Finding the Right Medical Specialist for My Psoriasis
It’s not the sort of day you include in your diary. Seemingly from nowhere, you wake up with thick, red, rough, scaly patches on both your elbows.
A few minutes of online searching has you suspecting psoriasis. Now what? Can your primary care doctor treat this condition with a prescription? Or will you need to find a dermatologist and other specialists? How can you find specialists who are in your health plan, experienced with psoriasis treatment, and a good fit with you personally?
Take a breath. It’s important not to get ahead of yourself at this stage, and there’s no reason to. While psoriasis is a complex condition that may need a team approach to your treatment, this article will familiarize you with the different doctors and specialists and give tips for researching and selecting them.
How Your Primary Care Doctor Can Help
Scheduling an interview with your primary care doctor, or general practitioner, is a smart first step, says Dawn Davis, MD, a dermatologist with the Mayo Clinic. “They often do a fantastic job managing skin rashes,” she says. “Primary care is a great place to start to get a diagnosis that this is psoriasis and to get basic skin treatment.”
Your primary care doctor will update your medical history, examine you, and likely prescribe a topical steroid cream or medicated shampoo to ease your symptoms. Also, your doctor can suggest ways to take better care of your skin and perform tests for conditions that often accompany psoriasis, a common issue which doctors call “comorbidities.” These are often long term (also known as chronic). A few examples of what might accompany psoriasis are psoriatic arthritis (swelling and stiff ligaments and joints), heart disease, high blood pressure, anxiety, and depression.
If tests come back positive for any of those conditions, your primary care doctor may be able to treat some of them, like high blood pressure. Or they may refer you to a specialist, either in the same health network or hospital or maybe someone unaffiliated.
“It’s important to remember that psoriasis is not limited to the skin; it’s really part of an inflammatory disorder that affects multiple systems in your body,” Davis explains. “At times, psoriasis can be diagnosed when you are getting treated for psoriatic arthritis, and you’re not even showing any skin problems.”
When to See a Dermatologist
Suppose a steroid cream doesn’t do the job and the pain and itching keep getting worse, or psoriasis crops up on your palms and fingernails.
You might benefit from ultraviolet light therapy (aka phototherapy) or special medication called biologics that targets your immune system. This means you likely should see a specialist.
“Someone who has advanced skin disease, whose psoriasis is starting to spread out of control, absolutely needs to see a dermatologist,” says Paul Benedetto, MD, a dermatologist with Cleveland Clinic Florida.
“You want to see a medical, not a cosmetic, dermatologist. A small number of dermatologists specialized in advanced-level skin disease, but for just about any general dermatologist, psoriasis is bread-and-butter treatment.”
Selecting a Dermatologist
Your health insurance plan’s directory will list dermatologists in your area, and your doctor can probably offer referrals, especially if they are affiliated specialists. If you want more options, try:
You may consider picking one dermatologist and treating the first appointment as an interview. Or maybe you will home in on a few prospects and ask their offices for information. Either way, these questions will help you make an informed choice:
- Is the dermatologist certified by the American Board of Dermatology or at least board-eligible (meaning recently trained)? “Board certification shows a level of competency by the dermatologist,” Davis says.
- How many patients with psoriasis does the practice see? Do they include people with both straightforward and complex psoriasis?
- Does the practice have a phototherapy machine?
- Who else from the practice would I see, and how does the team work together?
- Does the dermatologist favor any one treatment approach in particular?
- Is the dermatologist comfortable with more advanced psoriasis treatment, such as prescribing biologics?
- How does the practice handle referrals to specialists in treating associated conditions?
Above all else, Benedetto says, you should get the sense that you will enjoy an open line of communication with the dermatologist. “People don’t want a 5-second exam from the doorway. They want someone who’s going to take their time, get them into a gown, and really examine their skin.”
Davis agrees, adding that if you prefer a doctor who is conversational and gives you multiple treatment options, then you need to deliberately search for someone who fits the description. Ditto if your ideal doctor is blunt and recommends the single-best approach.
“Dermatologists are in short supply in most areas of the country, and skin disease is very common,” she says. “Sometimes, it can be difficult for people to select a dermatologist carefully, and they pick the first one they can get an appointment with.” That’s not what you want to do.
Depending on your symptoms, you may also be referred to or need to seek out specialists such as:
- A rheumatologist to treat psoriatic arthritis
- A physical therapist if the joint discomfort from arthritis makes it hard for you to get around
- A cardiologist if your heart issues appear serious
- A psychologist or therapist if the stress of psoriasis is causing anxiety or depression or is affecting your work or personal relationships
In group medical practices, dermatologists will sometimes order X-rays and tests on an affiliated rheumatologist’s behalf before your first appointment. Otherwise, you’ll probably get your prep work at the rheumatologist’s office.
Dermatologists frequently directly refer people with psoriasis to psychologists and psychiatrists, Davis says, but rarely to physical therapists. So you would have to rely on your own research.
“A multi-disciplined approach to psoriasis care is always helpful,” Benedetto says.
