Know your options
Time with your dermatologist can be limited. Thinking about what feeling free from psoriasis would mean to you, understanding your disease severity and knowing the different classes of psoriasis treatments will enable you to get the most out of your consultation.
1 — LEARN
Discovering what's new
Psoriasis is by nature a chronic, and currently incurable disease with an unpredictable course of symptoms and triggers.1 Lifelong management is often required to control the inflammation related to the disease to help avoid or delay the progression of the severity and/or developing additional conditions.1,2
Your dermatologist will select the right treatment approach that is most suitable for you, ensuring that it is not only efficacious, but also safe over long periods.1
The understanding of psoriasis and its treatment has increased significantly over the years. Treatments are constantly evolving, bringing exciting possibilities and even the potential prospect of achieving clear/almost-clear skin. To reflect these scientific advancements, guidelines now recognize that clear/almost-clear skin is a realistic target goal for those with psoriasis.3–6
What a psoriasis-free feeling could mean to you
Your dermatologist will consider different factors when setting up your treatment plan. Make sure you share your personal goals with them so that they have all the information needed to make a decision.
One way to help determine your goals related to psoriasis is to think what you would do differently if you did not have psoriasis. You can think about it from a physical, mental or social perspective.
Feeling free from psoriasis could mean different things to different people, for example:
- Stop the constant itching, pain and discomfort, to sleep well at night, concentrate at work, or restore intimacy with a partner
- Feel less frustrated to improve relationships with friends and family, or to reduce worry about everyday activities such as going to the hairdressers
- Wear the types and colors of clothes (e.g. summer clothes or swimwear) they want without second-guessing
Share your goals with your dermatologists. It is normal if they change over time. Keep asking about the latest advances that may help you achieve your goals; the science in psoriasis is continually changing.
How severe is my psoriasis?
The level of severity of your psoriasis can be measured in different ways and each method is slightly different and considers different factors. Some scoring systems look at the physical impact (PASI, BSA) while others look at the psychological impacts (DLQI).
Knowing the severity of your psoriasis is important to help determine what management options should be considered.
If you don’t know how severe your psoriasis is, talk to your dermatologist.
Click on each scoring system to learn more:
PASI is now the standard in many medical guidelines. It measures the severity and extent of psoriasis. The severity of your psoriasis is categorized as “none” (0), “mild” (1), “moderate” (2), “severe” (3) or “very severe” (4).
Your dermatologist will take different points into consideration to calculate the severity:
- Location: the percentage area affected by psoriasis is evaluated in the four regions of the body (head and neck, upper limbs, trunk, lower limbs)
- Intensity of redness, thickness and scaling
BSA measures the amount of body surface area affected and the severity. It is still widely used in clinical practice. Using the surface of the hand to equal 1% BSA, psoriasis is considered:
- Mild when less than 3% of the body is affected
- Moderate when 3%-10% of the body is affected
- Severe when more than 10% of the body is affected
The aim of this questionnaire is to measure how much your skin problem has affected your life and daily activities over the last week. It consists of 10 questions concerning symptoms and feelings, daily activities, leisure, work, and school, personal relationships and treatment.
The final score will determine how psoriasis affects your life based on five outcomes ranging from “no effect at all on patient's life” to “extremely large effect on patient's life.”
How do I know what is right for me?
Every person with psoriasis has different needs and different treatment goals, which can change over time.4 Treatment will depend on the severity of your psoriasis, and even if you have a similar degree of severity to someone else, you may need a different treatment to them—one that suits you and your psoriasis.
You and your doctor will discuss what plan of care may be best for you based on the severity of your psoriasis, medical history and your lifestyle.
- Mild to Moderate Psoriasis
- Moderate to Severe Psoriasis
Patients with mild to moderate psoriasis are usually able to sufficiently control symptoms with topical medications or light therapy.3
Topical therapies used alone or combined with light therapy may be insufficient for patients with moderate to severe psoriasis.10
Topical Medications - applied to skin
What are they?
Topical treatments are applied directly to the affected areas of the skin. These can be in the form of creams, gels, ointments or sprays. Topical medications for psoriasis contain active ingredients to treat psoriasis as an initial treatment. Some people also find that other topical treatments that do not contain an active ingredient can offer some relief, such as general moisturizers.9
How do they work?
The active ingredients in topical treatments aim to slow down or normalize excessive cell reproduction and reduce psoriasis inflammation.3 They only treat the area of the skin that you apply them to. Not all topical treatments are the same, as they have different active ingredients that target different symptoms of psoriasis. For example, some aim to reduce the swelling and redness, and others aim to soothe the skin, remove plaques, or relieve itching.3 Talk to your dermatologist about the right topical treatment for you as it may depend on the area to be treated, such as the scalp or the body. Topical treatments can be bought over the counter on the advice of your doctor, and they can also be prescribed by your doctor.
Light therapy - phototherapy
What is it?
Phototherapy (or light therapy), involves exposing the skin to ultraviolet light on a regular basis under medical supervision.11
How does it work?
There are two types of ultraviolet light that can help to manage psoriasis.
is present in natural sunlight and penetrates the skin to slow the growth of affected skin cells in psoriasis. The UVB light is of most benefit in treating psoriasis.11
is also present in natural sunlight. Drugs called psoralens, also known as PUVA, can be taken to make the skin more sensitive to UVA.11
Phototherapy is administered in a doctor's office, psoriasis clinic or at home with a phototherapy unit. It is not suitable for long-term use to control your psoriasis.9 Short exposure to natural sunlight can also be beneficial for people with psoriasis. Tanning beds are not recommended due to the risk of skin cancer.
Treatments for moderate to severe psoriasis include oral medication or injectable therapy. These are also referred to as systemic medications as they are prescription drugs that work throughout the body.9
Systemic medications have been used for over 10 years and are prescribed for people with moderate to severe psoriasis who are not responsive, or are unable to take, topical medications or UV light therapy.9
What are they?
Oral medications are taken in either tablet form or liquid, taken through the mouth.9
How do they work?
Oral treatments are ingested, and impact the whole body (also known as a systemic effect), instead of just one localized area (like topical creams applied to specific plaques). Different oral medications have different modes of action, such as suppressing the immune system or acting as an anti-inflammatory to reduce rapid growth of skin cells.11
There have been developments in oral medications; these new oral treatments selectively target molecules inside immune cells. By adjusting the complicated processes of inflammation within the cell, these treatments correct the overactive immune response that causes inflammation in people with psoriasis, leading to improvement in redness and scaliness as well as joint tenderness and swelling.11 If your current oral medication isn’t working for you, ask your dermatologist about the latest oral medications.
What are they?
This kind of medicine, sometimes called "biologics" are usually prescribed for patients who have not responded to other treatments, and are administered through an injection. Like oral medications, they are known as systemic treatments, however, they only target specific parts of your immune system, which is what sets them apart.11
How do they work?
Biologics are given by injection or intravenous (IV) infusion (a slow drip of medicine into your vein), directly entering the blood stream. Biologics are different from other psoriasis treatments as they target specific parts of the immune system.11
There are specific types of immune cells (called T cells), and particular proteins in the immune system, that play a major role in the development of psoriasis. The aim of biologics is to block the action of these
Get clear with your doctor
You deserve to feel confident in your skin, but how do you have a clear conversation about your psoriasis goals with your doctor? Sometimes speaking up can be the hardest part.
2 — PREPARE
Dermatologists' top five tips
We asked dermatologists for the top five things that they would like to hear from you. Here is what they want you to share with them:
Our top conversation tips
- Writing a checklist can help so you don’t forget to mention anything. For example a list of the treatments you have tried and why they may not have helped; how psoriasis affects your mental and physical health; your dreams and aspirations for a healthier life; what has bothered your psoriasis since last you saw your doctor; how much pain or itch you have. Tell them if you have a spot, that may seem insignificant to them, but is the worst thing for you.
- Take pictures of your psoriasis to share during the visit with your dermatologist, showing how large the lesions are, but also the areas they are located, especially when you have a flare-up.
- Rehearse what you want to tell your doctor. Use forums and advocacy groups for support if you have any questions or concerns ahead of your appointment.
- Talk to your friends or family about the impact of your psoriasis, and that you are seeing a specialist. They may want to help you prepare for your appointment, or come with you.
- Describe how psoriasis affects your daily living (e.g. pain/itching, clothes choice, public situations, new relationships, embarrassment, sleep pattern, work, intimacy with partner). You don’t have to provide in-depth details, but it is vital to tell your dermatologist how severely your day-to-day activities are impacted, in order for them to tailor your management plan.
- Describe how psoriasis affects you psychologically and emotionally (e.g. anxiety, stress, confidence, mood). This is as important as the physical burden, as feeling stressed, or worrying about your psoriasis, can actually lead to more flare-ups.
- Talk openly about your current treatment experience. What has worked well and what has not worked in the past and don’t forget to mention any safety concerns you may have.
- Be open and ready to discuss new options.
- Do contact your dermatologist if you have any questions.
- Don't stop your treatment without speaking to your dermatologist first—they are there to help you.
- Talk to your dermatologist first before taking any other medications.
- Keep track of your symptoms (physical and mental) when you start a new treatment to share with your dermatologist during your next appointment.
Download our interactive discussion guide to help you plan questions for your next appointment.
3 — ACTION
Ready to talk to your dermatologist?
Use our interactive discussion guide to create a personalised tool to help you to feel confident and fully prepared when talking to your dermatologist, to get the most out of your visit.
Speak Clearly: Perspectives on Psoriasis
- WHO, 2016. Global report on psoriasis.
- Mrowietz. 2012, JEADV,26(s2):12-20.
- Amatore et al. 2019, JEADV,33(3):464-483.
- Gisondi et al. 2017. JEADV,31(5):774-790.
- Dauden et al. 2016. JEADV,30 suppl.2:1-18.
- Smith et al. 2017. British Journal of Dermatology,177:628-636.
- Papaa. 2008. Available at: http://www.papaa.org/articles/psoriasis-area-severity-index. Accessed July 2019.
- Psoriasis speaks. Available at: https://www.psoriasis.com/psoriasis-severity. Accessed July 2019.
- NICE. 2012. Psoriasis: assessment and management. Clinical guideline [CG153] Available at: https://www.nice.org.uk/guidance/cg153/chapter/1-Guidance#principles-of-care. Accessed June 2019.
- Menter et al. 2019. JAAD, 80(4):1029-1072.
- National Psoriasis Foundation. About Psoriasis. Available at: www.psoriasis.org. Accessed June 2019.
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