Is Your Current Treatment Plan Good Enough?
Do you think your psoriasis treatment is good enough? If your psoriasis coverage is more than 3%, then it is possible the answer is no. The target response for treatment is 1% coverage according to the National Psoriasis Foundation.1
I had not asked myself this question for a very long time, and I don't know about you, but this question makes me a little bit angry. If you have ever left your dermatologist's office seething with frustration, then you will understand why. Research shows that people with psoriasis are undertreated2 however it has been my experience that on some of the occasions I have tried to get an additional treatment I have had a negative experience. These include being referred for treatments I have already failed at, being told I have to fail at another systemic medication before I am eligible for the next tier of treatment options and being told to use a cotton bud to apply a topical to the ten million spots…and to get my housemate to help me with my back. I am unsure how asking a friend to spend half an hour applying the cream twice a day is supposed to improve my mental health and support my quality of life. Two aspects which should be critical components when developing a treatment plan.
Have you had similar experiences?
It seems I am not alone. The National Psoriasis Foundation conducted a survey in which almost half of the participants indicated that they were not taking advantage of drugs that were available to them.3
I am one of those people that has psoriasis all of the time. It just fluctuates between various phases of severity. After 30 years I have almost made peace with that. In the same way that we take antibiotics, I always thought that medication should be taken only when needed. So currently, even though I am eligible for Methotrexate, I am simply taking supplements under the watchful eye of a nutritionist.
What about psoriasis comorbidities?
I had not thought about the negatives of undertreating my psoriasis as I believed this was the best way for optimal health. Until I read this months issue of Psoriasis Advance magazine from the National Psoriasis Foundation. In one of the first articles, the author discusses the fact that active psoriasis plaques can suggest there is still inflammation inside the body. This inflammation could be contributing to conditions we are more susceptible too such as cardiovascular disease and metabolic syndrome.
And herein lies the dilemma. Should I stop the highly biased n=1 experiments I am currently conducting on myself (with the help of a nutritionist) and obtain a new prescription? I would have clearer skin and possibly reduce systemic inflammation which could reduce the chances of developing of co-morbidities. However, when taking prescription medication, there is the added risk of drug side effects. If I decide to continue with my current treatment plan, I run the risk that comes with increased systemic inflammation (and only bad things happen when you have chronic systemic inflammation).
Making the best treatment decision for you
After some contemplation, I have decided to stick with my original plan but as Albert Einstein once said; “The important thing is not to stop questioning.”
This is my opinion today, as I write my skin is not itching. I look at the risk factors for co-morbidities like heart disease and diabetes and other than inflammation, I don't fall into the category in many other places. I have a healthy BMI, a healthy diet, and exercise regularly. This makes my decision easier.
If you have risk factors for conditions that are linked to psoriasis, then this decision will be a harder one. But the key here is to make sure that you keep asking yourself the question. Is my current treatment good enough? Our circumstances change so rapidly living with chronic disease; we need to be able to ask ourselves the same questions repeatedly to make sure we can adapt.
In my case as an example, should I wake up with Strep throat in the morning I will be queuing up outside my doctor's office to get access to drugs to mitigate the fiery onslaught of evil that I know will come to me within the week.
So I ask you, Is your treatment good enough? If the answer is no, then go and see your dermatologist. The National Psoriasis Foundation recommend three months as the best time for a follow up the appointment so make sure you schedule that appointment too. For the treatment to be classed as effective, your psoriasis should not cover more than 3% of your body surface area, or you should have seen a 70% improvement.1
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