When Psoriasis Meds Don’t Work

Months before her wedding, Kim Brown began using adalimumab (Humira), a drug to treat her psoriasis. She’s had the disease, which causes painful, scaly skin rashes all over her body, since age 10.

But her dreams of walking down the aisle with clear skin didn’t come true.

“I thought I was breaking out in wedding stress hives. But it was because of the drug,” says Brown, who lives in Lynchburg, VA. “I had a rash, hives on my chest, and a very bad yeast infection, which is not something you want, especially on your honeymoon.”

Brown’s doctor told her to stop using the drug. She’s tried many psoriasis treatments over the years. They work great for a while but then stop. Others cause side effects like blisters or an upset stomach, making it hard to keep using them.

Why Some Meds Don’t Work

Psoriasis causes inflammation because your body’s immune system isn’t working properly. It’s called an autoimmune disease.

Its many causes make it hard to treat, says Jesse Keller, MD, assistant professor of dermatology at Oregon Health and Science University.

“It’s partly genetic, partly environmental, and partly triggered by lifestyle factors such as body weight and alcohol use. We have no idea why psoriasis affects some more than others in a more aggressive or widespread fashion,” Keller says.

Creams that you rub into your skin (your doctor may call them topical) work well for many people. But if you have psoriasis all over your body, they’re hard to apply, Keller says. And they may not get through the thick skin of your palms or soles to treat rashes there. Neither creams nor light therapy work for outbreaks on your nails.

In those cases, you may need drugs to try to make your immune system work like it should. They all act differently, so you and your doctor will use trial and error to see if one will help you, Keller says.

Doctors can’t predict who will respond to what because everyone’s immune system is different, he says. The wrong drug may cause a severe flare, “leaving you worse off than what you came in with.”

If you can’t afford the cost of your drugs, speak up. Don’t just let your prescription run out, Keller says. He’s seen many people who, rather than reach out to the doctor, will just let the disease get worse.

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Trial and Error

Jamie Lyn Moy and her son, Andy, both have psoriasis. Finding the right treatment is frustrating, says Moy, who lives in Waterford, MI.

“It’s crazy how many medications we have both been through, even biologics,” she says. “They’d work for 6 months, then not, then we increase the amount. Then 8 months to a year later, they stop working again.”

After one dose of infliximab (Remicade), a drug that’s given by IV into veins, Andy had an allergic reaction. “He had trouble breathing. Not where we felt we had to rush to the hospital, but it was just not quite right,” Moy says.

A few years later, Andy tried the drug again. His doctors thought he might be able to handle it better since he was older. His psoriasis cleared up quickly, but after the third treatment, they did have to rush him to the hospital with a severe reaction. 

It’s hard, because you want the best for your child, Moy says. "But sometimes, there’s nothing else to try.”

Even psoriasis meds that work for months or years may not keep working or may not work as well as they did in the past, Keller says.

“Injectable psoriasis drugs work great, but if they are stopped for any length of time, your body develops resistance, so that the same medication that was working well for you can become ineffective the next time you restart it.”

When Good Drugs Go Bad

If your drug causes a sudden allergic reaction, like trouble breathing or wheezing, hives, or sudden itching and a rash, let your doctor know right away.

If you have more than one reaction, like a rash and breathing problems, go to the emergency room.

When Your Meds Fail

Tell your dermatologist if your drugs don’t work or seem to stop working after a while, Keller says.

“There are many psoriasis treatments, ranging from conservative up to more aggressive,” he says. If your first drugs don’t work well, you may need something stronger, different, or a combination of treatments.

Talk to others with psoriasis to learn about new treatments or managing side effects and stress, Brown says. She’s turned to Facebook and the National Psoriasis Foundation’s message boards for tips and support.

Don’t be afraid to try a new treatment, even if you hear about side effects that could be rare, Moy says.

“You almost hold your breath, because you don’t know how long clearing is going to last. If you have a bad day, you think, is this the start of this medication not working? Or is it just a bad day?”

WebMD Feature Reviewed by Stephanie S. Gardner, MD on February 23, 2016

Sources

SOURCES:

Jesse Keller, MD, assistant professor of dermatology, Oregon Health and Science University School of Medicine.

American College of Allergy, Asthma and Immunology: “Types of Drug Allergies: Overview.”

National Psoriasis Foundation: “About Psoriasis.”

Kim Brown, Lynchburg, VA.

Jamie Lyn Moy, Waterford, MI.

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