Many medicines are on the market for people with psoriasis. There may be ones available that work better than others you’ve tried.
The approach to treatment has changed, too. Current guidelines suggest doctors aim for the most clearing possible. The goal is to have plaques on 1% or less of your body after 3 months of treatment.
April Armstrong, MD, who heads the Psoriasis Program at the University of Southern California, helped write the guidelines. She says they help folks with psoriasis and their doctors set treatment targets and a timeline for reaching them.
What if you’re not meeting your goals or your treatment isn’t helping?
Andrea Neimann, MD, a dermatologist and assistant professor at NYU Langone Health, says that can happen.
“In a perfect world, we would like to have [people] as clear as possible with no or 1% symptoms," she says. "And if they’re not clear at 3 months, we change their treatment until they are clear.
"But you also have to weigh the pros and cons of treatment. And that will be different for each [person]. My goal is to get patients to the point where they’re happy,” she says.
How Long Does It Take?
It’s best to try any treatment for at least 3 months. Give it time to work. If you don’t see a change, talk to your doctor about other options.
“I track how well [folks] are doing,” Neimann says. “Are they happy or happy enough? If not, I make changes.”
For instance, she starts folks with mild symptoms on a cortisone cream. If that doesn’t help, she might add a vitamin D ointment. If that’s not working, she tries steroid shots or a focused laser light.
Your doctor may need to mix treatments. Finding the right ones can take time. For most people, the results are worth the wait. Keep in mind that if you have a few spots, your results won’t be as dramatic as someone with a more severe case.
All medicines have them. Even sunlight, which normally helps psoriasis, can make symptoms worse if you get too much of it.
Some side effects are mild, like peeling skin or an upset stomach. Others can be serious, including the chance of infections or cancer.
Strong medicines like methotrexate and biologics may give better or faster results. But often, they cause more side effects. Biologics can also cost thousands of dollars a month. So doctors often start slowly, with steroid creams or light therapy, and move on to stronger medicines only when needed. (If your symptoms are severe, your doctor may start with a medicine like methotrexate or even a biologic).
If side effects make you want to stop taking a drug -- or never start in the first place -- talk to your doctor. Together, you can find a treatment you’re comfortable with, says Philip Mease, MD, a professor at the University of Washington School of Medicine in Seattle.
“The beauty of these [talks] is that [people] get to [say] what’s most important to them,” he explains.
The Long Haul
Psoriasis is a lifelong disease. That means you might always need something to control your symptoms. Yet even rubbing on an ointment can seem like a lot when you have to do it for years.
“Some [people] want to take a break,” Neimann says. “They may have had psoriasis a long time and forgot how bad it can be. Or they’re worried about side effects -- all kinds of reasons.
"The problem is, once you stop your treatment, your symptoms come back.”
She says stopping and restarting a treatment can also make it less effective.
“When you stop taking a biologic, your body may start to build [a defense] against it. Then when you start taking it again for the second or third time, it may not work as well or at all.”
What You Can Do
You play a big role in making your treatment work.
Be honest about your treatment goals and concerns. Do you want complete clearing or are you OK if your skin is just less red and itchy? Are you worried about side effects or costs? Can you find time for light treatments three times a week?
Tell your doctor if you have trouble sticking to your treatment plan. Often, you can try other things.
Call your doctor right away if you get an infection or have side effects from your medicine.
Keep in close touch. Neimann says you should see your doctor every 3 to 6 months for the first year of treatment. If you take a strong medicine like a biologic, you may want to go more often. “You can’t just disappear,” she says.
Have all the blood work and tests your doctor asks for.
See your primary care doctor often to have your blood pressure and blood sugar checked. People with psoriasis are more likely to have other health problems, like heart disease, diabetes, and obesity.
“Be sure you have a primary doctor who’s in charge of your overall health,” Neimann says.