5 Things Your Doctor May Not Be Telling You About Your Psoriasis
There’s a lot more to psoriasis management than just treating symptoms.
Psoriasis is more than just an inflammatory skin condition. It’s a complex disease that can affect you and your health in unexpected ways.
If you’re living with a chronic condition like psoriasis, it’s important to take a multidisciplinary approach to managing the disease and preventing complications.
Here are five things you should talk to your doctor about.
1. Psoriasis Raises Your Risk for Other Health Problems
“There are multiple comorbidities [associated with psoriasis], including psoriatic arthritis, depression, inflammatory bowel disease, obesity, and diabetes,” says Jeffrey M. Weinberg, MD, an associate clinical professor of dermatology at Mount Sinai School of Medicine in New York City. It is important for doctors to screen patients with psoriasis and refer them to an appropriate expert for other conditions, Dr. Weinberg says.
People with psoriasis are at a particularly high risk for joint problems such as psoriatic arthritis, gout, and osteoarthritis, points out Zhanna Mikulik, MD, a rheumatologist at the Ohio State University Wexner Medical Center in Columbus.
According to the National Psoriasis Foundation, psoriatic arthritis occurs in about a third of people with psoriasis (especially those with severe psoriasis) and typically develops around 10 years after a psoriasis diagnosis.
Psoriatic arthritis is debilitating, and the underlying inflammation can lead to a cascade of other health problems, including vision and hearing loss. Any inflammatory condition that affects collagen, the main component of connective tissue, can affect the white of the eye (sclera) and lens cap (cornea), according to the Arthritis Foundation. This can lead to a type of eye inflammation (uveitis), which causes pain and redness and can even lead to vision loss. Your risk is also higher for glaucoma and cataracts.
People with psoriasis and psoriatic arthritis are more susceptible to hearing loss as well. Indeed, according to a study published in June 2015 in the American Journal of Clinical Dermatology, people with psoriasis are about 50 percent more likely than others to be diagnosed with sensorineural hearing loss (SHL), a mild form of hearing loss; according to a large study published in January 2019 in the Journal of Rheumatology, psoriatic arthritis is associated with a significant increased risk of hearing impairment.
Early detection and treatment of vision and hearing problems can prevent long-term damage.
2. Psoriasis and Stress Can Be a Vicious Cycle
Psoriasis is a chronic and often lifelong disease that can have a profound impact on a patient’s physical and emotional well-being, says Lindsay C. Strowd, MD, an assistant professor of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina. “Many studies have looked at the impact on a patient’s quality of life with regard to psoriasis,” says Dr. Strowd. “It can negatively affect patients more so than other chronic illnesses such as asthma and diabetes. Part of this may relate to the stigma associated with skin disease.”
Strowd says patients should ask their physicians for tips on how to deal with the negative effect the disease has on their life. “Psoriasis causes stress, and stress can flare psoriasis, so this is a critical aspect of disease management,” she explains. “The good news for patients is there are many resources to help cope with psoriasis, including social media platforms and support groups through the National Psoriasis Foundation (NPF) and the American Academy of Dermatology.”
3. Lifestyle Changes Can Affect Psoriasis Symptoms
Psoriasis does not occur in a vacuum. Everything you do or don’t do can potentially worsen or lessen your symptoms.
“Your doctor should discuss lifestyle changes with you,” says Dr. Mikulik, “including sleep, exercise, nutrition, social connectedness, and stress relief.”
Take diet, for example. There is no medical evidence to support a specific psoriasis diet, though many patients believe that avoiding certain foods and eating others can help manage flares and reduce inflammation. The NPF recommends the Mediterranean diet in particular to lower the risk for related conditions such as heart disease.
The Mediterranean diet emphasizes olive oil, plant-based foods, whole grains, and at least two servings of fish weekly, especially fish high in omega-3 fatty acids, such as salmon, herring, mackerel, and anchovies.
4. Losing Weight May Improve Your Psoriasis Outlook
“About 40 to 50 percent of patients with psoriasis are obese,” says Mikulik. Psoriasis experts are still trying to understand the relationship between weight and psoriasis, but it does seem that obesity early in life is associated with the development of psoriasis in adulthood.
Weight loss can improve responsiveness to 30 pharmacological treatments, says Mikulik.
5. You May Be Eligible for Aid to Meet Treatment Costs
Treatment costs for psoriasis and coexisting conditions are steep — so much so that out-of-pocket costs make nontreatment and undertreatment a significant problem.
According to data collected by the NPF, 40 percent of patients with psoriatic disease say they’re paying too much for treatment and 15 percent weren’t treating their condition because of expense. Cost as a barrier to treatment is particularly problematic with biologics, which are effective in treating psoriatic disease but are very expensive.
Fortunately, there are financial-aid programs available, and your health insurance may provide benefits you’re not aware of. Talk to your insurer and your doctor. You can also visit the NPF’s Patient Assistance Center, which offers access to many resources for financial support.