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**Holly** (0:17)
Brian Lehrschall was 13 years old when psoriasis arrived, and it arrived fast. Within six months, he went from zero to more than 90 percent body surface coverage. Psoriatic arthritis followed at 15
He has spent the last 30 years living inside the full scope of this disease, and inside the full scope of what medicine has tried to do about it. He joined the National Psoriasis Foundation as a volunteer in 2000 He has been an advocate for improving access to care ever since. What makes Brian perfect for this episode is that he has not just witnessed the revolution in psoriasis treatment, he has lived through it. He knows what came before. He knows the difference. Today, we're going to tell the story of how that revolution actually happened and why nobody planned it.
Brian, welcome to Our Skin. We are so delighted that you're here with us.

**Brian Lehrschall** (1:13)
Thanks for having me, Holly. I appreciate it.

**Holly** (1:15)
Brian, I would love it if you would take us back.
You were in your teens when psoriasis first appeared, and as I just said, you went from almost zero to more than 90 percent body surface coverage in about six months, which is so intense to think about. What was that like as a kid before you had any kind of framework of understanding what was happening to your body?

**Brian Lehrschall** (1:40)
As you can imagine, 13 years old is the worst possible time to get a skin disease, especially because it's middle school. Middle schoolers are notorious for picking out people who are different. One day, I woke up with a scaly patch on my arm, and then six months later, I have it everywhere but my face. I went through about every kind of conventional treatment you could think of back then.

**Holly** (2:06)
And then you were diagnosed with psoriatic arthritis just a little while later.
Two major diagnoses at a time when you already feel self-conscious and vulnerable.
Did that diagnosis answer some questions about symptoms that you were already having?

**Brian Lehrschall** (2:22)
Absolutely. It definitely answered some questions about the stiffness and soreness that I was feeling in the morning, and why I was so tired all the time, and I already had joints that were deformed at the age of 15

**Holly** (2:35)
From a scientific standpoint, I wonder, was it hard as a kid to understand how this same thing could be impacting both your skin and your joints?

**Brian Lehrschall** (2:46)
It was at first. I got diagnosed by a pediatrician. He sent me to a local dermatologist. We went through the vitamin A treatment and the radiation treatment, and I got to where he said, I can't treat you anymore because you're getting worse and I don't know what to do. So he referred me to Duke University Medicine, and I'm proud to say I have had the same doctor since I was 14 He's still my doctor. Once I got to Duke, I had a lot more scientific understanding. I felt like this doctor, he's literally a professor of medicine, and it's his job to teach people. So I was like, explain to me what this is and why my body is doing this, and he did.

**Holly** (3:26)
I love that. What a great attitude, just trying to take the knowledge into your own hands. You referenced this a moment ago, but I would like to talk about it a little more. Having an illness that shows up on your skin and slows you down with achy joints is so hard for a kid and other kids I know did not make that easy for you. Will you talk a little bit about the bullying that you had to contend with?

**Brian Lehrschall** (3:49)
Yeah. Not only did I have to contend with bullying from my peers, I actually had to contend with bullying from my teachers. I had the normal range of teenage insults leveled at me and leveled at my brothers because of me, but I had a teacher who once told me or she had the school nurse remove me from her classroom every day.
I asked the nurse why this was happening and she said, well, the teacher considers you a health hazard because when you get up, there's a pile of skin on the floor. So I called my mom, I told her what happened and I then called my doctor at Duke, and I told him what happened. The man took an entire afternoon off of clinics, drove from Duke University to my high school, and then had a meeting with all of my teachers and proceeded to do some basic education about psoriatic and psoriatic arthritis disease.