Fail or Flare?
Last updated: June 2018
Psoriasis is weird, huh? It reminds me of a bratty teenager that is happy one moment and angry the next. There doesn’t seem to be any rhyme or reason to the shift in mood. Similarly, my psoriasis seems to be calm and out of the picture, then BAM! Plaques aplenty are all over my legs. This is what has been happening to me over the last few months. What started with one small patch on my shin has expanded to about 8 spots of varying sizes up and down both legs. It’s kind of funny—anyone else that had bloody, scaly wounds on their legs would be up in arms and rushing to urgent care. But to me, I initially felt, “Well this isn’t too bad. At least it isn’t covering my whole body again.”
I’m conflicted. How do I know if this is just a flare versus another biologic failing? My first biologic was deemed a failure by my dermatologist after plaques came back a mere three months after starting it. I have been secretly dreading going in with this update, because I am comfortable with this medication; I am used to it. The thought of starting a new one scares me. I’m scared it may have side effects that this one doesn’t have, but I am also scared that I am running through my options too quickly. I am constantly wondering if they will develop other treatments fast enough that I never have to be left without options. Because of this, I want to try and “stretch” this treatment as long as possible.
I can’t ignore that stress may be a factor. After all, I am being pulled in many directions with work, being a husband, a father, a friend, etc. Knowing stress is correlated to my flares is easier than actually doing something about it. As a dad of three, I don’t know what a quiet moment sounds like! This is one area I find myself getting frustrated. I’m stressed about trying to figure out how to reduce stress.
I understand that feeling this way is coming mostly from my emotional mind. My logical mind knows that even with a few patches, although they don’t seem as “bad” or “unsightly” and before, it means there is inflammation still in my body. I read a study about this once, and it has always stuck in my mind. They published this picture. 1
The PET/CT scan on the left shows a person with psoriasis, and the PET/CT scan on right is someone without psoriasis. This study goes on to say that inflammation could be seen in the skin, muscles, joints, liver, and arteries of the patient with psoriasis. This was a huge wake up call to me that psoriasis really isn’t just about the skin. If there is inflammation on the outside (my patches) there is inflammation on the inside.
Remembering this study made me come to the resolution that I need to see my doctor. Whether it is a flare or failure of my medication, the bottom line is that ignoring it isn’t going to make it go away. It’s really easy to get caught up in the disappointment of seeing those all-too-familiar lesions showing up, but if I’m too lackadaisical, I could find myself completely covered again. It’s better to try and get a leg up (pardon the pun) and not let my fears and stress win.
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