6 Signs It’s Time to Call Your Dermatologist about Your Psoriasis

By Claire Gillespie

Reviewed by Allison Truong, M.D.

September 18, 2023

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If you live with psoriasis, having a great dermatologist on your side is key. If your condition is under control, you might only need to see your specialist at your annual checkup or at a scheduled review of your medications. But like with all chronic skin disorders, psoriasis can often throw a wrench in the works at any time. If your condition is changing, worsening, or not responding to treatment, it’s a good idea to get your dermatologist’s advice as soon as possible.

Here are six signs you should get in touch with your dermatologist about your psoriasis.

Sign #1: You’re having a particularly bad outbreak.

“Psoriasis can have flare-ups that cause itching, discomfort, scaling, and flaking of skin, along with other symptoms like scalp involvement, nail abnormalities, or even joint pain and swelling,” says Tanya Nino, M.D., a dermatologist at Providence St. Joseph Hospital in Orange County, California.

When something triggers your psoriasis, it can often lead to a severe flare that might require a change in treatment to get it back under control. “The longer psoriasis goes untreated, the longer it will take to get back in control,” says Tina Bhutani, M.D., a psoriasis community expert and co-director of the Psoriasis and Skin Treatment Center at the University of California, San Francisco. “It’s always better to be proactive!”

Sign #2: You have new or worsening symptoms.

Yes, it’s frustrating when you’ve been following your psoriasis treatment plan to the letter and symptoms get worse, but this condition is nothing if not unpredictable. “New symptoms are important to report because they could signal a new disease or the starting of an associated disease, such as psoriatic arthritis,” says Bhutani.

To stay on top of things, get in touch with your dermatologist as soon as possible to review your therapy plan.

“If psoriasis is worsening despite treatment, sometimes we have to visit other treatment options,” says Nino. The good news is that there are so many options to consider, including topical, oral, and injectable (biologic) treatments, even phototherapy.

Also, new or worsening symptoms may signal a side effect to a psoriasis treatment. For example, if a person develops a chronic cough, this could be an early sign of infection while on a biologic medication. Any new symptoms (even if not related to the skin) should be reported to your dermatologist, so they can test you, if needed, or refer you a specialist so you get the best treatment for your concern.

Sign #3: Your treatment doesn’t seem to be working.

It’s important to give any new psoriasis treatment time to work; how long it takes varies depending on a couple of factors.

“I always like to wait three to six months before deciding a treatment is not working,” Bhutani says, noting that some people respond more quickly than others.

Also, certain drugs work faster than others to clear the skin. For example, some biologic drugs prescribed for psoriasis may take up to three months to work, while topical treatments like corticosteroids tend to make a difference after a few weeks.

Sign #4: Your symptoms are affecting your mental health.

Every person who lives with psoriasis knows that its impact goes far deeper than the surface of the skin. The inflamed appearance of psoriatic lesions can trigger feelings of embarrassment and shame, which may lead to social isolation and mental health issues like anxiety and depression.

As a psychodermatologist and consultant dermatologist, U.K.-based Alia Ahmed, treats the mind and skin together. She encourages patients to share the mental and emotional burden with their doctors. “There is evidence to show that addressing psychological factors can improve outcomes for people with skin conditions,” Ahmed explains.

Sign #5: You notice nail changes.

Nail changes, like dents (known as pits), discoloration, crumbling, blood, buildup beneath the nail, or separation between the nail bed and the finger, are common symptoms in people with psoriasis, according to the American Academy of Dermatology.

You may require a change in your treatment to get this under control, says Bhutani. While many of the same treatments prescribed for skin symptoms of psoriasis will also work for nail psoriasis, it tends to be more resistant to therapy, she adds. So, it may require treatment with systemics, like pills or biologics, in addition to any topical treatments you’re already using.

Bhutani points out that nail psoriasis is often associated with psoriatic arthritis, which is another reason to get those nail changes checked out. “Your dermatologist can screen to see whether you should see a rheumatologist,” she explains.

Sign #6: You’re experiencing joint pain.

Psoriatic arthritis is a chronic inflammatory disease of the joints that affects about 30 percent of people with psoriasis, according to the National Psoriasis Foundation. If you experience joint pain, swelling, or stiffness, let your dermatologist know.

“If there is psoriatic arthritis, joint destruction can be irreversible, so it is important to stop it in its tracks,” warns Nino. Together with your doctor, you can choose a treatment to reduce your symptoms and potentially stop or slow down progression of the disease, while also easing some of your discomfort.

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