Why I Chose to Treat with Biologics

Psoriasis isn’t known for having the best options for treatments. You’ve seen the commercials, right? Scary. The safest method of treating is thought by many to be topicals but those didn’t work for me. First of all, I am not a small guy. It is actually humorous that my last name in French translates to petite. I could easily use an entire tube of ointment to cover the plaques that take up three-fourths of my body. Not to mention that it takes a lot of time to apply all that gunk. Then, after I did drain the tube and cover each spot, I was left greasy and sticky. So, I had two options: wrap myself in plastic wrap like leftovers or get grease stains on my furniture, clothes, and anything else I needed to touch.

Exploring treatment options

The next best choice seemed to be phototherapy. I did this for awhile and can say it was moderately effective. I never reached clearance, but my plaques were subdued and I had much less flaking and discomfort. The downside was that it wasn’t sustainable with my schedule or my finances. To keep up any results, I had to visit my dermatologist 2-3 times a week and pay a $35 copay each visit. That adds up quick! I was never told about home phototherapy units back then, but having a small studio apartment, I don’t think that would have been a reasonable choice anyways.

I then moved on to talks about methotrexate with my derm. A pill that can make my psoriasis dramatically improve? Sign me up! Wait. It can take a toll on my liver. Well, that isn’t going to work. I was also lucky enough to inherit some bad liver genes. My enzyme levels were already high for my age. That option was a no-go.

Living, suffering, and learning

I spent over a decade rooted firm in my decision to let my psoriasis take my skin over, because rough skin wasn’t worth having nervous system disorders, spending enormous amounts of time slathering myself in ointments and cream for little results, spending a fortune, or compromising my already-downtrodden liver. It is like my body knew I had given up and took full advantage. My twenties were full of cracked, bleeding, angry skin. My skin had some serious beef with me. It wouldn’t let up. I was in a constant state of flare for 10 years.

Finally, I educated myself. I found out things that dermatologist after dermatologist had never told me. Psoriasis is an autoimmune disease. Psoriasis is associated with cardiovascular disease, eye disease, obesity, diabetes, and even cancer. The inflammation of psoriasis is not just on the skin, it is on the inside too. I was so worried about finding something to make the outside better, I didn’t realize that I needed to make my insides better also.

Hitting the target

That is when I decided to take another look at injectable biologics. I made the choice to not live in fear by what some fast-talking commercial deity said, and instead look at real studies that had been done. What I found was that these medications weren’t as petrifying as I made them out to be. One review of the oldest biologics on the market in relation to incidences of demyelinating disease (fancy word for nervous system disorders) found the following--

In clinical trials: 6990 patients had received treatment with etanercept with one reported case of multiple sclerosis; 5204 patients were treated with adalimumab with no cases identified and 2322 patients were treated with infliximab with one case of demyelinating polyneuropathy. Outside of clinical trials: 19 individual cases of demyelinating disorders from TNFi treatment have been reported.1

Those were odds I was comfortable with. There is a risk anytime you take a medication, even something as common as over-the-counter pain relievers. I had to weigh the risks and determined that the benefits would be much greater than the threats. If I left my disease untreated, I was taking a chance at developing some very debilitating conditions because of the inflammation.

The hard thing with psoriasis is that what works for one person doesn’t always work for someone else when it comes to treatment. Just because biologics are working great for me, doesn’t mean that would be the case for another sufferer. Don’t ever feel pressured or obligated to do one treatment or another, but do push yourself to research and talk to your doctor to come up with a plan you are comfortable with.

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