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Finding the Right Treatment for Psoriasis: It Takes Courage

If you have psoriasis, you likely know this cycle: You try a medication. You fail. You try another. You fail. Sometimes it seems like finding an effective psoriasis treatment is a never-ending loop of new medications and regimens while playing the waiting game. As someone who’s lived with psoriasis for many years, I’ve learned that to get the results you want, you must have perseverance, self-control, and lots of courage.

In November 2016, the National Psoriasis Foundation (NPF) published in the Journal of the American Academy of Dermatology a set of treatment targets for patients with psoriasis. The purpose of these targets is to help patients get their psoriasis plaques to cover only 1% of their body surface area (about the size of your entire hand) or less within three months of treatment.

What you can do: The NPF recommends having a serious discussion with your dermatologist if you haven’t met this psoriasis target of 1% body surface area. It might be time to increase your medication, add in other options to complement your current treatment, or change course altogether to try a treatment that is better suited for you.

As much as you and your doctor would like to wave a magic wand and have your treatment work on day one, it usually takes time to figure out if a medication will work or not. Talk with your doctor about what timeline you should expect from your treatment, including:

• Light treatments: You often have to go to the light box a few times each week and increase the length of exposure in the box over time. It might take a few weeks to find out if the therapy is helping or not.
• Creams and ointments: You might go through a whole tube before you see results.
• Systemic medications: You might have to wait weeks to see if your medication is making a dent in clearing your skin.

What you can do: When discussing a new treatment with your doctor, be sure to ask how long you’ll need to wait to see if it will work. If it takes weeks, find out what you can do in the meantime to manage your symptoms. It might be that you can bridge two treatments to help ease the flare. Be patient while waiting for results, and try to stay optimistic that in time, you will see clearer skin.

No matter how much you want your treatment to work, it will fail right out of the gate if you are not compliant. Have an honest discussion with your doctor about how your lifestyle and personal preferences fit into your treatment plan, and cover any issues that might prevent you from being able to take your medications as prescribed. For example:

• Your preference for pills or injections: Personally, I hate taking pills. I would rather inject myself with medication than swallow pills. I know this is not rational, but I also know my limitations. If I am prescribed 30 pills to take in a month, chances are very good that there will be 28 pills left in the bottle on the last day. I’ve talked to my doctor about this, and my treatment plan prioritizes my preferences.
• The reality of dietary changes: Maybe your doctor wants you to try a gluten-free diet to see if it will calm your skin. Often, it takes strict adherence for at least a few weeks before you can start to see results. If you fall off the wagon, you might need to start back at square one. Talk to your doctor about any challenges you anticipate having when it comes to big changes like this. Come up with solutions and strategies so you’re as prepared as possible to make it work.
• The possibility of drug interactions: With some medications, like methotrexate, consuming alcohol can cause negative side effects. If you like to go meet coworkers for happy hour, be sure to ask your doctor if this social event is okay and how many drinks (if any) you can have.

What you can do: Be honest with your doctor. You know you best. If you don’t think you can comply with the treatment recommended, say so. If not, you could just be wasting a lot of time and money.

There is no cure for psoriasis, but there are many treatments you can try to manage your disease. You will likely need to invest time and discipline to get the results you want, but there is no guarantee that any will work, and you shouldn’t blame yourself if you’ve done all you can do. Find courage to keep trying. Many patients eventually find relief, and I hope you do, too.