I trained atMount Sinai, which has probably one of the most robust psoriasis programs.
I do the full range of dermatology.
I do medical, I do cosmetic.
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So I see a wide range of patients, many of which are psoriasis patients.
They can have a silvery scale on them.
They can be quite thick.
They can flake a lot.
Sometimes they can be itchy, but oftentimes they’re not as itchy as aneczema patient.
You see [the patches] on the elbows.
Oftentimes you’ve got the option to also see them in areas where you get trauma.
That’s called koebnerization the phenomenon that a skin disease or skin dermatosis will follow areas of trauma.
you might see that with psoriasis.
It wasn’t a big part of my practice.
And it’s interesting how this time forced us into a technology that now we really appreciate.
They’re pretty stable, they understand their condition well.
I prefer follow-up patients to new patients [for telemedicine].
They’re so thrilled they can do it from the comfort of their home.
I think there’s something really special about seeing patients in their home.
There are other things you learn from seeing people in their environment.
You see what’s reasonable for them.
And a comfortable patient is an open and receptive patient.
Sometimes there’s a little bit of white coat hypertension when people are outside of their normal space.
I’ve been doing this for a long time.
Even the complex types of psoriasis I could probably diagnose via telemedicine.
Once we make that diagnosis, we try [treatments] with the least side effects.
Using your iPhone, which has really good quality, take a sharp photo.
I have them email it to me so I can look at everything in better detail before seeing them.
Write down all of your questions.
Sometimes I even like my patients to do a disease journal.
They’ll say, “I was better on Monday, I was better today.
These are the things that happened.
Today, I ate tacos and I felt like it was worse.”
What are your symptoms?
How are you feeling?
Past medical history, family history, behavioral history, medications,allergies, all of those things.
There are certain types of psoriasis that are triggered by illnesses or new medications.
Does it feel much thicker than the surrounding skin?
Then we probe for other symptoms.
Are you having joint pain?
Because there’s something called psoriatic arthritis, which can be really destructive to the joints.
I want [my patients] to be comforted by the fact that psoriasis is exceedingly common.
It’s really one of the top 10 conditions that we see and train on.
If you have a complex [case], you may want to see a specialist.
TheNational Psoriasis Foundationcan help guide you to a physician who has made psoriasis a big part of their practice.
We understand how muchit affects you socially.
All of these things matter, because they affect your quality of life.
There are higher levels ofdepression in psoriasispatients.
There are higher levels ofheart disease, higher levels ofobesity.
It can affect so many systems, so having the right diagnosis is important.
It’s not “just a skin thing.”
It is a full-systemic condition.
Treating psoriasis is absolutely not vanity.
We always call ourselves “skinvestigators.”
Your skin tells us what’s going on inside your body.
