When Should I Start Treatment for Psoriasis?

Psoriasis is a chronic skin condition that causes skin cells to grow too quickly, leading to buildup on the skin’s surface that forms plaques. These plaques can be red, scaly, or silvery and can cause itching and discomfort. 

Unfortunately there is no cure for psoriasis, but there are treatments that can significantly reduce symptoms and manage the condition long-term. Some of these treatments include topical treatments, systemic therapies, and light therapy.   

Newly diagnosed individuals may be hesitant to start psoriasis treatment for worry of possible side effects, but research suggests that early intervention may help to prevent complications and improve a person’s quality of life.

In this article, we’ll explain the benefits of early treatment of psoriasis and what signs to watch out for if you’re newly diagnosed with the condition. We’ll also cover the most common treatment options and what steps you can take to help ensure your symptoms stay at bay. 

When to Start Treatment for Psoriasis

Experiencing psoriasis symptoms for the first time can be daunting. Some individuals may choose to leave the condition untreated, hoping that symptoms will resolve on their own. In fact, research shows that the condition is widely underdiagnosed and undertreated.

Since there is no cure for psoriasis, leaving it untreated may allow symptoms to persist or worsen.  Evaluation by a medical professional as soon as possible is the best way to help keep symptoms under control.

Consulting with a healthcare provider paves the way for an official diagnosis and individualized treatment plan. If your symptoms suggest psoriasis, your provider can work with you to figure out the best treatment and management strategies for your needs. 

If your symptoms are an indication of another condition, your provider can provide additional evaluations and/or testing in order to get to the root of the problem.

Red Flag Symptoms

Signs of psoriasis that prompt a visit with your healthcare provider include:

• Persistent plaques Though there are different types of psoriasis, the most common type is chronic plaque psoriasis, which causes symmetric plaques on the skin that appear red, scaly or silvery.  Plaques may be itchy or painful, or there may be no physical discomfort.If you notice new plaques on your skin that don’t go away on their own, reach out to your healthcare provider or dermatologist for evaluation.
• ‍Rapid spread of lesions: Psoriasis lesions can appear quickly, due to the accelerated rate of skin cell growth.
• ‍Impact on daily activities: If your psoriasis symptoms are affecting your ability to accomplish daily tasks, you should reach out to a healthcare provider.‍
• Joint pain or swelling: Stiff, swollen, or painful joints could be a sign of psoriatic arthritis, a condition associated with psoriasis. If left untreated, psoriatic arthritis could lead to long-term joint damage.
• ‍Emotional and psychological impact: Psoriasis can cause extensive emotional and psychological effects, including impacting social functioning and interpersonal relationships. If you believe your symptoms are negatively impacting your mental and emotional well-being, reach out to a provider for help.

In addition to keeping an eye out for any of the above signs of psoriasis, it’s a good idea to reach out to a healthcare provider any time you experience new or worsening symptoms that affect your day-to-day life.

Severity Assessment Guidelines

During the initial assessment of your psoriasis symptoms, your healthcare provider will conduct a visual evaluation and ask you a range of questions to help determine the severity of your condition.

Understanding the severity of your symptoms will help to inform their recommendations for treatment and management. 

Psoriasis Area Severity Index (PASI)

The Psoriasis Area Severity Index (PASI) is a tool used by many healthcare providers to measure the severity and extent of psoriatic lesions as well as a person’s response to treatment. 

The PASI uses a numeric score from 0-72, scores under 12 signify mild-to-moderate disease while any score over 12 is considered severe.

The four main criteria used to determine a person’s PASI are:

• Induration: Thickening or hardening of a lesion. 
• Erythema: Reddening of the skin. 
• Scaling: Peeling, flaking, or scaling of the skin.
• Body Surface Area Involvement: How much of your body is affected.

Though the PASI is considered the gold standard for evaluating psoriasis severity, it has some limitations. First, the index is subjective and based on each provider’s individual assessments, which means the same patient can receive varying PASI scores depending on who evaluates them. The PASI also fails to take a person’s mental and social well-being into account.

However, when applied with other criteria and evaluations, the PASI can help give both provider and patient a better idea of the overall severity of symptoms. 

Body Surface Area (BSA)

When determining your PASI, your provider will typically divide your body into four regions: 1) head, 2) upper extremities, 3) torso, 4) lower extremities. These regions account for 10%, 20%, 30% and 40% of your total body surface area (BSA), respectively.

Quality of Life Impact Assessment

Because psoriasis is known to impact a person’s mental and emotional health, it’s important that your provider take this into account when evaluating the severity of your condition.

One method for evaluating the impact of psoriasis on your quality of life is called the Dermatology Life Quality Index (DLQI). This questionnaire poses ten questions about your symptoms and feelings, daily activities, leisure, work and school, personal relationships, and, if applicable, treatment. 

Benefits of Early Treatment

Treating psoriasis symptoms early can offer several benefits for your mental and physical health. 

Finding the right treatment for your psoriasis may take time, and some side effects are possible, but starting treatment early can offer important benefits.

Preventing Disease Progression

Perhaps the most straightforward benefit of treating psoriasis early is preventing the disease from progressing in severity. The earlier you’re able to fInd the right treatment for your psoriasis symptoms, the less likely your symptoms are to worsen over time.

Reducing Flare Frequency

Another primary goal of psoriasis treatment is to reduce the frequency of flares. Staying consistent with treatment and lifestyle changes can help keep psoriasis flares at bay.

‍One systematic review of randomized controlled trials found that people who used a combination psoriasis topical therapy experienced an average reduction in their PASI scores of 65-74%. Within four weeks of treatment, flares had either significantly cleared or cleared completely. 

Minimizing Long-Term Complications

Unfortunately, psoriasis is associated with other medical conditions, known as comorbidities, that can affect overall health.

Conditions associated with psoriasis include:

• Psoriatic arthritis, which may affect up to 30% of people with psoriasis.
• Cardiovascular disease.
• Type 2 diabetes. 
• High-blood pressure.
• Depression and anxiety.

Treating psoriasis can help reduce the risk of developing these comorbidities.

Improving Quality of Life

Psoriasis can cause physical pain and discomfort, but it can also affect your mental and emotional quality of life. According to one report, up to 60% of people with psoriasis experience depression, anxiety or another mental health disorder. Treating your physical symptoms can have a positive effect on your overall quality of life, including your social relationships, self-esteem, and mental health. 

Primary Care vs. Specialist Care

There are three types of providers able to treat psoriasis, including dermatologists, primary care physicians (PCPs), and rheumatologists.

When first seeking care for their symptoms, many people choose to reach out to their PCPs. PCPs are trained in diagnosing common skin conditions, including psoriasis. 

But depending on the severity of your symptoms, your PCP may recommend that you reach out to a specialist for treatment guidance, including a board-certified dermatologist or dermatology provider. Or, if you have signs of psoriatic arthritis, they may refer you to a rheumatologist.

In some cases, your PCP and your specialist will work together to manage your treatment and its impacts on your overall health.

Preparing for Your Appointment

There’s no special preparation you need to take before an appointment with your PCP or dermatologist. If it’s your first time seeing this provider, bringing a copy of your medical record can help them to get a complete picture of your health. 

Plan to answer questions about your symptoms, health history, as well as questions about your symptoms’ impact on other parts of your health, including your mental health.

Treatment Options Overview

There are many treatment options for psoriasis. To understand whether or not a treatment option is right for you, consult with your healthcare provider. 

Keep in mind that treatment recommendations should be personalized based on factors such as the location and severity of your condition, presence of comorbidities, your response to previous therapies, and individual preferences. It’s also important that you work with your provider long-term to monitor your treatment and its effectiveness.

Below are some of the most common treatments for mild-to-moderate psoriasis.

Topical Treatments

Topical treatments, including corticosteroid creams, non-steroid topicals, vitamin D analogues and retinoids are often used as first-line treatment for mild-to-moderate psoriasis. These options are effective and safe for many people.  

Systemic therapies

Your provider may recommend systemic treatments if your psoriasis is moderate-to-severe, or if topical therapies fail to bring you relief. Examples of oral systemic treatments for psoriasis include methotrexate, apremilast, acitretin, and cyclosporine. 

Biologics

Biologics are injectable medicines used to treat moderate-to-severe psoriasis and psoriatic arthritis. They’re made from biological or living sources and work by targeting specific cells or proteins of the immune system. While effective, biologics carry some risks , including an increased susceptibility to infections.

Light Therapy

Light therapy, sometimes called phototherapy, involves shining an ultraviolet light on the affected area of skin. A dermatologist or healthcare provider may recommend light therapy if a large area of skin is affected by psoriasis or in moderate-to-severe cases of the disease. Light therapy may also be used for localized areas that are resistant to biologics and/or topicals.

There are several types of phototherapy, but narrowband UVB (NB-UVB) phototherapy is more commonly used due to safety and effectiveness in the treatment of psoriasis in both children and pregnant women.

Conclusion & Next Steps

Discovering psoriasis symptoms can be stressful, but getting help as soon as possible can help relieve your discomfort and improve your quality of life.

At Zest, you have unlimited virtual access to our expert, specialized care for psoriasis. You can make an appointment within days or use our 24/7 chat messaging service to get relief faster, all covered by major insurers.  

Dermatology experts at Zest will help manage your psoriasis with individualized treatment plans that take your disease severity, health history, and preferences into account. To find safe and effective relief from your symptoms, book a virtual appointment within days.