CACI for Psoriasis – When it comes to medical certification, the FAA concerns itself with three main considerations.

Ruling out the risk of sudden, complete – or nearly complete – incapacitation is at the top of the list. No passenger wants to fly with a pilot with an outsized risk for seizure, stroke, heart attack, or other cause of unpredictable loss of consciousness. Even pilots suffering from a medical condition that predisposes them to such an outcome understand and generally accept this principle. 

Then there are medical conditions that cause more insidious alterations of consciousness. In this category, think about cognitive impairment due to fatigue, medication side effects, poorly controlled mental health conditions, or substance abuse or dependence. These types of conditions might seem less concerning at first, but pilots are less able to recognize the related effects. That usually means the FAA will require most frequent follow-up appointments with treating physicians so that a trained professional can evaluate a pilot’s suitability to continue flying on a regular basis. 

Somewhat less severe, but much more common, are a host of conditions that affect aviation safety by simply causing symptoms severe enough to cause distraction. Headaches, musculoskeletal pain, and acute injuries and illnesses all fall into this category. 

Psoriasis provides a somewhat prototypical example of a condition that can cause distraction while flying. It describes a common inflammatory skin condition that can cause pain and severe itching. While the FAA must rule out life-threatening variants like pustular psoriasis and has other requirements for related conditions like psoriatic arthritis, it is primarily concerned with making sure that symptoms are not severe enough to interfere with safely operating an airplane. 

Psoriasis Fast Facts

Psoriasis affects more than 10% of the population according to some studies and seems to be more common in northern latitudes [1]. While not directly linked in a causal relationship, psoriasis is often associated with obesity, other autoimmune diseases, alcohol use disorders, cardiovascular disease, and obstructive sleep apnea among other conditions [2].

While it is still considered a chronic disease, modern treatment options have dramatically reduced the historical severity of symptoms to the point that most people with cutaneous plaque psoriasis can successfully control their symptoms and lead normal lives. 

Medical Certification With Psoriasis

For pilots treated with topical medications only who do not experience significant discomfort from their symptoms, psoriasis is not disqualifying. Your AME can issue your medical certificate on the day of your exam without any additional documentation. 

On the other end of the spectrum, pilots who have erythrodermic, pustular, or otherwise severe psoriasis must obtain specialized documentation from their treating dermatologist or rheumatologist and wait for their application to be reviewed by the FAA’s Aerospace Medical Certification Division. 

In between those extremes, pilots can still leave their AME’s office with a medical certificate under the FAA’s Conditions AMEs Can Issue (CACI) program, provided they meet the criteria and submit appropriate documentation from their treating physician. 

Psoriasis CACI Criteria

As with ALL CACIs, pilots must provide their AMEs with current medical documentation from their treating physicians that adequately explains the current status of their condition. 

In the case of psoriasis, your doctor must verify all of the following criteria in order to avoid having your application deferred to the FAA:

• Your condition must be stable and be no more than mild or moderate in severity
• You must have no limitation in strength, function, or range of motion
• You must NOT have pustular or erythrodermic psoriasis
• If treated with medication, your prescriptions include any FDA-approved topical medication and/or methotrexate and/or no more than one of the following:
  • apremilast (Otezla) 
  • adalimumab 
  • certolizumab (Cimzia)
  • etanercept (Enbrel)
  • guselkumab (Tremfya)
  • ixekizumab (Taltz)
  • risankizumab (Skyrizi)
  • secukinumab (Cosentyx)
  • tildrakizumab (Ilumya)
  • ustekinumab (Stelara)
  • infliximab (Inflect; Remicade; Renflexis)
• If you are taking methotrexate, you must provide current laboratory testing results including a complete blood count, liver function testing, and creatinine testing

Fundamentally, these criteria are not hard to meet. As long as your symptoms are well controlled and you have not experienced side effects from most accepted modern treatments, your AME should be able to issue your medical certificate without waiting for additional centralized review by the FAA. The key is providing the right documentation from your treating physician so that the AME has the information they need to avoid deferring your application. 

Avoiding Medical Certification Delay

As with most FAA medical certification issues, the time it takes to get your medical certificate will be inversely proportional to the amount of effort you expend preparing for your application. The FAA wants safe pilots flying, but they only have the documentation that you provide them to decide if you are safe to fly. 

If your AME defers your application, it can often take months to sort through the misunderstanding and qualify for a medical certificate. Do not attend your AME exam with questions about what will happen at the end. Prepare for your FAA medical like a checkride to minimize the time you wait for your certificate. 

References

[1] I. M. Michalek, B. Loring, and S. M. John, “A systematic review of worldwide epidemiology of psoriasis,” J. Eur. Acad. Dermatol. Venereol. JEADV, vol. 31, no. 2, pp. 205–212, Feb. 2017, doi: 10.1111/jdv.13854.

[2] E. Farley and A. Menter, “Psoriasis: comorbidities and associations,” G. Ital. Dermatol. E Venereol. Organo Uff. Soc. Ital. Dermatol. E Sifilogr., vol. 146, no. 1, pp. 9–15, Feb. 2011.