When it comes to treating patients with moderate to severe psoriasis, it’s imperative that you remember there’s more than what meets the eye. It’s takes a considerably greater effort than writing a prescription for a topical cortisone and sending them on their way. Let’s review some of the topics you should discuss with these patients.

Hereditary Aspect of the Disease
Although there are many times my patient states there’s no family history of psoriasis, it is still considered to occur in patients with a genetic predisposition who are exposed to some form of trigger which causes it to appear. That trigger may be strep throat, trauma to the skin, certain medications, etc.

Systemic Manifestations
The affects of psoriasis are not confined to the skin alone. The inflammation associated with this condition has been demonstrated in places such as the joints and the heart. Simply treating with topical medication makes no attempt to control the inward manifestations of the disease.
Chronic Disease we HOPE to Control
Psoriasis is a condition we can control for most patients, although it can never be cured. It’s important to tell them they are always predisposed for future flares.

Psychological Ramifications
It’s normal for patients to experience the “Heartbreak of Psoriasis”. Studies have shown conclusively the negative impact psoriasis has on the patient’s outlook on life. Ignoring this fact is not caring for the whole patient. It is crucial to acknowledge these are normal feelings associated with this condition. And, it’s crucial to recognize how it is impacting your patient so you can gauge the appropriateness of systemic therapy.

Range of Therapeutic Options
I don’t assume what the patient feels or what type of treatment they’ll wish to undergo. My only role is to walk them through each option spelling out the expectations of this form of treatment along with the potential risks. I don’t try to sway the patient in any direction other than to help them understand that not addressing the internal disease can have a long lasting impact on their quality of life.

Optimism for Tomorrow
Last but not least, I try to leave each patient with the understanding that this is a common condition. That they are not alone in this struggle and depending on the modality of treatment they choose, stand a pretty good chance of getting in under control. I also point them in the direction of the National Psoriasis Foundation who can be a wealth of information and support for your patient.

Keep in mind that psoriasis is not just an inflammatory disease of the skin but can have a profoundly negative impact on the health and psyche of your patient. It’s imperative you recognize this if you hope to treat the disease in its entirety.