabric that is our community. I am sure that someone somewhere shares in your diagnosis. I also find the scalp notoriously difficult to treat, Diane wrote a great article about this: <a href='https://plaquepsoriasis.com/living/scalp' target='_blank'>https://plaquepsoriasis.com/living/scalp</a>. Clobetasol is something that I steer away from if I can, I have had to use it many times out of desperation, and over the last 2 years I have tried to clear off from using it for the same reason. Our editorial team wrote a great article about the BCC too, I am linking it here for you to read: <a href='https://plaquepsoriasis.com/cancer-risk' target='_blank'>https://plaquepsoriasis.com/cancer-risk</a>, and then here is a personal experience article from the lovely Vicki: <a href='https://plaquepsoriasis.com/living/skin-cancer-risk' target='_blank'>https://plaquepsoriasis.com/living/skin-cancer-risk</a> Wishing you an easy and itch-free day, Warmly, Clair ( Team Member)