Psoriasis

Get help straight away if

These are uncommon, but they need same-day care — go to an emergency department, do not wait for an appointment.

• Redness and scaling spreading over most of your body, with shivering or feeling generally unwellGo to an emergency department. Skin affected this widely stops controlling temperature and fluid properly.
• A sudden crop of small pustules over large areas of skin, with feverGo to an emergency department.

Contact us promptly if

Not an emergency, but worth being seen sooner rather than waiting it out.

• Joint pain or swelling, stiffness for more than 30 minutes in the morning, or a whole finger or toe swelling upWorth telling us even if your skin is mild — joint involvement is treated differently and earlier treatment protects the joint.
• A flare spreading quickly, or new psoriasis appearing after starting a new medication

What usually happens

It is not contagious and it has nothing to do with hygiene. That needs saying because a lot of people with psoriasis have been treated as though both were true, and it changes what they are willing to do in public.

Psoriasis is not only a skin condition. Around a third of people develop joint involvement, it can start when the skin is barely affected, and treating it early is what protects the joints — so joint symptoms are worth raising at a skin appointment.

How much skin is covered is a poor measure of how much it matters. Scalp, hands, feet and genital psoriasis can be small in area and dominate daily life, and treatment decisions should follow the impact rather than the percentage.

It travels with cardiovascular and metabolic risk, so blood pressure, cholesterol and blood sugar are worth keeping an eye on alongside the skin.

Treatment is staged, and needing to move up a step is not a failure — of you or of the last treatment. Most people go through several before finding what suits them.

At your appointment

We will look at all the affected areas, including scalp and nails, which are easy to leave unmentioned and change what we would suggest.

We will ask directly about joints, because the answer affects treatment more than almost anything else about the skin.

We will ask what it stops you doing, rather than only measuring how much is covered.

We will review cardiovascular risk factors periodically, since they run higher in psoriasis than in the general population.

Worth asking

• —Could my joint symptoms be related to this?
• —What should I do when it flares?
• —How long should I give this treatment before we decide it is not working?
• —Is there anything that should be monitored while I am on it?