Eye on the Target
It is official: biologic number two is no longer effectively clearing my skin. This was painfully (literally) obvious when I tried to take my hat off the other day and a piece of my scalp came with it. I set an appointment with my dermatologist, and at the appointment, she confirmed what I had already assumed. The medication has lost its efficacy.
I’m not going to lie—I was angry, frustrated, and sad at first. Two failures in less than 2 years. But I quickly shut down my self-pity party and looked onward and upward. I don’t know what specific treatment option I am going to look at with my provider next, but what I do know is that I am going to aim to follow the "Treat to Target" guidelines that were published by the National Psoriasis Foundation (NPF) this year.
What is "Treat to Target?"
More than thirty members of the NPF Medical Board, experts in psoriatic disease, developed these treatment goals to open up the dialogue of goal setting between a patient and their dermatologist. The guidelines suggest that three months after starting a treatment, a patient should expect to be down to having just 1% body surface area (size of your palm) covered in psoriasis. Having at least a 75% improvement or 3% body surface area is still within the acceptable range, but not completely to the target goal yet. By six months, you should check in with your doctor again and be at that target goal of 1%.
If you are not reaching that target, then it is a good time to talk to your doctor about how your treatment regime could get you closer to clear. The guidelines do not endorse or discriminate against any one type of treatment, and also suggests that combination therapy may be an option of a patient isn’t getting down to their goal.
Why I like it
Statistics from studies NPF has conducted over the years show that many people are not treating appropriately to their disease severity or are unhappy with their treatment progress.
I, for one, was a contributor to this statistic for a number of years. I was dissatisfied with the progress of various creams, ointments, or even my light therapy, but I figured my doctor knew best, so I never asked him about taking a more aggressive approach. I also have to take responsibility, because I never was upfront about how miserable I was. I honestly thought my disease was so severe that being clear was never an option.
You may be having the same feelings. You may be thinking to yourself (or talking to yourself—no judgment here!) “Whoa—those are some aggressive goals!” But when you step back and look at all of the advancements that have been made in all areas of psoriasis treatments, it really isn’t that far-fetched. I know most of us have heard the statement: if there was ever a good time in history to have psoriasis, it is now. And it really is true. Gone are the days of being banished from the cities for fear we are lepers. Gone are the days of having to go to a psoriasis day center and bathe in sticky smelly gunk for the majority of our day. We have options now—really good options! When you combine those options, it gets even better. You could try biologics and topicals, or systemic pills and diet, or phototherapy and ointments. Keep working with your dermatologist until you find what works for you.
Goals Are Good
Like anything worth achieving in life — a budget, a fitness plan, education — goals are an important step to getting where you want to go. It is always scary to take the first step, which is why I encourage you to write down those fears and work through them. Do you think your doctor won’t be receptive? Having a provider you can trust is important. All the credentials in the world don’t match a good bedside manner. Worried your goals will be restricted by insurance? Find out what is on your pharmacy formularies a head of your visit and develop a plan. Afraid to get your hopes up, because you have never been that clear and can’t imagine it? Dream big. Nothing feels as good as clear.
Does your psoriasis skin feel out of control? How are you managing?