10 Signs It’s Time to Call Your Dermatologist About Psoriasis
While regularly scheduled visits are essential to manage psoriasis, there may be times you need to contact your dermatologist in between your usual appointments. Here’s when to make the call.
It’s crucial to see your dermatologist regularly if you have psoriasis, a chronic inflammatory skin condition. It's how you ensure your treatment is working and your symptoms are under control.
But in addition to routine checkups, there may be times in between your regularly scheduled visits when you need to call your doctor.
It's important to know the warning signs for when your psoriasis may be getting worse — or when they accompany symptoms of other conditions — so you can get help quickly.
1. Your Symptoms Aren't Improving, Even With Treatment
It's essential to give any new treatment time to work, although exactly how long depends on your treatment plan.
“Drugs that work the slowest are also some of the best,” says Mark Lebwohl, MD, the chairman of the dermatology department at the Icahn School of Medicine at Mount Sinai Hospital in New York and a past chairman of the psoriasis task force of the American Academy of Dermatology (AAD).
For example, some biologic drugs used to treat psoriasis may take as long as three months to work, he says.
“If you don't see some benefits at three months, it's not working,” Dr. Lebwohl says.
When it comes to topical treatments, such as corticosteroids or nonsteroidal creams, you should typically expect to see some benefits after four weeks.
If you've been following your treatment plan as prescribed for a while without results, talk to your doctor about whether it may be time to make an adjustment.
2. You Experience New or Worsening Symptoms
If you're faithfully sticking to a treatment that has been working but then have new or worsening symptoms, reach out to your dermatologist. It may be a sign that your treatment has stopped working.
“[Some] people simply seem to get used to therapies,” Lebwohl says. In other words, drugs can become less effective for certain people over time.
The good news is, with many treatment options available, your doctor could prescribe a new therapy that works for you.
What Are Common Signs and Symptoms of Psoriasis?
Andrew F. Alexis, MD, MPH, a dermatologist at NewYork-Presbyterian and Weill Cornell Medicine, provides insight into symptoms that may signify psoriasis.
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3. Your Symptoms Are Affecting Your Life
If your psoriasis symptoms are getting in the way of your daily activities, you may have options. With many available treatments for psoriasis, you can probably find a new solution that addresses your symptoms.
There's also one more — perhaps even more pressing — reason to talk to your dermatologist. The symptoms you're experiencing may be a sign of other health issues, such as psoriatic arthritis or high blood pressure, that you can address with the right treatment.
“There's a price you pay that you might not be aware of when you have inflammation. It's linked to heart disease, for example,” Lebwohl says. “Think about the future. Are you damaging your joints or increasing your risk of heart disease? It's not just about the fact that you have skin lesions.”
4. You Notice Changes in Your Nails or Scalp
People with psoriasis may notice changes to their fingernails and toenails, including:
Dents, known as pits
Crumbling
White, brown, or yellow discoloration
Blood or other buildup under your nails
Your nail bed lifting up from your finger
If you've just started a new treatment and your nails aren't getting better, that doesn't mean a drug isn't working. It can take up to three months before you notice improvements in your symptoms.
If you've given your treatment time to work and you notice your nails aren't getting better or are getting worse, talk to your dermatologist. Options may include injections with the drug methotrexate or corticosteroids directly into the affected nails.
You should also call your dermatologist if you develop symptoms of scalp psoriasis, which include dandruff-like flaking, silvery-white scales, and itching. Scalp psoriasis can be difficult to treat, but your dermatologist can help you develop a treatment plan that works for you.
5. You Have Joint Pain
Psoriatic arthritis is a chronic inflammatory disease of the joints that affects roughly one-third of people with psoriasis. It causes symptoms such as joint pain, swelling, and stiffness.
It's essential to talk to your dermatologist if you experience these symptoms. Developing psoriatic arthritis may warrant treatment or changes to current treatment, Lebwohl says.
6. You Have Signs of a Skin Infection
Skin infections, including yeast infections, are a common side effect of some psoriasis drugs but not all. Changes or addition of medication can address symptoms.
It's important for your dermatologist to rule out any skin infections you might have that aren't related to psoriasis. MRSA (methicillin-resistant Staphylococcus aureus), for example, is a bacterial infection that causes a red, swollen, painful bump or infected area on the skin and may accompany a fever. It is common and contagious, and it can lead to serious complications such as pneumonia if untreated, Lebwohl says.
7. You Have New Health Problems
Psoriasis complications could cause changes to your overall health. In addition to causing psoriatic arthritis, psoriasis can increase your risk of other conditions, including:
“Your dermatologist does need to know about major health changes,” Lebwohl says. “If patients have health problems in an organ other than the skin, they have to tell us, because it definitely impacts the treatment we select.”
8. You Want to Try a New Supplement or Treatment
While herbal or other natural remedies are prevalent, you should always talk to your dermatologist before taking them, Lebwohl says.
When tested in the lab, some supplements have been shown to contain steroids that can have side effects, he says. Others can interfere with certain medications, he says.
Keep your dermatologist in the loop about any new medication that another doctor prescribes to you so that you can be monitored for potential drug interactions or side effects, Lebwohl says.
9. You Have Pressing Health Questions
It's normal for questions to come up between appointments. If you have a pressing concern that only your dermatologist can answer, it's perfectly fine to pick up the phone — or at least it should be.
If your dermatologist isn't available to answer important health questions, you may want to consider a switch. The AAD offers a search tool to help you find a dermatologist who specializes in psoriasis.
10. You’re Planning to Get Vaccinated
Travel to certain places in the world often requires certain vaccinations, in addition to the annual flu shot or the COVID-19 vaccine. Before you finalize your plans and schedule your shot, it's worth talking to the dermatologist treating your psoriasis.
“Many drugs we use specifically state that you shouldn't use live vaccines because of the concern that they might either reduce the response to the medication or might even make you get sick when you get vaccinated,” Lebwohl says.
Research has shown that people with psoriasis can see their symptoms get worse for 10 days after their first COVID-19 vaccination. They resolve quickly with treatment, however, and did not worsen with additional COVID-19 vaccines. It may be wise to reach out to your dermatologist before and after your first COVID-19 vaccination.
The Takeaway
Psoriasis may indicate broader health concerns, such as psoriatic arthritis or cardiovascular disease, requiring medical attention.
Not all psoriasis treatments work for everyone. If your treatment isn't reducing symptoms, ask your healthcare professional about alternatives.
Psoriasis may increase your risk of developing type 2 diabetes, high blood pressure, or other conditions that a doctor could pinpoint.
Some supplements may not interact well with your psoriasis treatment. Reach out to your dermatologist or doctor before starting any new treatment.
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Resources
Psoriasis: Learn More – Skin care and topical treatments. IncludedHealth.org. April 27, 2021.
Gisondi P et al. Reducing the Risk of Developing Psoriatic Arthritis in Patients With Psoriasis. Psoriasis. August 10, 2022.
Elkhawaga OY et al. Review of natural compounds for potential psoriasis treatment. Inflammopharmacology. March 30, 2023.
Wu PC et al. New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Systematic Review. American Journal of Clinical Dermatology. November 23, 2022.
Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.
She is a procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.
Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook The Laser Treatment of Vascular Lesions.
Colleen de Bellefonds is a freelance journalist and editor who covers science, health, and parenting. Her reporting and writing regularly appears online for Well+Good, The Bump, and What to Expect, as well as in U.S. News & World Report, Women's Health, Self, and many other publications. She lives in Paris with her husband and two kids.
