Inside the Visit: Psoriatic Disease

[MUSIC PLAYING]

So Tom, we've known each other a long time.

Yes we have.

What's your recollections about starting your journey with psoriasis?

Well starting the journey with psoriasis was a long, long time ago. 1974 to be exact. I just remember it being frightening to hear the words, there is no cure, and that there's not a lot we can do for it, at that point in time was devastating.

How much of your body was covered with psoriasis at that point, do you feel?

Ended up at 60% to 65% covered with heavy plaque psoriasis.

Wow.

And it was bad. You did everything you could to try to hide. And I hate to say I was hiding, but that was what I was doing.

Early on, what actually worked for you first?

I don't know that anything worked. Some things worked toward slowing the progression down. I started out with the coal tars, light treatments, your body being wrapped in Saran Wrap. And that was the science of the day.

When you and I started out, all we really had were the topical steroids and emollients or moisturizers. And going further even with the topical treatments, we have new topical therapies that are coming out. So even for people with limited psoriasis, or patients who are on a biologic but have a few small plaques of psoriasis, there will be new products coming out in the topical realm that will be great.

I remember very vividly when you grabbed my shoulder and said, you can't give up now Tom. There's a future. Don't give up now. There's things that are going to be available. It's going to take time. I didn't know it was going to take that long, but it did take time. And then the science, the medicine caught up with the problems.

Back when I was telling you about the medications being developed, the ones that I knew about then, the biologics weren't even a concept. And so I wasn't even referring to what we have now. I think you're right. We have to have trust that as long as there is a true need of a large number of people, new treatments do get developed. You were on several pills for a while, and they all had their side effects.

Methotrexate was a drug that was used. It helped, but the side effects for me were awful.

I remember that. Now you were one of our earliest patients on the biologic medication.

Yes, I responded real well to the biological drugs, or the biologics. And I went from 65% covered to basically clear in 12 to 16 weeks.

That was probably one of the most gratifying parts of my career, as someone who focused his career on treating psoriasis, was seeing your response to the initial biologics.

To me, the biologics have been the answer to my prayers. And I realize that is not the case for every psoriasis patient.

Right. Now another issue with you Tom that we've had over the years is we've had to transition to medications. You were on a biologic that got taken off the market. And quite honestly, I was very nervous about how you would respond. And you did beautifully on that medication.

I was calling the FDA, anybody that would listen to me, about how do we keep this medicine out there? And then you got me calmed down, and said, let's find something else that's going to work for you.

I'm going to give you a hypothetical here. If for some reason the current drug stopped working for you, what would be your first thought?

My response to that is, who has guided you this far? You contact your doctor that you have faith in, and you say, OK, what are my alternatives? The pharmaceutical companies are developing new drugs daily. What do you recommend we try next? Is this a class issue, or is it simply my body and this medicine issue?

Right. We have so many choices now, and it's so great. Now we've changed our standard to where we don't like to accept less than 90% clearance. And if one biologic's only giving 50% clearance, we will switch. I think we are on the cusp of precision medicine that will allow us to know the percentage likelihood they are to respond to different classes of biologics, using the simple skin test or blood test or that sort of thing. So that's pretty exciting.

Oh yes it is. In the game of life, you've been dealt a poor hand. Let's just use that term. But you have no choice but to play it.

I think we may be on the cusp of even greater things for psoriasis. Greater results for our patients. So--

That sounds like a winner. I appreciate you.

Likewise Tom. I really appreciate you.

You take care.