By Anne Babcock-Stiner, as told to Hallie Levine
I’ve had psoriatic disease for almost 5 years. I cycled through all sorts of medications, ranging from prescription topical ointments to immunosuppressants, until I found a biologic that brought me relief.
A Disturbing Diagnosis
In early 2018, I came down with strep throat. It was the first time I’d had this childhood disease in decades. Then, a few days later, I noticed a rash. They were small, round, scaly red spots that were all over my arms, legs, and chest. At first, I thought it was from the antibiotics, but then they started to itch.
I saw my dermatologist right away, who explained to me that I had a type of psoriasis known as guttate psoriasis. While most people think of psoriatic disease as large, red, shiny plaques, about 8% of people with psoriasis develop guttate psoriasis. It’s usually triggered by an infection, such as the flu or strep throat. It can also be made worse by stress.
My dermatologist prescribed cyclosporine, which is an immunosuppressant (it was originally given to people who had had organ transplants, to prevent their bodies from rejecting their new organ). It’s also used to treat severe psoriatic disease. I was a little nervous about taking it since it’s such a strong medication. It also seemed to cause an almost constant headache. It worked well -- the spots vanished fairly quickly. I took it for about 16 weeks, which is the recommended treatment cycle. But when I went off it, within weeks my psoriasis had flared back up again.
An Unrelenting Search for Relief
I had gone off cyclosporine in late May. Over the next month, my psoriasis gradually returned. It seemed to be worsened by sweat and the heat. It was all over my body, but it was particularly bad in areas where there were creases, like my armpits, my groin, and the folds of my elbows and knees.
Finally, around July 4th I found some relief. I was at a barbecue at my sister’s house and was complaining about the constant itching. She darted inside and returned with a tub of prescription steroid cream that she told me to try. I took it, and after a couple of days, it seemed to help.
I went back to my dermatologist, who prescribed two steroid creams: betamethasone, for my legs, arms and torso, and triamcinolone, for more sensitive areas like my groin and armpits. They did help — the psoriasis never totally disappeared, but it was at least a relief from itching that kept me up at night and prevented me from getting work done. But my doctor wanted me to use it for only short periods of time -- a week on, for example, and then a week off -- and I couldn’t do it. Once I stopped, within a day or so the intense itching would return.
A Miracle Cure
This past February, I had a weekend where I just didn’t feel well. I had a persistent headache and just felt exhausted and out of sorts. After a couple of days, it went away, and I didn’t think anything more about it until a week later, when I got out of the shower and saw my torso covered in those same telltale small, round red spots.
I saw my dermatologist right away, who told me I was having another flare of my psoriatic disease. While my strep test was negative, she also ran antibody tests that revealed that I’d been exposed to the bacteria recently. While I’d been mainly asymptomatic, it was enough to trigger a resurgence of psoriatic disease.
This time, my psoriasis was everywhere. It didn’t just cover my torso and limbs; it was on the bottom of my feet and on my scalp. My dermatologist first put me on stronger prescription steroids, as well as something called a coal tar treatment. It took me 20 minutes in the morning and 20 minutes at night to put this ointment all over my body, but it didn’t work, and it stained all of my clothing.
After 2 weeks, I went back to her office to discuss options. I didn’t want to go back on immunosuppressant medication during a deadly pandemic. But I was so miserable, I didn’t know what else to do.
Thankfully, my dermatologist had some good news. She said to me, “The world has changed since the last time this happened to you, and it’s not just because of COVID-19.” Over the last few years, there’s been an increase in a new type of drug to treat psoriatic disease, known as biologics. Like cyclosporine, these drugs would target my overactive immune system, but unlike cyclosporine, they would only quiet the part of my immune response that was involved in my psoriasis. As my dermatologist said, “It only takes out all of the foot soldiers versus all of the generals.” This meant it had less risk of side effects, too.
She put me on a biologic drug that was approved in 2019 to treat moderate-to-severe psoriasis. The treatment involves two shots spaced a month apart in my dermatologist’s office, and then every 12 weeks afterward. The results were dramatic; it started helping within 5 days. Most of the plaque patches disappeared -- including the persistent, itchy patches under my armpits and groin -- except for spots on my shins. But those almost vanished after my second shot. The itching is completely gone.
It's unclear how long I’ll need to be on biologics, but I’ll take them for as long as my dermatologist says I need to. It’s a relief not to have to worry about sweating, or heat, or any of the other environmental factors that would trigger unrelenting itching. I’ve had psoriatic disease for less than 5 years, and that was enough to make me see how debilitating it could be. I’m just relieved to get my life back.
Photo Credit: NikiLitov / Getty Images
Anne Babcock-Stiner, 49, attorney and advocate for psoriatic disease, Rochester, NY.
National Psoriasis Foundation: “Guttae Psoriasis,” “Treating Plaque Psoriasis with Skyrizi.”
American Academy of Dermatology: “Psoriasis Treatment.”