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How to

Talk to your dermatologist

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Answer the questions below, and bring this with you to your next dermatologist appointment. Be sure to discuss your complete medical history and any medications you are currently taking with a dermatologist. Together, you can decide which treatment option may be right for you.

1. Check the boxes below to show what part of your body are currently affected by psoriasis (Check all areas that apply)

Scalp
Neck
Arms
Elbows
Hands
Legs
Ankles
Body
Face
Chest/Back
Groin
Buttocks
Knees
Feet

2. Tell us about the severity of your psoriasis

A palm is about 1% of the body surface – how many palm-sized areas are affected?

Mild (less than 2% of the body's surface is affected)
Moderate (between 3% and 10% of the body surface is affected)
Severe (Over 10% of the body’s surface is affected)

3. What are you currently using to treat your psoriasis? (Check all that apply)

Over-the-counter cream or ointment
Over-the-counter shampoo or conditioner
Prescription topical cream or ointment
Prescription shampoo or conditioner
Phototherapy (Light therapy)
Systemic therapy (Pills)
Biologic therapy (Intravenous or injectable medicine)
I am not currently using anything to treat my psoriasis

4. Would you be willing to try something new to help you manage your psoriasis?

5. How does psoriasis affect your day-to-day life? (Check all that apply)

I avoid certain social situations
I avoid outdoor activities, like swimming and biking
It is difficult for me to go to work/I can not work
I experience feelings of frustration and depression
I am self-conscious about the appearance of my skin with family and friends
I am self-conscious about the appearance of my skin with colleagues
It affects my intimate relationships
Psoriasis does not affect my day-to-day life

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