Skip to Accessibility Tools Skip to Content Skip to Footer
Eye on the Target

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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Lori Anne
    3 months ago

    I don’t have psoriasis that bad. I have a difficult case of psoriatic arthritis. 15 PsA drugs in 12 1/2 years. I walked into his office with 1 swollen joint. I now have 10 joints. 6 of which are in my feet. I blew thru all the biologics. He’s told me I have a “particularly resistant” case. Not much more he can do. I am literally considering borrowing $20,000 to have all the metal taken out of my mouth (fillings). I’m almost 60 & am struggling to walk. I’ve tried deleting things from my diet with no results. I pray you find some relief. I’ve all but given up hope. Good luck.

  • Barbara
    3 months ago

    I thumbed through your other articles and notice there’s nothing on diet. Last May I started a “slow carb” diet and saw my psoriasis go dormant inside of 20 days. I maintain the diet mostly now, but for an occasional slip up (of mostly suggary desserts) and I get an almost immediate flare up. It susbides just as quickly if I lay off the high carb foods.
    Offending foods: highly processed grains and sugar.
    Everything else seems ok. I still have a few tiny patches that I think might go away completely if I went on a keto or Atkins diet. But I’m relatively happy. No itch. No flakes. Nothing anyone would even notice.

  • Clair G moderator
    3 months ago

    Wow Barbara!! I am so happy to hear that this is helping you. Wonderful news. do you find that it is something you can do long term? Slow carb sounds very interesting.

  • Poll