How Medical History & Physical Examination Help To Diagnose Psoriasis

To find out if you have psoriasis, healthcare providers will take your medical history and carry out a physical examination. Together, the physical exam and medical history will often provide the healthcare provider with enough information to make a diagnosis of psoriasis².

What happens when a healthcare provider takes a medical history?

When taking your medical history, a healthcare provider will usually begin by asking you about your symptoms and how they are affecting you. For instance, the provider may ask you questions about plaques on your skin², such as:

• When did they first appear?
• Where are they located?
• What do they feel like?
• Did you notice any kind of injury to the skin where the lesions developed?
• Is there anything that makes them feel better?
• Have you tried any treatments or medicines, and if so, did they help?

Healthcare providers will ask a series of questions about your health, your family history, and your lifestyle³. These topics may include:

• Information about any health conditions you have or have had in the past
• Any allergies you have
• Any medications you take currently, or have taken recently
• Your emotional health
• How often you get sun exposure
• Your diet and exercise routines
• Your job, and whether you come into contact with anything that might irritate the skin
• Any travelling you have done recently
• Your skin, hair, and nail care routines, including how often you shower or bathe and at what temperatures, what types of soaps, shampoos, cosmetics, and other products you use
• Your hobbies
• Whether you use tobacco, alcohol, or recreational drugs

Because the tendency to develop psoriasis is passed down through families, the healthcare provider will also take a family history to find out if anyone else in your family has or had psoriasis or any other skin condition.

Healthcare providers will also be looking for other risk factors, in addition to family history, that make a person more likely to develop psoriasis. For example, they may ask whether you have had a recent viral or bacterial infection and whether you are experiencing high levels of stress or anxiety¹.

What happens during a physical examination?

A patient will usually come to a primary care physician or healthcare provider such as a dermatologist after developing lesions on the skin. These areas of reddened, thickened, itchy, often painful and frequently cracked patches of skin are called plaques.

During a physical examination, your healthcare provider will examine your skin, scalp, nails, and mucous membranes (the inside lining of your mouth, nose, and eyelids). Your healthcare provider will be looking for patterns where the symptoms have developed on your body because psoriasis plaques often develop in the same place on opposite sides of the body (for example, around the same areas on both legs).

Healthcare providers will also examine any plaques and other symptoms carefully, in order to decide if they are being caused by psoriasis or some other type of skin condition. For example, removing the layer of scale from the top of a psoriasis plaque will leave a smooth, red surface with tiny pinprick sized spots of blood. This is called the Auspitz sign.

Many people with psoriasis develop symptoms on their fingernails and/or toenails. Your nails will be examined for symptoms such as pitting, thickening, discoloration, and separation of the nail from the nail bed. Nail involvement is also an early sign that you may be more likely to develop psoriatic arthritis.

In some cases, your healthcare provider will need to take a small sample of skin from an area of plaque so it can be examined in a laboratory. However, this is not always required.

The healthcare provider will also screen you for certain health conditions that are more common among people with psoriasis. These are called comorbidities, and they include:

• Heart disease and other cardiovascular conditions
• Metabolic syndrome
• Type 2 diabetes
• Obesity
• Inflammatory bowel diseases
• Certain types of cancers

It is important to share information about any medications and therapies, including alternative and homeopathic remedies you are taking for any health condition, not just your psoriasis. This information will help your healthcare provider optimize their recommendations about treatment options.

People who are taking a biologic medication should carry a biological therapy alert card with them at all times. If you have to be treated in an emergency situation, this will enable healthcare providers to know you are taking a biological medication that may put you at increased risk of infection. They will also need this information to other drugs you can and cannot be given.