JERRY BAGEL, MD: So you don't haveany nail pitting.That's good.
CLAYTON LEACH: But here I am,a seventh graderwith this monstrous plaque rightin the middle of my forehead.So my first encounterwith this disease was not justa little rough skinor a little here and there,but something thateverybody-- it was justpresented so for everybodyto see.
JERRY BAGEL, MD: Psoriasis isan immunologic diseaseof the skin.This has major impacton social developmentand self-esteemresulting in a higher riskof depression.How do you deal with it?It's simple.Clear them up.People that are candidatesfor phototherapy in factare also candidatesfor biologic agents.It's a matter of preference.However, having said that,biologic agents do decreasethe immune system someand increase your risksof infections.
CLAYTON LEACH: I've been involvedwith biologics since 19-- welllet's just say 1998, and for me,it changed my life.
JERRY BAGEL, MD: You may havea few patches left.There's going to be some peoplethat are totally clear,and unfortunately there's goingto be a percentage that itdoesn't work well enoughto continue.But the vast majority of peoplehave an excellent responseto these drugs.
CLAYTON LEACH: It'sa total non-event.
JERRY BAGEL, MD: It's like the patientdoesn't even see the needle.They touch it.It goes in very quick,and when they first started,they were burning.The solutions they were inmight have been toobasic or acidic.They've modified it,so most patients arecompliant with injections.Let's go back 10 yearsbefore the FDA approvedany biologic agents.The best treatment for psoriasisat that timewas known as Goeckerman therapy.We had it in this office.People would come here for sixhours a day, five days a weekfor four weeksto go into a tar bath, tarointment, moisturizer cream,scalp debridement, moisturizers,increasing incrementsof ultraviolet B light,and Anthralin.They'd stay here for six hoursa day, five days a weekfor four weeks.You want to talkabout intimidation.It's going to take between 12and 24 weeks before we seemaximum effectivenessfrom this drug, so you're goingto have to havea little patience.Some drugs kick in quickerthan others.Some patients respond quickerthan others,and in some patients, the drugswork for a few yearsand then lose efficacy.
CLAYTON LEACH: I'm lookingat this stuffthat I had been battlingmy entire life,and it's going away.It's just going away.
JERRY BAGEL, MD: Remember, and this iswhat I tell most of my patients,when they ask mehow long are they going to haveto be on a biologic agent,I say you havea chronic immunologic diseaseof the skin.This is not poison ivy.This is not a three weekdisease.If I told you had diabetesand you had to go on insulin,you wouldn't ask me how long.You would say, how much,and how do I check it?Well, psoriasisis a chronic disease as well.It waxes and wanes.It gets better,and it gets worse.But most of the time,it's going to come back,so you're going to need to beunder some sortof chronic therapy.