Psoriasis is a chronic inflammatory condition that is caused by a combination of genetic and environmental factors. Many patients with psoriasis have a family history of the disease, and experience their first outbreak of red, scaly plaques on the skin after an illness or stressful period. Although there is no cure for psoriasis, there is a wide range of treatment options available, including topical medicines such as creams or ointments, light therapies, pills, and injectable medications. With all of these choices, how do I develop a treatment plan for patients with psoriasis? I consider 5 key points to help formulate the plan.
1. What percentage of the body surface is affected by psoriasis?
It is easy to use a topical medication or a focused light treatment such as Excimer laser if only a very small area of the skin is affected. But if there are numerous plaques all over the skin, using a cream alone can be difficult.
2. Does the patient have psoriatic arthritis?
Persistent back pain, painful or swollen joints, or pain at spots where tendons or ligaments connect to bone (ex. “tennis elbow”) can be symptoms of psoriatic arthritis. If psoriatic arthritis is present, I often work in conjunction with a rheumatologist to recommend a treatment that would be beneficial for both the skin as well as the joints.
3. What impact does the psoriasis have on the patient’s quality of life?
Many of my patients have psoriasis affecting only a small area of the body, but if the area affected is having a big impact on their everyday lives, I will typically use more aggressive treatments. For example, patients with psoriasis on the hands, feet, or scalp tend to have more difficulty than those with psoriasis on the elbows or knees.
4. What other medical problems is the patient experiencing?
It is necessary to consider the patient’s medical history when formulating a treatment plan, as certain medications might be contraindicated, or off-limits.
5. What lifestyle factors need to be considered?
Methotrexate is a pill used commonly for psoriasis, but shouldn’t be taken by patients who drink a lot of alcohol. Injectable medications known as “biologics” wouldn’t be the best choice for a patient who has a high risk of exposure to tuberculosis. It is important for me to know about a patient’s job and leisure activities.
After reviewing these key factors, I work with the patient to generate a treatment plan that will be safe and effective.
By Allison K. Arthur, M.D.