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Patient Perspectives


Lakshi Aldredge
Alan Menter, MD

A Patient’s Perspective on the Dermatologist-Patient Relationship

Dr. Alan Menter is the chief of the Dermatology Division at the Baylor University Medical Center in Dallas, Texas and is also a psoriasis patient himself.

Early on in my career, I planned to work in the field of obstetrics and gynecology. However, those plans radically changed when at the age of 22 while in my second year of medical school, I was diagnosed with mild scalp psoriasis. The disease also affected my 2 brothers who developed severe cases of psoriasis accompanied by comorbid conditions, including Crohn’s disease. This close connection with the disease—as well as my experience treating a ward of psoriasis patients during my fellowship in London—changed the trajectory of my career and triggered a desire to continue work in dermatology, especially psoriasis-related.

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My personal experience with the disease has afforded me a greater understanding of how patients with psoriasis feel and a deeper sensitivity to their needs, which encompasses treatment and support. I know that psoriasis goes beyond the physical manifestations. Therefore, I believe that healthcare providers should acknowledge and assist patients through the psychological and emotional aspects of the disease. Our team treats with the goal of enhancing a patient’s self-confidence, acknowledging that many patients are reluctant to discuss deeply personal ways the disease affects them, such as in the case of genital psoriasis, seldom mentioned by patients but seen in up to 60% of all patients.

Treating the disease for the long term is the approach I take with all my patients. I want to improve my patients’ psoriasis the best I can and continue to maintain that improvement. To this end, I perform a full medical history of my patients and engage in a lengthy discussion about comorbidities, especially the metabolic syndrome. I take the time to explain to patients that their immune system is “out of whack” and medication is necessary to modulate their system. I then monitor and modify treatment based on how long the patient remains clear. Of course, I recognize that there are challenges when prescribing a treatment, as choice of therapy is often driven by insurance coverage and patients are obviously concerned with the side effects.

In the early 1990s, I co-developed the first gene bank for psoriasis with the focus on genetic examination, testing, and family profiling. Here, the genetics of psoriasis are being explored, yet not all risk and trigger factors have been identified. Of note, although members of my immediate family have the same genetic profile, each one manifested the disease differently with varying outcomes. Today, my psoriasis is in remission and I am currently not on treatment. In addition, both of my brothers’ psoriasis is adequately controlled.

I believe one of the most important things is to build an alliance with patients—to take the time to understand the stressors in their lives that may trigger an outbreak. I often share my history with patients and apply my personal experience to patient care while gently explaining the systemic nature of the disease and the increased risk of lymphomas. This way, my patients know that I truly understand what they are experiencing, as evidenced by the many personal notes and hugs I receive from them daily. Knowing that I have made a positive impact in their lives is the most rewarding part of my job!

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Luma
Luna Azulay-Abulafia, PhD

A Patient’s Perspective on the Dermatologist-Patient Relationship

Moderate to severe plaque psoriasis is a disease that affects many different types of people from all walks of life. Because of these differences, the journey each person takes on the path to treatment and the ways in which each deals with this disease on a daily basis are unique. Psoriasis is a lifelong condition, and so it is important that each patient’s goals, both for treatment and for life, are taken into account when developing their treatment plan. Good communication between the patient and dermatologist is the key to understanding these goals, and also to ensure that the patient receives the necessary disease education.

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Shirley, a 60 year old native of Rio De Janeiro, Brazil, was diagnosed with psoriasis 13 years ago. She is now the President of the psoriasis patient association in Rio de Janeiro – PSORIERJ, and has an excellent relationship with her dermatologist, Dr. Luna Azulay. At first, however, Shirley struggled with her condition.

“At the beginning, I started to see little bumps and bubbles on my leg. Then, after a surgery I had that year, the bumps spread all over my abdomen, arms and legs. The doctor who diagnosed me told me it was a chronic disease that wouldn’t go away. I didn’t know anything about psoriasis then and I was in despair.”

Many aspects of Shirley’s life have been affected due to her condition. “Before I developed psoriasis I weighed 60 kilos. Now I weigh 84 kilos. The way I look, being overweight, and the way I have to dress, has prevented me from getting work. It is hot here in Brazil, but I have to wear long sleeves to hide my psoriasis, and I cannot go to the beach because I feel self-conscious.”

However, Shirley’s psoriasis and health-related quality of life improved after she started treatment with Dr. Azulay. “I felt like all the doctors were making false promises until I met Dr. Azulay. She encouraged me to join the patient association to learn more about my disease. She taught me that this is the type of disease that you have to manage every day, and that because there is the potential for other diseases, you have to be screened for them. Now I am the President of the association, and I am happy giving help to other people with psoriasis. The attention and dedication of a good doctor was the most important thing for me during my treatment. I believe in her.”

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