What to Ask Your Doctor About Severe Psoriasis Meds

Reviewed by Brunilda Nazario, MD on October 07, 2020

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.

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.

How Biologics Work for Severe PsoriasisWhat do biologics do inside your body to help soothe your psoriasis? See what happens when they go to work.68


SPEAKER: Psoriasis appears

on the outside of your skin,

but it really begins

inside your body.

It happens when

your immune system starts

attacking healthy skin cells

by mistake.

What triggers this attack though

is a mystery.

As your blood cells widen,

your skin becomes warm and red.

At the same time, your body

starts making more and more skin

cells at a faster rate

than normal.

This causes thick, red, scaly

patches to form on your skin.

If your psoriasis is severe

and isn't responding

to treatment, a biologic may be

able to help.

Biologics are

protein-based drugs that come

from living sources.

They target

the specific proteins and cells

of your immune system

that are causing

the inflammation in your skin.

By attaching to its target

protein or cell, the biologic

blocks it from interacting

with other cells.

In this way, it helps stop

the cycle of inflammation that's

causing your psoriasis

and other medical problems.

National Psoriasis Foundation: “Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs.”<br> National Psoriasis Foundation: “The Making of Biologics.”<br> International Journal of Molecular Sciences: "Old and New Biological Therapies for Psoriasis.<br> F1000 Medicine Reports: "The role of TNF inhibitors in psoriasis therapy: new implications for associated comorbidities."/delivery/aws/dc/a3/dca3eb54-d493-3f22-9ab7-50fa770ae9b3/091e9c5e81dcfc6c_funded-medical-animation-psoriasis-how-biologics-work_,4500k,2500k,1000k,750k,400k,.mp412/10/2019 14:37:0018001200photo illustration of biologics/webmd/consumer_assets/site_images/article_thumbnails/video/1800x1200_funded_medical_animation_psoriasis_how_biologics_work_video.jpg091e9c5e81dcfc6c

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.  


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.

Preparing for Bath Time With Psoriasis A warm bath may be the answer to flaky, irritated skin caused by psoriasis.72


SPEAKER: If your skin is itchy

and irritated from psoriasis,

sometimes a bath can help.

Soaking in a warm bath

can be soothing for your skin.

Just make sure the water isn't

too hot because hot water can

make the skin irritation

and dryness worse.

And be careful scrubbing.

Too much can cause a flare up.

Hop in the shower for 10 minutes

or soak in the tub every day.

There are a few things you can

add to your warm bath water

to help with the redness

and flaky skin.

An oatmeal bath

may be comforting

and can help to loosen scales.

You can either buy

an over-the-counter product

or blend 1 cup of oatmeal

into a fine powder

and add it to your bath water.

Epsom salts and Dead Sea salts

can also help remove scales

and decrease itching.

Add them to your warm bath

and soak in the tub for up to 15


Don't forget to apply

moisturizers when you get out

of the tub.

Pat your skin dry so you're not

dripping wet, and apply lotion

right away.

You might even find

that cool lotion is more


So try keeping your moisturizers

in the fridge.

A warm bath with oats or salts

and cool lotion may be just what

you need to soothe

your itchy skin.

National Psoriasis Foundation: "Managing Itch," "Herbal and Natural Remedies."<br> University of Maryland Medical Center: "Psoriasis."/delivery/e3/ab/e3ab1cd6-bd0c-4842-845b-6383cdb76ae4/vd-1384-ah-bath-time-with-psoriasis_,2500k,400k,1000k,750k,4500k,.mp401/18/2018 12:56:00650350running a bath/webmd/consumer_assets/site_images/article_thumbnails/video/bath_time_with_psoriasis_video/650x350_bath_time_with_psoriasis_video.jpg091e9c5e815dfc79
WebMD Medical Reference



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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