Psoriasis Approach to the Patient
The burden of psoriasis is both physical and psychological. Involved skin may be itchy or painful. The patient’s ability to work may be compromised. The psychosocial impact can be equally severe. Patients may feel shunned or excluded from social activities. Embarrassment and a sense of being unattractive often makes the patient avoid activities that reveal the disease such as public swimming or wearing shorts in the summer. In general, the younger the patient, the more severe the burden, especially with regard to peer interactions, sexual relations, and employment. Suicidal ideation is significantly higher among younger patients with severe disease.
The patient with psoriasis may feel hopeless and helpless with this chronic skin disease. They need to know that psoriasis is not contagious, that psoriasis neither affects or reflects their overall health and that, with treatment, psoriasis can be put into remission.
There are many effective treatments for psoriasis. Explain that the patient needs to let you know if psoriasis is limiting him or her from normal life activities. Explain that you will be there to treat as aggressively as needed to allow the patient to resume a normal life.
Realize that topical treatment take time to apply and are difficult to comply with. Determine what the patient’s lifestyle and schedule will allow for time to treat. Simplify your treatment plan to maximize compliance. Provide enough medication to allow for effective treatment. Combine treatment modalities when convenient for the patient. Be aware of the long-term consequences of the therapy. Consider rotational therapy throughout the seasons.