Talking with Your Doctor About Progressing Psoriasis

It may be that your psoriasis flares are occurring more frequently or lasting for longer periods of time. Maybe you've noticed that your psoriasis has spread to new areas of the body that previously weren't affected. Or maybe you have new symptoms that you hadn't experience in the past such as inflamed eyelids or joint pain. Any of these developments would be a good reason to schedule an appointment with your medical provider to discuss. There continue to be advances in psoriasis treatment so it can be helpful to check in with your provider about what new things might be available and that might help with your progressing psoriasis symptoms.

Let's start with the basics

While it may seem frustrating and repetitive you often will need to review basic, yet essential information each time you visit your provider. This information helps a provider to track changes in your condition. This will include questions about your overall health as well as aspects of the condition that you are currently experiencing. Keeping a journal that helps you to track symptoms can be a helpful way of tracking symptoms history. Taking your journal to your provider's appointment can help you remember what you've been experiencing and where so you don't have to rely on your memory during the appointment.

Since psoriasis is so unique to each individual triggers can often be challenging to determine. It may not always be just one thing that triggers your psoriasis it could be several things. It can be good to mention to your provider if you have noticed any changes in what has been causing your psoriasis to flare. Some things that may trigger a psoriasis flare that you should note and discuss with your provider are:

• If you recently injured or damaged your skin.
• If you recently were sick or had an infection.
• If you are feeling or experiencing stress in your life.
• If you have started any new medications or have any changes in the dosage amount of medications.
• Changes to your sleeping habits, exercise routine, or dietary changes.
• Note if you have increased your consumption of alcoholic beverages or increased how often you smoke.
• If you have recently been exposed to extreme fluctuations of temperatures.

While any of the above reasons could be a factor why your psoriasis has progressed it also could be from other reasons as well. Noting any of these can help you better partner with your provider to create or update a treatment plan.

Current treatment plan- What's working what isn't working?

When it comes to your current treatment plan honesty is going to be your best policy. Being honest about how adherent you are to your current treatment is really important, but also being honest about how you feel about your current treatment plan is also key. If you find aspects of your conditions difficult to maintain or have concerns about the cost it is okay to mention these things. You and your provider can collaborate on if it is a true failure of your current treatment plan that may be causing your psoriasis to flare, or something else.

Have you heard of the National Psoriasis Foundation's philosophy called "treat to target?" This approach to treatment focuses on reducing a percentage of psoriasis on the body over a specific period of time. If after the designated time period you haven't reached your target (ex: having 75% improvement in 3% of your body surface after 3 months) this is a good time to talk to your provider about your "treat to target" goal and what other options could get you closer to your goal.

Not just on the surface- evaluation for comorbidities

After much research, we now know that psoriasis is an autoimmune condition, which means that the chronic inflammation that occurs within the body can have an impact on both the skin as well as other systems of the body. While your "treat to target" goal is important, progressing psoriasis might also include an evaluation for comorbidities that are connected with psoriasis. Some types of comorbidities that are linked to psoriasis include:

• Psoriatic arthritis
• Cardiovascular conditions, such as high blood pressure and heart disease
• Type 2 diabetes
• Obesity and metabolic syndrome
• Inflammatory bowel diseases, including Crohn’s Disease
• Certain types of cancers
• Mental health conditions, such as depression and anxiety

Making the most out of the appointment

Being prepared for your appointment is key. Often times you may only have a limited amount of time with your medical provider at your appointment, so going into the appointment prepared can help make sure you get to discuss what your concerns and hopes are for treatment while also allowing the provider to document the information they need to. Some tips are to write down what symptoms you are currently experiencing and if you have identified any specific things that might contribute to your psoriasis flares such as weather, stress, medications or even certain foods. Do some research, have you heard about any clinical trials or new treatments that have come out? If so, don't be afraid to ask about those and if you might be a candidate to try them. Remember your treatment plan should be a collaborative effort between you and your medical provider. If you feel like you don't have a great partnership, you should feel empowered to speak up or to seek out a new medical provider.