What to Ask Your Doctor About Severe Psoriasis Meds

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.

What are the side effects of this medication?

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. 

Do I need to have testing before, during, or after this treatment?

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.

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What are my other treatment options?

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.

Can I take this medicine with other medications?

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.

When will I know if it’s working?

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.

How long will I need to take this medicine?

Because systemic drugs impact your immune system and can have serious side effects, you can’t use them for long periods of time. Your doctor should tell you when you’ll need to take a break from medication, and what other treatments to use in the meantime.

What if this doesn’t work?

If your psoriasis doesn’t respond to one treatment, others may be an option. 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.   

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When should I follow up with you?

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.

WebMD Medical Reference Reviewed by Arefa Cassoobhoy, MD, MPH on November 13, 2019

Sources

SOURCES:

International Journal of Molecular Sciences: “Treatment Approaches to Moderate to Severe Psoriasis.”

UpToDate: “Treatment of Psoriasis in Adults.”

Mayo Clinic: “Psoriasis.”

National Psoriasis Foundation: “Systemic Treatment: Methotrexate.”

FDA: “Clinical Research vs. Medical Treatment.”

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