Meet Dr Crowley
I’m Jeffrey Crowley. I’m a board-certified dermatologist in private practice in Bakersfield, California. I’ve been involved in the treatment of psoriasis patients for many, many years.
Diagnosing psoriasis
To establish a diagnosis of psoriasis, we examine the entire patient’s skin. That includes the scalp and the entire body. Psoriasis can sometimes hide in certain places, like, people can have it just on the scalp or just on the hands or just on the feet. Sometimes psoriasis can even involve areas that aren’t seen... in the underarm or in the groin area.
So we generally examine the entire skin, but before we examine the skin, we talk to the patient, and it’s important to understand what they’re concerned about. Are there rashes that they’re concerned about? What has been going on with their skin? Do they have itching? Do they have a family history of psoriasis? Do they have any symptoms of arthritis? And that’s very important. Are they having some morning stiffness in their hands? Are they having back problems? Problems in their joints? And so, really, it’s a very comprehensive exam in terms of, determining whether a patient has psoriasis, and then what type of psoriasis and how severe the psoriasis is. And then, of course, how much the psoriasis is affecting the patient’s daily activities and life.
Importance of seeing a dermatologist
So in our healthcare system now, you often have to see a primary care provider, whether that’s a physician, a physician’s assistant, or a nurse practitioner. And that may be the first place that you seek care for your skin. And that may be all you need, you know, if you just need a topical treatment. But it really is important to get an expert opinion, and an expert opinion comes from a dermatologist, and especially a dermatologist that’s interested and treats a lot of patients with psoriasis.
Preparing for your dermatologist appointment
When you go and see your dermatologist—when you set your appointment—that is your time, and you need to really set the agenda for what you want to get out of that visit with your doctor. And I would recommend really making a list. What are your concerns for your psoriasis? What are the issues that you’re concerned about? What do you want to achieve with your psoriasis? Are there certain areas that you’re more concerned with? Do you have joint involvement? Do you have arthritis? Those are all things that you want to address with the dermatologist because the dermatology practice is very busy, just like all doctors are—just like we all are—and so they may not address all your issues without you specifically asking the questions. So I recommend being prepared for your visit, especially your initial visit with your dermatologist.
Doing some research on your own, I think, is an outstanding idea. The National Psoriasis Foundation has an excellent Web site, which can provide you with background information. There are other Web sites that are available as well, which can give you information on psoriasis. They can tell you not only the types of psoriasis, but the different types of treatments available, too, and if you are armed with that knowledge going into the appointment, you’re going to get a lot more out of that visit.
Sharing all the ways psoriasis affects you
So psoriasis can affect you both in terms of how you look and how your skin feels—itch, things like that—discomfort, trouble sitting… all sorts of different physical symptoms can occur with psoriasis. And then, of course, there’s the emotional aspects of psoriasis, and this really varies dramatically by patients, and some patients with even fairly small amounts of disease may be very troubled emotionally by their psoriasis. I have patients who basically are recluses in their home. Now we have treatments that can help these people, and we’d like to see more of those patients in our practices and be able to help them.
Don’t be afraid to tell the doctor what is bothering you. Don’t hold back, you know, if the psoriasis is keeping you from having the social life that you want, keeping you from doing the things that you want to do, the fact that you can’t wear shorts because you have these ugly plaques on your legs—those are the kind of things you need to communicate with your doctor. You need to tell him the emotional toll that it’s taking on you. Is it affecting other people in the family as well? Is this affecting relationships? Those are all important things to convey.
Psoriasis treatment options
There are a wide range of treatments for psoriasis, and more than one treatment may be appropriate for you. There’s phototherapy, which is usually done in-office, but sometimes can be done at home with a home phototherapy unit. This can be very effective, even for fairly widespread psoriasis. There are topical therapies. These usually work better for patients with smaller amounts of disease because it’s very difficult to put topical medications on large areas of your skin.
And then there are more systemic-type therapies; there are therapies that have pills that you can take, such as methotrexate and cyclosporine, which have been used for psoriasis for many years. And then we have the biologic therapies, and there’s a whole host of different agents available.
Finding the treatment that’s right for you
One of the most important things that I look at every time a patient comes in the office—are they happy with their current treatment, and that is the most important question. Are you happy with how things are going? And this is, of course, on a follow-up visit. You know, sit down, how is it going? How is the current treatment going? And if it’s not going well, if there’s not a good degree of satisfaction, then something else should be done, and at that point, we discuss the options. That may include changing to another medication.
If you have a question about how to use your medication, if you didn’t understand what the dermatologist was telling you or they didn’t even communicate it to you effectively, you need to ask. You need to call, you need to ask.
Taking control
You may be very frustrated with the attempts you’ve made to improve your psoriasis, with the treatments that you’ve tried, with the healthcare professionals that you’ve seen. You need to know that there are other options, and that you haven’t had every treatment available. And you need to find someone—a healthcare provider, preferably a dermatologist—who you can work with to make your psoriasis better.
So if you’re sitting there at home and you have psoriasis, you’re frustrated, you’ve been checking on the Internet trying to see what’s out there, but you haven’t been happy with the experience that you’ve had with physicians in the past or with the healthcare system in the past, you really need to give it another chance. And I would do some research. I would ask friends, check on the Web sites for the National Psoriasis Foundation—find doctors who are treating psoriasis, find dermatologists who are interested in treating psoriasis, and give them a chance.
Living well
One of the most important things in managing your psoriasis is taking care of your overall health—eating healthy, being healthy, exercising. There are a lot of things that contribute to making psoriasis much more difficult to treat. These include being overweight, they include not eating well, drinking alcohol to excess… all of these can be factors that can make your psoriasis more difficult to control.
One of the wonderful things is having a patient back who’s used a therapy and is pleased. And, it’s changed their lives, you know, and it really can change your life. Now you may not even realize how much improving your psoriasis may change the way you feel, the way you see yourself, the way others see you.
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