Psoriasis treatment has come a long way. New medications like biologics have helped more people achieve clearer skin.
But everyone with psoriasis is different. What works for one person won't always help someone else. A certain medication might clear your skin for you for a while, then stop working. Some may have side effects that you find bothersome.
Women with psoriasis say it can take time and experimentation to find what works best for you. That might mean medications, lifestyle changes, or home remedies. It can also mean adopting a new mindset -- to stress less, reach out for support, and practice self-acceptance.
One Biologic After Another
Tami Seretti was diagnosed in 1996, when many doctors still treated psoriasis like a skin condition instead of an autoimmune disease. At the time, topicals -- medications you apply to the skin -- were the main treatment.
The first one she tried was a corticosteroid oil applied to the scalp.
"You had to put it in, wear a shower cap all night, and wash it out in the morning," Seretti says. "It was messy. I ruined nightgowns and sheets. And it didn't really work that well for me. It pulled the scales out, but it pulled my hair out with it."
She also tried other corticosteroids and all kinds of greasy lotions.
Then she started on disease-modifying drugs. She's tried many biologics, drugs that block the part of the immune system that cause those scaly plaques.
One worked well for her -- for a while. "I was in total remission. But when it stopped working, it really stopped working," she says. Two years ago, her doctor suggested she switch to her current medication.
"It started working in about 10 days, and it's been working ever since. I went from 80% covered to 15% covered [in psoriasis]." She's been able to grow her hair past her shoulders for the first time in her life.
Seretti also uses two topicals, a cream and a scalp solution. And she uses an ultraviolet B (UVB) light wand at home.
In addition, she finds relief from soaking in an Epsom salts bath. "It softens up all the scales and it relaxes me," she says.
"Psoriasis-wise, I'm doing fantastic. I could not be happier," Seretti says. "I don't think twice anymore about wearing flip-flops, sleeveless tops, or shorts."
She says she also doesn't have to cancel social plans anymore because she's too uncomfortable to get dressed. "This freedom is incredible."
Medication and Stress Relief
A tiny patch of itchy skin on the back of her head was Melissa Withem-Voss's first symptom. What she thought was stress turned out to be psoriasis, which her doctor diagnosed in early 1996.
She's tried many medications over the years, including steroids, methotrexate, and even injections of a compound containing gold. Finally, she and her doctor found a biologic that worked for her. "After 21 years of not being 100% clear, that was the first thing that cleared me."
But biologics can eventually stop working. That's what happened to Withem-Voss after about 3 years on one medication. Now she's on her 4th week of a different biologic drug. "So far, it is helping," she says.
As a chef, Withem-Voss has experimented with diet, too. She finds that eliminating bread and sugar helps her skin. "I haven't found that any one diet has ever solved it," she says. "But I feel better."
She also meditates for a half hour before bed each night to tame the stress that causes her psoriasis to flare up. "It keeps me calm. It keeps me relaxed," she says.
Over time, she's learned to live with her condition. "I used to hide. I used to cover myself," she says. "I have come to accept it about 90%."
When Jessica Lorion noticed tiny spots on her legs and stomach in 2011, she thought they were bedbug bites. She was an actor living in New York City, so bedbugs wouldn't have been far-fetched. But when the spots didn't go away, her doctor diagnosed her with psoriasis.
"I was covered from head to toe. From the top of my scalp all the way down to my feet," she says. She tried a steroid ointment before going on a biologic drug. "After about 6 months, I was significantly clearing," she says.
Eventually she was also diagnosed with psoriatic arthritis. Her doctor put her on the anti-rheumatic drug methotrexate, which helped with both conditions.
But in the back of her mind, Lorion was worried. She wanted to start a family, and methotrexate isn't safe for a growing baby. Her rheumatologist told her she could go on a pregnancy-safe biologic, but "I was scared," she says. "You hear these commercials with all these side effects."
Lorion started to experiment with food. After doing some research, "I made the decision to go on an elimination diet, to make my body as strong and healthy from the inside out as possible," she says.
For the first 30 days, she followed a strict regimen. No gluten, dairy, caffeine, processed foods, sugar, grains, or most oils. Then she slowly started reintroducing foods. Today, she still avoids gluten, dairy, artificial sweeteners, and processed foods.
She says the diet has helped her wean off most of her medications. "At this point, I'm at the lowest dose," she says. "I just have a little bit [of psoriasis] on my elbows and heels, but it's under control."
She's started a podcast, called Mamas in Training, to share her journey with an autoimmune disease and help other moms-to-be advocate for themselves.
"It's my way of helping others and helping myself stay in a positive mindset," she says.
Medication -- and a Strong Support System
Being outdoorsy, Vickie Wilkerson mistook her first psoriasis patch for poison ivy. That was 18 years ago. Back then, topicals like coal tar were her main treatment option.
"In my opinion, the coal tars are the worst ever. The smell, the greasiness -- it messed up your clothes. It was terrible," she says.
The psoriasis eventually spread to so much of her body that her doctor put her on methotrexate. But the side effects were "horrible," she says. "I'd be very nauseous. I couldn't even try to lift a glass of water. I was so fatigued."
Then she tried biologic after biologic. One cleared her hands but not the rest of her. Another worked for a year and a half, then stopped. A third helped her psoriasis, but she developed stomach problems while on it.
On her latest biologic, she says, her skin is almost completely clear. "In the 18 years I've been battling psoriasis, I've never once been clear. To finally be on something that is working is just amazing," she says.
She also watches what she eats and listens to music to relax. And she credits a strong support system with helping her through the most difficult times. Her biggest sources of support are her husband, her children, and the people she's met through the National Psoriasis Foundation.
"I turn to them when things are bad or I'm in a flare because they understand what I'm going through," she says.
Photo Credit: PeopleImages / Getty Images
JAMA Dermatology: "Comparison of Biologics and Oral Treatments for Plaque Psoriasis: A Meta-analysis."
Jessica Lorion, actress, New York.
Melissa Withem-Voss, chef, Gurnee, IL.
National Psoriasis Foundation: "Biologics."
Tami Seretti, psoriasis advocate, Pennsylvania.
Vickie Wilkerson, website contributor, Shreveport, LA.