Treatments From Your General Practitioner

Did you know that a general practitioner can help with psoriasis? Me either.

It took me 28 years with psoriasis to realize that my general practitioner (GP) could help me manage and control my condition. Your GP is a resource that can provide guidance in selecting a treatment plan and can even help push for a different treatment if you find yourself struggling.

The importance of keeping skin moisturized

Maintaining a healthy skin barrier is important and general practitioners can certainly help with this. Moisture is king when it comes to psoriasis care. All it takes is checking your skin in the dry winter months to see the damage moisture loss can bring to the surface.

It sounds boring as heck, I get you, but there are a few reasons why moisturizing is insanely essential:

• It makes your psoriasis feel better. Tight skin is not nice.
• It prevents painful cracking and embarrassing bleeding.
• It can help avoid psoriasis worsening- as skin damage can lead to more psoriasis via the Koebner effect.
• There is some evidence that shows some topical treatments work better on well-moisturized skin.

It is also important to note that shower gels and other foaming agents can dry out the skin and your primary doctor can recommend bath oils or prescribe emollient cleansers that can be used instead. These products can moisturize and reduce the risk of drying out the skin.

Discussing treatment options with your general practitioner

Vitamin D derivatives

Previously I have used Dovonex (Calcipotriol) alone but am currently taking the medication to ease the transition from topical steroids. There are other options out there such as Curatoderm (Tacalcitol) and Silkis (Calcitriol). Vitamin D topicals are used as they slow down the production of skin cells and have an anti-inflammatory effect. While they are suitable for long term use, this should be under the care of a doctor including your GP.

Topical steroids

If topical treatments were sweets; topical steroids would be the chocolate fudge cake with extra cherries on top. I have a love relationship with hydrocortisone, the mildest topical in this family. Why? Because I get psoriasis in and around my ears 100% of the time and this small tube of cream gives me the freedom (with a few days pre-planning) to tie my hair up, or meet friends without my eyebrows flaking.

I also use other members of this family. Dovobet is my go-to simply because in the NHS (National Health Service in the UK) this seems to be what I get, but I save this for special occasions i.e. being a bridesmaid at a friend's wedding. The reason I save this is that I usually get a post flare soon after use, so I need to apply this as a conscious decision. Even though I get post steroidal flare, I still love it. Again for me, it means freedom, albeit briefly from itching if I’m in a mega flare and waiting for a dermatology appointment or need to save my friend's wedding photos from my dotty decolletage. Other options include Eumovate, Betnovate and Dermovate.

Long term use is not recommended because there is a risk of thinning of the skin, but if you're sincere and open with your GP about your mental health, they can be more accommodating to fit within your lifestyle needs. At your initial appointment, it's important you discuss with your doctor how you will transition off topical steroids. Weaning off is recommended. In the past, I've stopped cold turkey as soon as my event was over (the date/ school prom/ weekend away to the beach) and had a notable worsening of symptoms. I rarely attended my follow up (I also don’t recommend this! I was 18, and of course, knew everything back then.)

Embarrassing fact: I didn’t learn that you can wean off Dovobet with the vitamin D topical Dovonex until this year - that's 31 years after I was diagnosed! Yikes!

Dithranol preparations

I have not tried this treatment but the information available clearly states it is for plaque only application. This is not for psoriasis on the genitals or face and treatments are started at the lowest strength. The treatment also needs to be washed off. These titbits of cautionary advice make me think that this stuff is pretty intense so if you're frustrated with your current approaches- this may be one to discuss with your GP. Some product names include Micanol and Dithrocream.

Topical immunomodulators

This class of drugs knows as calcineurin inhibitors block a chemical that causes inflammation in the skin so it can help reduce redness and itching. This is topical for atopic eczema - but can be used in psoriasis. They are also available for long term use and can be used on the genitals. Which, if you have experienced genital psoriasis, is a good thing. Just consider this; its primary use is not for psoriasis so you may want to do some research before your GP appointment. This is important in case your GP isn’t up to date in these broader treatment options (taking a print out is a good idea). Also, consider that the treatment will make your skin more UV sensitive, so you will need to moderate your UV exposure.

Vitamin A derivatives

Zorac (Tazarotene) is an example of a vitamin A derivative treatment. Applied topically it can be used to treat well-defined plaques for up to 12 weeks. There are lots of reasons why you may not be eligible for this treatment, but as with most things, bring it up with your GP.

If the thought of applying vaseline or the like to your plaques and surrounding skin one hour before treatment sounds unfeasible, this probably isn’t for you. Likewise, if using the treatment only to plaques sounds unbearable (because you have 476 of them) then again, probably a no-go.

Anyting else? Tar of course!

When I was hospitalized as a child, I remember the nurses applying tar and I remember the smell. Strangely instead of feeling hostility, the scent of tar brings a feeling of nostalgia. Anyhow, my favorite tar based treatment is shampoo. T-Gel is popular, but I hate sodium laureate sulfate and its a psoriasis trigger for me, so I use one by Oregon Healthcare instead. Refined tar preparations are not all prescription only, and a number of them can be bought over the counter. T-gel can be purchased from my local pharmacy and my local supermarket. Creams and lotions containing tar ingredients are Exorex and Psoriderm, and they can be used for the scalp and the body.

Tar-based preparations do smell and can stain clothes. This is especially true of the ‘old school’ unrefined tar-based products. Treatments at night and old bedsheets are a must. If you end up down this route it's worth chatting to people in forums about their strategies as there are other side effects too. My (dyed) blonde hair turned a strange shade of orangey blonde as a result of regular tar-based treatments. I imagine there are fellow psoriasis sufferers out there with strategies to help with whatever frustration you have. Just make sure you double-check safety with your GP first.

Following up with your G.P. to discuss how the treatment is going

If you are already on medication and are finding your prescribed regiment hard to follow, or if you're feeling down and disheartened please go to your doctor. Struggling to apply your treatments will affect how well they work consistently, and your GP will help you find a regime that works better for you.

You have to be honest about what you are going through though.

Set up a follow up four weeks after your initial appointment to review the progress of your treatments. If the psoriasis is bad, ask for a referral to the dermatologist. If you live in the UK or Ireland, it's best to get your name down now because in some places the waiting list can be up to 2 years. I promise, it's not lousy everywhere, mine is currently six weeks.

If you are just starting out

The typical starting point for newbies is Vitamin D derivatives and topical steroids so prep questions about these treatments before you go. Well done for being so organized. Knowing what your options are will make discussion with your GP much more productive.