Talking to your doctor again may seem like a difficult step. The videos on the Give Nothing to Psoriasis homepage can give you advice and tips, but this page is here to answer some of the more detailed questions you may have.
TALKING TO YOUR DOCTOR – FAQs
It’s important to have regular contact with your GP to check you are getting the treatment and support you need.
Visiting your GP once a year can help you work together to develop the right long-term management for your psoriasis. It also gives your GP the opportunity to discuss your progress and see how your treatments are working for you.
There is more information on the benefits of a once-yearly psoriasis consultation on the Annual Review page:
*NICE guidelines recommend an annual psoriatic arthritis assessment for all psoriasis patients. An annual review is recommended (to assess for the presence of steroid atrophy and other adverse effects) for adult patients using potent or very potent corticosteroids and for children and young patients who are using corticosteroids of any potency.
1. Psoriasis NICE Clinical Guideline 153 (Oct 2012) Available: https://www.nice.org.uk/guidance/cg153/chapter/Introduction Accessed 2017
While psoriasis can’t be cured, there are many treatment options available and what works for one person may not suit another. If you're feeling stuck with treatments that aren't helping you, make an appointment to explain your concerns to your GP, as they won’t know your psoriasis isn’t controlled unless you tell them.
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Different treatments may have different methods of application so it’s important to read the instructions.
If you’re unsure whether you’re using your treatment correctly, there are a number of options available to you. Read the information leaflet that was supplied with your treatment, this will contain information on how you should be using it. If you prefer, you can also speak with a healthcare professional such as your pharmacist, GP or GP practice nurse, as they can offer advice about the best way to use a treatment.
Your doctor may not realise how much of an impact your condition is having on your life. They might not understand fully how impractical it is for you to apply messy treatments frequently. They may not even realise your treatment isn’t controlling your symptoms unless you tell them.
Try writing down your concerns with some examples of the impact your treatment is having on your life. You may find it helpful to take a family member with you so they can give their perspective, too.
Generally, treatments for psoriasis are divided into topical treatments (applied to your skin), systemic treatments (affect the whole body, like tablets or injections), and phototherapy (light treatment).
Please read the information leaflet that comes with your treatment and talk to your doctor if you are unsure how to use your treatment, or for how long you should use it. Topical treatments include:1
Moisturisers (emollients) – these can be used in addition to other treatments to help keep the skin supple and reduce cracking and itching.
Coal tar preparations – these used to be the mainstay of treatment, but tend to be messy, don’t smell nice and can stain clothes. More modern versions may be less messy and smell less strong. Coal-tar based shampoos can be useful for scalp psoriasis.
Dithranol creams – these can work well but irritate normal skin and have to be applied very carefully. They can also stain clothes and need to be used for a very short time before being washed off (the time can be gradually extended from a few minutes).1
Vitamin D analogues – these are widely used. They’re also less messy and smell less than coal tar preparations and don’t stain clothes like dithranol or coal tar. A minority of people get skin irritation and you need to be careful not to exceed the licensed dose.
Steroid creams and ointments – these work by reducing inflammation and are easy to use. They are recommended in courses rather than continuously to reduce the risk of flare-ups when you stop using them.
Combined vitamin D analogue and steroid – these use a combination of ingredients. Each part of the combination works on one of the two parts of psoriasis: inflammation and excess skin production/flakiness.
Phototherapy and systemic treatments are usually only given by specialist hospital departments and tend to be reserved for severe psoriasis that hasn’t responded to topical treatments. Most systemic therapies work by suppressing the immune system. Because psoriasis is an autoimmune condition (where you body’s immune system, which normally protects you against infection, recognises itself as an ‘enemy’) these can be highly effective. However, they can have significant side-effects and need careful monitoring. Light therapy can involve courses of exposure to either ultraviolet B (UVB) or PUVA (psoralen and ultraviolet A) which involves ultraviolet A light along with a tablet called psoralen, to increase the effect.
1. Psoriasis Association UK website. Psoriasis Treatments. https://www.psoriasis-association.org.uk/psoriasis-and-treatments/treatments/from-a-gp Accessed July 2017.
People with psoriasis are at increased risk of depression and anxiety.1 Psoriasis is so much more than ‘just a skin condition’. It can have a major impact on your self-esteem and general well-being, which in turn can affect your mood.
No matter what the cause of your depression is, it’s important to seek professional and medical help for it. Your GP can talk to you about all the options available, including counseling and medication if appropriate.
1. Cohen BE et al. JAMA Dermatol. 2016;152(1):73-9.
It’s great news that your psoriasis has improved, but this doesn’t necessarily mean you can stop using any or all of your treatments. It may be that it’s improved because your psoriasis is being kept under control by the treatment and it would come back if you stopped.1 However, psoriasis does tend to run in cycles of flare-ups with less severe phases in between.2
You should never stop any treatment that has been prescribed except on the advice of your doctor.
1. Psoriasis NICE Clinical Guideline 153 (Oct 2012) https://www.nice.org.uk/guidance/cg153/chapter/Introduction (Accessed July 2017)
2. NHS Psoriasis – Symptoms (May 2015) http://www.nhs.uk/Conditions/Psoriasis/Pages/Symptoms.aspx (Accessed July 2017).
Psoriasis can’t be cured, but there are now more effective, more cosmetically acceptable and less messy options available than there were in the past. You may find it helpful to book an appointment to speak to your GP again.
If your GP doesn’t have any more options for treatment that they feel confident prescribing, and your condition is not adequately controlled, they can offer to refer you to a dermatology specialist.
There are also a number of other options available. Some GPs have extra training in dermatology and can advise you in more detail, these GPs are referred to as ‘GPs with a specialist interest in dermatology’. You also have the option to see a hospital-based dermatology specialist. You could also arrange a consultation with a private dermatologist.
It can be difficult not to get frustrated, but it can help to prepare what you want to say in order to put your case forward calmly. Try practicing what you’re going to say beforehand, or writing a list of the ways in which your psoriasis is affecting your life. That way, you’ll be able to give a full picture.
Your GP might not realise how much distress your psoriasis is causing you. Make an attempt to get on the same wavelength as them by planning what you want to say. Keep a diary of your symptoms and your treatments and show it to your GP at your next appointment.
Write down your concerns so you remember everything you want them to understand. Make an appointment just to discuss this, rather than tagging it on to another medical query, so you have the maximum time to go through your concerns in detail and do tell the doctor how much impact your condition is having on your life.
If you still feel you’re not being taken seriously, consider seeing another GP from the same practice and asking if there is a GP in your practice with a special interest in dermatology.