The initial symptoms of psoriasis can be confusing. People rarely know what is happening, and sometimes, before visiting the doctor – often due to availability, they may prefer searching for a diagnosis online or visiting a pharmacy. However, both should guide you to the doors of a dermatological clinic. And what happens behind them?

Medical history

The first visit to the dermatologist begins with taking your medical history, and the doctor may ask you the following questions:

  • When did you start experiencing symptoms?
  • How have they progressed so far?
  • Do they come and go, or are they stable?
  • Are the patches on your skin and/or scalp itchy and painful?
  • Do you also experience joint pain?

The onset of psoriasis often results from a specific trigger. That can be, for example, a cut or other injury to the skin, sunburn, insect bite, excessive stress, or hormonal changes (especially in women). If you noticed changes in your skin after any of these events, please mention it during the examination.

In the clinic, they may also ask about the occurrence of psoriasis in your family, as the condition has a genetic basis. They will also inquire about other diseases and medications you regularly take.

Physical examination

Along with medical history, a physical examination is necessary during the first visit to the doctor. That includes:

  • Inspection of skin symptoms,
  • Count and size of lesions,
  • Their localization, shape, and overall appearance.

The examination proceeds similarly for scalp symptoms.

If you mentioned during medical history taking that you experience joint pain, the dermatologist may refer you to a rheumatologist suspecting psoriatic arthritis.

After taking your medical history and conducting a physical examination, the doctor usually knows whether it is psoriasis. If unsure or suspicious of a different type of psoriasis other than the plaque type (the most common), the doctor may request further examinations.

Skin biopsy

A biopsy is used to confirm or refute the diagnosis, for example, when the doctor is uncertain whether it is psoriasis, atopic eczema, or perhaps a ringworm.

Biopsy involves taking a sample of the skin and its microscopic examination (histological examination). During a skin biopsy, the doctor will administer local anesthesia. The procedure is usually accompanied by mild pain, depending on the biopsy location.

Based on the examinations and biopsy, the doctor should be able to confidently determine whether you have psoriasis and what type (more about types in this article).

Subsequently, considering the stage of the disease, the doctor will prescribe treatment, which in mild cases involves only regular local application of topical medications (creams, gels, ointments, etc.).

You can find more about psoriasis treatment on this page.