Chapter 3 – Doctor’s Diagnosis

Chapter 3 – Doctor’s Diagnosis Anyone that has a skin condition that causes concern should make an appointment with a physician.  The traditional symptom of psoriasis, a red raised patch of skin with silvery scales, is a strong indication, but schedule an appointment for any skin eruption that bothers you.   Many cases of the disease are viewed by the patients as only a temporary problem, but getting a diagnosis is an important step.   A doctor or health care practitioner usually diagnoses psoriasis just by looking at the patches on the skin, as there is a distinct typical appearance.   If there is some uncertainty, a skin biopsy can be performed in order to guarantee the diagnosis.  Typically this is not needed, and is not done unless there might be other contributing factors or conditions. If a person with a skin condition has sore joints or other symptoms that might be psoriatic arthritis, they may want to schedule an appointment with a rheumatologist, a doctor whose specialty is various forms of arthritis.  Early treatment of psoriasis or psoriatic arthritis often prevents further progression of the symptoms and can give significant relief.  Left untreated, psoriatic arthritis can lead to joint deformity and deterioration, and so rapid diagnosis is very important. Once there is a diagnosis of psoriasis, the level of treatment of the condition varies.  For many people it can be only a minor discomfort and they pay minimal attention to it.  For people with large patches or with psoriatic arthritis, working closely with their physician becomes much more important.  Even for those people who have mild psoriasis, at times a flare up may be much more extensive than usual, and causes significant discomfort and pain.  At other times particular inflamed areas may make it difficult to perform routine daily tasks.   In any of these cases, it is a good idea to have another talk with the supervising physician so that he can keep a current record on the state of the disease.   There are a number of medications available to treat the symptoms, and a different prescription may make a huge difference in the comfort of daily living.  Make sure that the physician knows not only if the current treatment is successfully treating the lesions, but also any side effects that the medication might cause. Patients who have a diagnosis of psoriasis should be aware of some other effects that the disease may have.  These include emotional reactions, such as depression, increased stress, anxiety, low self-esteem, and embarrassment for their skin to be seen in public.  Patches of inflamed skin may be severely itchy, which, if scratched and not treated, may lead to permanently thickened skin or bacterial skin infections.   Those who have severe pustular psoriasis may suffer from fluid and electrolyte imbalance due to the number of pustules that the body is producing.    Psoriatic arthritis, like some other forms of arthritis, can make it difficult to go about normal daily tasks.  Additionally, it may cause some erosion of the joints. Complications of the psoriasis are not common and should not produce any anxiety for the patient. Many of the complications of plaque psoriasis are related to the treatments used for the disease. Overly aggressive use of topical steroids could lead to more severe forms of psoriasis (for example, the form of the inflammation could change from plaque to pustular). Bandages should not be used with topical steroids because inflammation and swelling may occur. When a patient gets a firm diagnosis of psoriasis from the physician, there are a number of concepts that the patient should know.  First, the patient should know the particular form of psoriasis that has appeared.  Some patients do have lesions for two different types, such as plaque and guttate psoriasis, but the doctor should state precisely what type of psoriasis it is.  Second, the inflammation can be classified as mild, moderate, or severe psoriasis, and the patient should know the severity of the inflammation.   The physician should tell the patient what to look for in order to notify the doctor if the inflammation spreads or increases in severity.  It is important for each patient with psoriasis to have an idea of what to expect in the next few weeks and months.  Since psoriasis indicates that the patient’s immune system is not functioning well, the doctor should discuss if there are chances that another rheumatic disease may develop.  Though psoriasis is not strongly linked to other diseases (even with psoriatic arthritis, only ten per cent of patients with psoriasis develop this problem), it is important to discuss this possibility.   One very important topic is the treatment that the doctor recommends as an initial treatment.  Nearly all physicians that treat patients with psoriasis will suggest the least aggressive treatment first, and monitor the lesions to determine how well this treatment works.  If the psoriasis responds well, then no further treatment methods will be needed.  If not, after several months the physician may suggest an alternative treatment.  If the doctor determines that the case is mild and suggests several over-the-counter creams and moisturizers, take time to ask which he and his patients have found most effective. Since flare ups of psoriasis are aggravated by stress, cold weather, and other trigger factors (and these are covered in a different location in this report), it is important to discuss what factors can be eliminated to minimize the current outbreak.   Avoiding these factors can help prevent the reoccurrence of them in the future.    In addition to getting this information from the physician, use other sources (such as the Internet) to find out as much as you can about psoriasis and treatment options.  This report on psoriasis is a good first step. A number of skin conditions may have symptoms similar to psoriasis, and this is another reason to get a diagnosis from a physician.  One disease that may be mistaken for psoriasis is seborrheic dermatitis, which is characterized by greasy, scaly, itchy, red skin.  Much of the time the affected skin is found on oily areas of the body, such as the face, upper chest and back. It can also appear on the scalp as stubborn, itchy dandruff.  Another disease with symptoms similar to psoriasis is lichen planus, where the inflamed areas appear as rows of itchy, flat-topped bumps (lesions) on the arms and legs. The rash can last from months to years, and may occur again after the initial symptoms have gone away for some time.   A third disease of this type is neurodermatitis, and can also be known as lichen simplex chronicus.  These symptoms arise because of repeated scratching. Chronic scratching can cause patches of thickened skin that is brownish in color. These patches have definite edges to them and the patches are thick and leather-like (lichenified). The most common locations for neurodermatitis are on the scalp, neck, wrist, upper forearm and ankle.  One more disease often mistaken for psoriasis is pityriasis rosea. It usually starts as one large spot on the chest, abdomen or back (and this first spot is known as the herald patch).  The symptoms then spread over a larger area of the body. The rash of pityriasis rosea often sweeps out from the center patch, with a shape that can resemble drooping pine-tree branches.