What to Ask Your Doctor About Severe Psoriasis Meds

Medically Reviewed by Brunilda Nazario, MD on October 18, 2023
4 min read

Many people with mild psoriasis can control their symptoms with mild treatments, like skin creams and light therapy. But if you have severe psoriasis, your doctor may recommend you take medication to help with:

  • Plaques over large areas of your body
  • Plaques in uncomfortable areas like your hands, feet, face, or genitals
  • Pustular or erythrodermic psoriasis
  • Psoriatic arthritis
  • Psoriasis that doesn’t get better with milder treatments

Medication for severe psoriasis is known as systemic treatment. It’s medicine that you take by mouth or through shots that target your immune system to control your psoriasis symptoms.

When your doctor recommends this type of treatment, think about asking these questions so you know what to expect.

Your doctor will try to find an effective treatment with as few side effects as possible. But it’s helpful to know how these medicines can affect you.

Systemic treatments turn down your immune system in order to lower the inflammation that causes psoriasis. Because of that, they can have serious side effects. For example, methotrexate can lead to liver damage and blood problems over time. Biologic drugs (medications made from substances in living things, which target your immune system) can up your odds of dangerous infections. Some psoriasis medications can also raise the risk of birth defects if you’re pregnant, so you’ll want to talk to your doctor if you’re planning on having children in the next few years.

Make sure you’re clear about the effects of a medication before you take it. Ask your doctor if there are ways you can manage or ease those side effects. 

Most of the time, you don’t need a test to find out if you can take a psoriasis medication. But there are some exceptions. For example, your doctor may screen you for tuberculosis before you begin a biologic medication. (Tuberculosis can be deadly, so it’s not a good idea to take a drug that turns down your immune system while you have it.)

You may need testing while or after you take some severe psoriasis medications. For example, if you use methotrexate, your doctor may recommend a test to see if the medication has damaged your liver.

No matter what your doctor recommends, it’s up to you to decide whether you want to try that treatment. That’s why it’s a good idea to find out if there are other options available. Asking the same questions about those treatments (for example, “What are the side effects?”) as the one your doctor recommended can help you make an educated decision about your treatment plan.

Your doctor may recommend that you continue using milder treatments (such as skin creams or ointments) along with medication for severe psoriasis. If you’re not sure what you should take, ask. And find out if the new treatment you’ll be using will interfere with any other supplement, over-the-counter drug, or prescription medicine you already use.

It may take several weeks or even months for a psoriasis treatment to work. You’ll want to know how long you should wait to see an improvement – and when to call your doctor if you think your medication isn’t working.

Ask your doctor how long they expect you to be a on a medication. Is it only for times when your psoriasis flares up, or should you stay on it indefinitely to keep things stable? They may be able to give you an idea. Keep in mind that psoriasis can be unpredictable, even if you know your triggers. 

Your doctor may prescribe some medications only for short-term use. Other drugs, like biologics, are meant to be taken for longer spans of time. Your doctor will monitor you to see if you need to switch treatments. 

If you want to stop a treatment right away, ask your doctor first. You can stop some treatments without a problem, while others could make your psoriasis worse.  

If your psoriasis doesn’t respond to one treatment, you may have other options. 

Your doctor may even recommend you think about taking part in a clinical trial. That’s a research study in which scientists test a new medication or new way of using an older treatment to see if it’s effective and who could use it. If the clinical trial has good results, the FDA will consider approving the treatment for wider use.

Knowing that you have options can help you stay hopeful if your psoriasis doesn’t respond to one type of treatment.  


Ask your doctor when you should come in for another office visit to figure out if your treatment is working. You should also know what side effects aren’t normal and when to reach out if they happen. If your treatment plan is making it hard to do activities you love or making you feel worse, let your doctor know right away.