Psoriasis Doctor Discussion Guide

Moderate To Severe Psoriasis Doctor Discussion Guide

Get the most from your doctor's visit!

Answer these questions about your psoriasis to get your customized, printable Doctor Discussion Guide:

Psoriasis signs and symptoms:

What triggers your psoriasis? (Choose all that apply)

How much is your psoriasis affecting your life? Use the Psoriasis Questionnaire if you're not sure.

What triggers your psoriasis?

    How much is your psoriasis affecting your life?

      My psoriasis treatments

      Topical treatments (e.g., creams, lotions, ointments)
      anthralin
      When did you take it?
      When?:
      calcipotriol (Dovonex®)
      When did you take it?
      When?:
      calcipotriol plus betamethasone (Dovobet®, Xamiol®)
      When did you take it?
      When?:
      calcitriol (Silkis™)
      When did you take it?
      When?:
      coal tar (e.g., Targel, Doak Oil™)
      When did you take it?
      When?:
      tazarotene (Tazorac®)
      When did you take it?
      When?:
      salicylic acid, which is often combined with other topical medications such as: coal tar (e.g., Targel SA, Polytar AF®); and corticosteroids (e.g., Diprosalic®, Nerisalic®)
      When did you take it?
      When?:
      topical corticosteroids (e.g., amcinonide [Cyclocort®], betamethasone dipropionate [Diprosone®, Diprolene®], betamethasone valerate [Betaderm®, Valisone®], clobetasol propionate [Dermovate®], desoximetasone [Topicort®], hydrocortisone [Emo Cort®], and prednicarbate [Dermatop®])
      When did you take it?
      When?:
      Other
      When did you take it?
      When?:
      Systemic treatments
      Systemic treatments taken by mouth
      acitretin (Soriatane®)
      When did you take it?
      When?:
      cyclosporine (Neoral® and generics)
      When did you take it?
      When?:
      Systemic treatments taken by mouth or by injection
      methotrexate (Methotrexate® and generics)
      When did you take it?
      When?:
      Systemic treatments taken by injection
      infliximab (Remicade®)
      When did you take it?
      When?:
      When did you take it?
      When?:
      etanercept (Enbrel®)
      When did you take it?
      When?:
      alefacept (Amevive®)
      When did you take it?
      When?:
      adalimumab (Humira®)
      When did you take it?
      When?:
      Other
      When did you take it?
      When?:
      Light therapy
      PUVA (psoralen plus ultraviolet A light)
      When did you take it?
      When?:
      UVB (ultraviolet B light)
      When did you take it?
      When?:
      Other
      When did you take it?
      When?:

      Topical treatments (e.g., creams, lotions, ointments)

        Systemic treatments taken by mouth

          Systemic treatments taken by mouth or by injection

            Systemic treatments taken by injection

              Light therapy

                Concerns about my psoriasis treatment

                How satisfied are you with your current psoriasis treatment? (Choose one)

                Do you have any concerns about your psoriasis or psoriasis treatment? (Choose all that apply)

                How satisfied are you with your current psoriasis treatment?

                  Do you have any concerns about your psoriasis or psoriasis treatment?

                    My questions about psoriasis

                    Check off all questions that you would like to ask your doctor about psoriasis.

                    Questions to ask your doctor: (unselect those questions that do not apply to you)

                    For each treatment option:

                    Questions to ask your doctor about psoriasis:

                      For each treatment option:

                        Share your information with your doctor

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