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Q: I have a friend who has a bad case of psoriasis. Is there a cure? We don't know what to do. It's very bad. Please help us. -- J.H., Ormond Beach, Fla.

A: As you and your friend are well aware, psoriasis is an infuriating chronic skin condition. It's rarely life threatening, but it often affects the emotional health and quality of life of the person with the condition.

It's also infuriating because it is easy to diagnose but there's no cure; the cause is not known (although there is probably a genetic tie-in); and there's no way to prevent it. We're left with treatment of the scaly patches of psoriasis in the skin-scalp, elbows, knees, etc.

Your friend surely knows the importance of self-care: keeping the skin well lubricated; avoiding trauma to the affected areas; using mild soaps; and not over-bathing.

Many medical treatment options are now available. The right treatment for your friend is best chosen in consultation with a physician, taking into account the extent and severity of the condition and, importantly, with a clear understanding of the risks and benefits of the treatment.

I have many questions. You noted that your friend has a severe case. Were the standard steroid creams and tar preparations tried and proven ineffective? Has your friend tried covering the affected areas and leaving the covering on for up to a week? This has been shown to be effective in as many as one-third of the people who tried it in a research study.

Has your friend considered the short- or long-term ultraviolet light treatments? Also, methotrexate has been found effective in treating severe psoriasis, but the rather substantial side effects have to be considered.

So, while psoriasis is not curable, there are many ways your friend can control the disorder. Any decision for treatment ought to be an informed one, which means consultation with a health care provider. I'm sure you're keeping your friend's spirits up through encouragement, empathy and otherwise just being a good friend.

Q: I hope you can be objective. I need your general opinion. I have a nervous disorder and have been seeing my primary care physician for four years. On my last two-month checkup, I felt desperate and requested a month's stay in the hospital to help me stabilize. To make a long story short, he told me I had to be practically suicidal before most health insurance carriers would pay for the benefits. I was astounded. Is this a sign of a good doctor? -- V.R., Tonawanda, N.Y.

A: Because of many things you didn't say, I will have to read between the lines. Even so, your letter raises many important things to think about. One of these is that focusing on your relationship with the doctor will often produce better results than trying to assess "how good" a doctor is.

Certainly your doctor was looking out for you when he indicated concern about who would pay for the hospitalization. However, the statement that you must be "practically suicidal" is not true. Also, I hope that you specifically discussed what your own insurance would and would not cover.

Obviously, I can't tell whether hospitalization for any length of time, much less a month, would be of benefit for you. If you feel that a hospital is the best place for you to rest up, maybe you need to focus on what you can do about your day-to-day living arrangements to improve your life and your ability to live with your condition. It's also something that you and your primary physician should talk about.

If your "nervous" condition is bad enough to require a doctor's visit every two months -- and with you feeling so desperate -- was it suggested that you seek care from a specialist? Also, getting home health care is an option that may be helpful as well.

Apparently you have a lot of unanswered questions, so write them down and make sure you get answers you understand the next time you visit your doctor. No matter how good a doctor is, if the two of you cannot communicate effectively, the doctor may not be good for you.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Avenue, Suite 1400, Chicago, IL 60611.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health care provider.

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