Top 10 Treatment Topics

Psoriasis is a chronic autoimmune condition that cannot be cured. There is a wide range of treatment options available and many people find that they are able to manage their symptoms. In spite of this, people with psoriasis experience a variety of treatment challenges, and have questions about their treatment options even if they have been living with psoriasis for years. Here are 10 treatment topics that are important to the community:

1. Managing flare-ups

Most people with psoriasis will cycle through periods of flare-ups and remission. Flare-ups are periods of time when symptoms get worse. Remissions are periods of time when the symptoms get better or even go away completely for a time. People who have psoriasis can learn to identify and avoid their own psoriasis triggers, which are things in the environment that can cause psoriasis symptoms to flare up.

Some treatments may cause symptoms to flare-up briefly, prior to achieving skin clearance, and other medications may need to be used in combination with the psoriasis treatment in order to maintain skin clearance and minimize other symptoms of inflammation.

2. Medication rebounds

People who completely stop using a psoriasis treatment, like a topical corticosteroid, after using it for a longer period of time may experience a rebound effect. A rebound effect is when psoriasis symptoms resume, and often suddenly get much worse when treatment is stopped.

Unfortunately, there are many medications that can actually make existing psoriasis worse: prednisone, antimalarials, and antibiotics. There are many other medications that are known to aggravate psoriasis, some of which include: Beta-blockers, like metoprolol and atenolol, some medications for depression or anxiety, like lithium and clonazepam, and Heart medications, like quinidine and digoxin.

3. Side effects

According to our Psoriasis In America 2016 survey, about one-third of people living with psoriasis are dissatisfied with treatment options, for a number of different reasons. One reason is the side-effects that they may experience with certain medications.  Topical treatments can be messy, feel greasy, and can irritate skin or cause thinning of skin if used for long periods of time. Long-term use of systemic treatments needs to be closely monitored by your healthcare provider to ensure there is not damage to internal organs. Phototherapy can cause discomfort to the skin and may increase the risk of skin cancer for some people with psoriasis.

Most biologics are injectable or delivered by infusions. Because they are designed to target the inflammatory pathways that cause psoriasis symptoms, changes to the immune system may increase the risk of infections for some people.

4. Topical Treatments

Estimates are that 70% to 80% of people living with psoriasis have mild disease that can be adequately managed with topical therapy. Topical treatments are typically the first type of treatment a person with psoriasis will try. They come in many forms including creams, foams, lotions, and shampoos. Prescription topical treatments generally work by slowing down the excessive cell reproduction and inflammation associated with psoriasis.

Most people with psoriasis have used a variety of over-the-counter (OTC) products to help manage their skin symptoms, alleviate the itching and discomfort of irritated skin, and to prevent flare-ups.  OTC products include moisturizers, emollients, shampoos, and anti-itch creams.

5. Resistant "problem spots"

Managing psoriasis symptoms is difficult partly because there is such a broad range of symptoms and affected body areas, each of which does not respond equally to available treatments. Plaque psoriasis can develop anywhere on a person’s body, but may often form on the scalp, elbows, knees, lower back, hands, feet, nails, genitals, and skin folds. A person with psoriasis may have plaques just in one area of the body, or they may develop in multiple locations.

In our Psoriasis In America 2016 survey, we asked people what areas of their body were affected by psoriasis at the time they were diagnosed.  The most frequently affected parts of the body, that were affected in over 50% of those who responded to the survey were: the scalp 62%, arms and/or elbows 58%, and legs and/or knees 55%.

6. Plaque clearance

One of the most challenging aspects of psoriasis treatment is that what works for one person doesn’t always work for someone else. People understandably can get discouraged with treatment failures or when their treatment goals are not met within a timeframe that matches their expectations. Dissatisfaction with treatment options often leads to discontinuation of treatment.

Often people have concerns like what if this medication stops working? What side effects am I likely to experience? What will happen if I have to stop using this medication? Being up front with your healthcare provider about your treatment expectations and concerns will help your overall healthcare experience and help your healthcare provider work with you to optimize your treatment plan.

7. Combination Therapy

Recently, there has been increasing interest in combination therapy for people with psoriasis. With combination therapy, it is possible to optimize treatment outcomes due to the potential for one medication to boost the efficacy (or minimize the side effects) of another drug.

Combination therapy also offers an opportunity for your healthcare provider to work with you to tailor a treatment to your specific situation. For example, people who also have psoriasis and psoriatic arthritis or those who are at risk of organ damage due to long-term use of systemic therapies, are most likely to be good candidates for combination therapy. People who have plaque psoriasis that is generally well controlled but is resistant to treatment in certain areas, like the scalp, might also be candidates for combination therapy.

8. Other health conditions linked to psoriasis

Psoriasis is an autoimmune condition in which skin symptoms are caused by inflammation in the body. People who have psoriasis tend to have a higher risk of developing other health conditions, many of which are also linked to chronic inflammation in some way.

Chronic inflammation of psoriatic disease (psoriasis and psoriatic arthritis) can affect the joints, the heart, and eyes of people with psoriasis.  In addition to these affected body parts, other symptoms of chronic inflammation in people with psoriasis include fatigue, depression,inflammatory bowel disease, and vascular inflammation.

People who have psoriasis should be carefully monitored by their healthcare providers for signs and symptoms of other health conditions so that they can be treated promptly before conditions become more severe.  In many cases, comorbidities that are detected early are easier to treat effectively.

9. Moderate-to-severe plaque psoriasis

Many of the newer treatment options have been developed for people with moderate-to-severe plaque psoriasis, but what does that really mean? Plaque psoriasis is generally classified into three categories: mild, moderate, or severe. Approximately 80% of people diagnosed with psoriasis have mild to moderate disease, and 20% are diagnosed with severe psoriasis.

Healthcare providers assess the severity of a person's psoriasis based upon how much of the body is affected or "covered" with plaques, and the impact their symptoms have on their quality of life.

The severity of psoriasis will help your provider determine your treatment options.  For people with mild psoriasis, first-line treatment may include topicals or light therapy.  For people with more severe psoriasis, or with joint or vascular involvement, more aggressive treatment options may be warranted. Biologic therapeutics are developed to target specific parts of the immune system known as inflammatory pathways and can be an important part of a treatment plan for people with moderate to severe plaque psoriasis.

10. Developing a treatment plan with your doctor

Ask your healthcare provider about things that you can do help identify your psoriasis triggers and how to best manage flare-ups.  It is important to talk to your healthcare provider before starting or stopping any new treatments, including OTC and alternative treatments since discontinuing a therapy can cause a flare-up or a rebound effect if you stop too soon.

Bring a list of questions and anything else you want to talk about. To ensure you don’t forget anything, you may want to write down what you have discussed including any complimentary courses of action to take – such as a nutrition or exercise plan. If you are newly diagnosed, there may be a more extensive list of questions you want to prepare to ask your healthcare provider in advance.