Transcript
Announcer:
You’re listening to DermConsult on ReachMD. On this episode, we’ll learn about the burden of psoriasis beyond visible skin symptoms with Dr. Tina Bhutani. She’s a board-certified dermatologist at Synergy Dermatology in San Francisco, as well as a fellow of the American Academy of Dermatology and an Associate Clinical Professor at USF Dermatology. Let’s hear from Dr. Bhutani now.
Dr. Bhutani:
So when we talk about psoriasis, I think everybody tends to focus on the visible signs of the disease, and that is hugely impactful for patients, right? To have a rash on your skin, especially in areas where you might not be able to cover it up. So, a lot of patients get disease on the scalp, sometimes even the face. But even if you get it on the arms and legs, when you're wearing short-sleeve tops or shorts and things like that, it's never great to have to explain to people what is going on on your skin.
But I think, potentially more importantly than the visible signs of what we see with psoriasis, are sometimes the other symptoms that are associated with it.
Itch is the number one symptom that my patients with psoriasis report to me, and it can be really debilitating. Just think about constantly scratching at your skin, or waking up in the middle of the night to scratch. And then every time you scratch, you're leaving flakes and pieces of skin everywhere, so it's really, really tough for patients.
Sometimes psoriasis can even be painful, especially if it's on the palms and soles and the skin starts to crack. It can uncomfortable to walk or to use your hands. And then if patients have symptoms of psoriatic arthritis, which about 30 percent of patients with psoriasis will also get psoriatic arthritis, then you can also have pain in your joints. You can have stiffness when you wake up in the morning. You feel like you can't do the things that you used to be able to do. You feel very tired.
So there's a lot of different things that go into psoriatic disease. And so it's not just a cosmetic thing, you know? It's not just a rash on the skin. There are other things that are happening inside the body, and we really need to be asking these questions of our patients. Oftentimes the patients will say, "Everything's great. I'm working well, I'm in school, I'm in a relationship," and things sound positive, and I think that's wonderful. But oftentimes you might get the sense—they might not say that they're unhappy, but you can quickly get the sense either from facial expressions or from the way that they answer the question—that there might be something else going on that we want to focus on.
The reason that's important is because patients with psoriasis do have a high prevalence of comorbid mental health disorders: depression, anxiety, unfortunately sometimes suicidality and suicidal ideations. And so again, even if you get an inkling that a patient might be depressed or might not be as happy as they should be, I would definitely try to get your patient support.
So have them follow up with their primary care doctor and give them resources for where to get mental health support. Most insurance plans do have some built-in mental health resources, so having them reach out to their insurance to talk to them about things like therapy or other mental health help is vastly important, because we might be the only clinicians asking our patients about these things. And so it really is important for dermatologists to be asking these questions.
Announcer:
That was Dr. Tina Bhutani talking about overlooked aspects of psoriasis. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
