9 Things Derms Love to Hear From Their Psoriasis Patientsby Linda Rodgers Health Writer
You may assume that your dermatologist is more concerned about the psoriasis meds you take than what’s going on in your life. But the truth is, most docs want to hear about the coconut oil you’ve tried or that stressful move you’ve got coming up. “I love for patients to be honest about what they’re thinking and feeling,” says Elizabeth A. Buzney, M.D., associate vice chair of dermatology at Brigham and Women's Hospital in Boston. “Open communication is very helpful.”
Which is exactly why we asked a few top derms to share the things they always love to hear from their patients with psoriasis.
“I wore shorts!”
There's a reason we put this one in the title: Not all patients are ashamed of the plaques on their skin, but, as Dr. Buzney points out, having psoriasis has been linked to depression. That’s one reason why derms give a collective thumbs up when their patients pull on shorts, don tank tops, or change in the locker room—it means they’re feeling happy and confident. “When patients tell me that they're no longer altering their lives because of the psoriasis and can do the activities that they want to do, that’s just fantastic,” she says.
“I started walking on the treadmill.”
Vickie Wilson, of Shreveport, LA, has psoriasis and psoriatic arthritis. Two years ago she joined a gym, and she's stuck with it ever since. Her dermatologist’s reaction? “He's very happy. He says the weight definitely needs to come off, and I know it, too,” she says.
“There is tremendous evidence that losing weight makes treatments work better,” says Mark Lebwohl, M.D., chairman of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. Another benefit to losing weight and exercise, he says: It lowers the risk of heart disease, which is higher for people with psoriasis.
“I quit my job!”
Well, no one’s really advocating you ditch the workplace just because of your psoriasis, especially if, you know, you need money. But skin conditions, including this one, can worsen with stress, Dr. Buzney explains. So she loves to hear about what patients are doing to channel or minimize their anxiety, whether it's yoga, doing acupuncture, or even taking a beach vacation. And yes, a couple of her patients did leave their jobs—and their psoriasis got better.
“I’m keeping on top of my meds.”
“As I tell patients: ‘Your medications don’t work in the medicine cabinet. You have to use them to get better,’" says George Martin, M.D., a member of the National Psoriasis Foundation Medical Board and a practicing dermatologist in Kihei, HI. That’s why he loves hearing that his patients are compliant with their Rx treatments. The only way he, and other derms, can tell if a treatment is truly effective or needs changing is when you’re upfront about how rigorously you’re following it.
“I am taking turmeric [or any alternative remedy of your choice].”
When Sabrina Skiles, a lifestyle and psoriasis blogger at Homegrown Houston, told her derm that she was taking turmeric, her provider made a note and moved on. That’s not surprising. Even though Dr. Lebwohl tells his patients there’s no evidence that turmeric has any effect, he also adds: “If a remedy works for you, it's okay with me as long as it's not dangerous.”
What doctors don't like to hear is that you're using alternative treatments exclusively. Here's why: “Psoriasis is a systemic disease that can lead to joint destruction in 20% to 30% of people, and it carries the risk of co-occurring conditions, like diabetes,” says Dr. Martin. So if you try something, say something.
“I’ve been sunbathing.”
Sunlight is good for psoriasis, which is why Dr. Buzney, who is also an assistant professor at Harvard Medical School, recommends her patients get 15 minutes a day of mid-day sun. “This isn’t an invitation to tan or to burn,” she explains. “It’s directing the sunlight at the plaques and putting sunscreen on the places that don’t have psoriasis.” Thanks to the summer sun, many of her patients temporarily take a break from their phototherapy or steroid treatments. Still, moderation is key: “I do hate to hear that patients overdo it because I worry that they’ve set themselves up for skin cancer later,” she says.
“I had only one drink.”
It's perfectly ok to enjoy a cocktail or two now and then, but Dr. Lebwohl encourages his patients to avoid alcohol binges. “I don’t tell patients not to drink, but over-drinking isn't good for anybody,” he says. For those with psoriasis, not only can excessive alcohol trigger a flare, it may even interfere with the effectiveness of your treatment, according to the National Psoriasis Foundation. If you're worried about the amount you drink, bring it up. Your doctor, including your dermatologist, can help you find the help you need.
“I’m going on a gluten-free diet.”
File this one under "Good to Know." Certain cure-all diets come up a lot, especially gluten-free ones. While dermatologists probably won’t frown upon your wheat-free meals, they won’t expect them to help much, either. The exceptions: "Adults with psoriasis who also have been diagnosed with celiac or a gluten sensitivity," says Dr. Lebwohl.
If you want to eat for your skin, try the Mediterranean diet or a plant-based one, both of which have been shown to reduce overall body inflammation, says Dr. Martin. Skiles found she was less itchy on a plant-based diet, but even if more vegetarian meals don’t improve your flares, they'll still be good for your cardiovascular system. Always a plus.
“I’m going the medical marijuana route.”
Dr. Lebwohl and Dr. Martin have psoriatic arthritis patients who swear that cannabis and CBD oils have made their arthritis better and lessened their pain. And topical CBD oils have anti-inflammatory properties that have been shown to reduce the signs and symptoms of skin lesions, at least in small-group studies, says Dr. Martin. Two key pieces of advice from Dr. Martin: One, use CBD or cannabis alongside your doctor-prescribed treatments. And two, eat weed, don’t smoke it; otherwise, it’s bad for your lungs.
“I’m not totally happy with this treatment.”
“As patients we need to be proactive and speak up for ourselves,” says Skiles. Case in point: Her dermatologist wanted to put her on a biologic (a type of drug that targets specific parts of the immune system), but as a mom in her child-bearing years, Skiles wasn’t comfortable with some of the potential side effects. Now she’s taking an oral systemic medication instead. So don’t be afraid to speak up. “That's really important,” says Dr. Buzney. “It doesn't help for someone to come in and say ‘This isn't really bothering me,’ when it really is.”