pSo Much More

10 questions you should ask your derm about psoriasis pSo Savvy

Dr. Katie Beleznay, BC Dermatologist

When it comes to your health, it’s important to know yourself and to be as informed as possible (just like you know the brunch menu of your fave Sunday spot). Taking control of your health and being in-the-know means taking note of changes in your health, asking the important questions, and staying up to date so that you receive the best care possible.

Whether you and psoriasis have been in a long-term relationship or you’ve recently been diagnosed, wouldn’t you want to know what questions to ask your dermatologist? Well friends, you’re in luck! Cuz I recently sat down with BC dermatologist Dr. Katie Beleznay for a little Q&A session.

Steph says Steph says Dr. Beleznay, before we get down to the itchy stuff, I’d like to know a bit more about you, since you are so much more than a derm (pun intended har har har Captain Hilarious here).

  • What’s your go-to cult comfort food in Van?
  • What about your fave shop for a quick bad day fix?
  • What’s a born and raised Van girl say that no other Canadian gal would?
  • Finally, #1 guilty pleasure (and I mean filthy guilty)?

Emilie saysDr. Beleznay says

  • JAPADOG is a big Vancouver thing. It’s like fancy Japanese style hot dogs; they’ve been expanding all over Vancouver and they got so popular they are even expanding in California!
  • For shopping, Granville Island market is a go-to to get all of your fresh foods and fresh fish, lots of fun little artisan shops. That’s a really great place for tourists or locals.
  • I’m born and raised in BC, I grew up on Vancouver Island. We would probably say something like: “Woah it’s not raining today?” High fives all around when it’s not raining.
  • Guilty pleasure: That’s an easy one, Chunky Monkey Ben and Jerry’s ice cream and Netflix. Those two combined.

Steph saysSteph says Haha that’s awesome! Thanks for sharing. I’ll make sure to visit these spots when I get to the city (JAPADOG is first on my list as I’m really curious about these hot dogs). Now, I’m sure you get tons of questions from your patients about psoriasis, from triggers, to dealing with itchy, flaky skin. I’d love to pick your brain for our readers who deal with psoriasis on the regular.

“It’s important to know you’re advocating for your own health and being certain to explore your options so that you know you’re managing your condition to the best of your abilities.”

Q1: To start us off, do you have any general recommendations or things to note for those who are visiting their dermatologist?

A1: It’s important for them to know the history of their psoriasis. Some things I will ask are:

  • When did they first get their psoriasis and what treatments have they tried. If people can bring in their creams or a list of what they have tried in the past, that is very helpful.
  • If there’s a family history of psoriasis, they might want to ask if anyone in their family has been known to have psoriasis.
  • What other treatments they’ve tried besides topical creams, like phototherapy or pills; and if they have any joint problems, issues with morning stiffness, or nail problems.

In general it’s important to make sure they understand the course of their psoriasis or specific triggers they have noticed and I’ll ask about their health in general because we know that psoriasis is associated with obesity, diabetes, high blood pressure, and smoking and alcohol use. I like when patients make a note of what treatments they have been using and what worked well: “I noticed an improvement in my psoriasis when I used this particular ointment” or if they notice their psoriasis got worse or didn’t change when they tried a particular treatment.

Q2: Okay, “What’s the first thing to do when you suspect you have psoriasis?” Why is this question important to ask?

A2: It’s important to know next steps. When you have something and you’re not familiar with it, it’s important to be educated about what it is and what to anticipate in terms of the course of the condition and how to manage it going forward. When you do suspect you have it, the first thing is to get educated. Consulting your physician is always a great first step. Your family doctor is often the first physician you will see and can help with management. However, if the psoriasis is widespread, or there are issues with joint problems etc., a referral to a dermatologist or other specialist will often be made.

Q3: When should you get a referral to a dermatologist or other specialist?

A3: That’s a good question because it’s important when advocating for your own health to think about this as many people want to explore their treatment options and know that they are managing their condition to the best of their abilities. The referral will come from the family doctor typically, so it is important to review this question with them. If you have widespread disease that isn’t properly managed by topical treatments, referral to a dermatologist may be necessary. Similarly, if there are comorbidities, referral to another specialist may be of benefit.

Q4: What types of things trigger psoriasis?

A4: If there’s a trigger you can avoid, it’s important to recognize. Nothing is set in stone, but there are things that have been related: stress, infections from streptococcal bacteria, and trauma can exacerbate psoriasis. Smoking, alcohol, and certain drugs (i.e., beta-blockers or steroids) can potentially trigger or worsen psoriasis.

Q5: Are there dietary considerations to have?

A5: Everyone wants to know whether diet can improve their skin - classic question. With psoriasis it’s not like some conditions where if you eat X food you can get Y reaction, but we do know that obesity is related to psoriasis so if you eat a well-balanced diet, eat nutritious foods, and take steps with diet to improve your weight, it will likely have a positive impact on psoriasis. There is no particular food proven to affect it, just a well-balanced diet.

Q6: What are other systemic or underlying health issues I should be aware of?

A6: Psoriasis is often thought to be just a skin disease, but we now know joints can be involved and that there are more comorbidities like depression, and cardiovascular disease that may be related. Arthritis is commonly discussed, but heart disease, metabolic syndrome, diabetes, obesity, and high blood pressure have been associated with psoriasis. These are conditions that we can screen for and help treat if necessary. If a patient comes in who is obese, smokes, or has diabetes, for example, we can take steps to minimize the impact of these factors on their psoriasis.

Q7: Can I expect to experience joint pain at some point in my life?

A7: It’s good to know what the associations are in order to help manage them. The risk of psoriatic arthritis is often reported as a range in the literature from 7-42%. Many people have skin psoriasis and that’s it. Some people have psoriatic arthritis but not skin psoriasis. There’s a chance of developing psoriatic arthritis, so it’s important to be educated in case they experience pain and aches in order to be able to take steps to manage it early before the joint disease progresses.

Q8: If I meet Mr. Right at some point, is this something I can pass along to our fabulous child?

A8: Good question. It’s important to know the genetic risk and if this can be passed on to your child. Psoriasis has a well-documented genetic component. One study showed that if one parent has it there is approximately a 15% chance that their child will develop it and up to 40% chance if both parents have it. There is a risk but it doesn’t guarantee it will be passed on – there are lots of different factors in play.

Q9: Are there special considerations to have when being pregnant with PsO?

A9: There are some dermatological conditions that can affect the pregnancy. Often psoriasis improves in pregnancy, and for a small group worsens. Some treatments can be used during pregnancy such as topical steroids and phototherapy. There are other systemic medications that would be contraindicated (meaning they should not be taken while pregnant). There’s a unique variant of pustular psoriasis which can present in the third trimester. This condition can impact both mother and child. If that were the case, we’d be monitoring more closely.

Q10: What non-prescription options or natural alternatives are available?


  • Education and counselling around the condition and comorbidities are a first step.
  • A balanced lifestyle to improve overall health is also important whether that is losing weight, quitting smoking, or avoiding alcohol.
  • Using a good emollient/moisturizer can keep skin hydrated. There are lots of things that are touted on the Internet and blogged/written about, but as a physician it’s harder to recommend because many of these products don’t have scientific evidence, just anecdotal evidence. Many people are happy to use phototherapy as a natural alternative. However, I would recommend a referral to a medical-grade phototherapy unit as it is safer and delivers a targeted wavelength of ultraviolet light for psoriasis over sunbathing, and we do not recommend tanning beds as they can be harmful.

Steph saysSteph says This was great, thanks Doc! Before I let you go, can you share with us what was the funniest thing you were asked about PsO?

Emilie saysDr. Beleznay says Lots of people don’t know what psoriasis is. People come in and are very worried that they have a contagious condition and they haven’t touched their baby in months. I get to be the good guy and tell them they are not infectious. I tell them “you’ve got a chronic condition, but it’s going to be a lot easier to deal with now that you know what it is.”

Steph saysSteph says And that’s why we are here to chat about pSo Much More!!!

Back at you peeps: what were your favourite tips from Dr. Beleznay? Did we miss anything from your point of view? Do you agree with her choices of restaurant and shop in Vancouver? Feel free to share or submit them in a question. Hope you’re all having a fab day – later gators!

Dr. Katie Beleznay

Dr. Katie Beleznay is a leading practitioner of medical and cosmetic dermatology. She’s a fellow Canadian, who practices in Vancouver at the Seymour Health Centre and studied at the University of British Columbia. Dr. Beleznay has published several articles, spoken at international conferences, and been the recipient of many academic awards and grants for contributions to the dermatology field.
Follow Dr. Beleznay on twitter @kbeleznay.

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