The decision is individualized and takes in several factors.
“Psoriasis is a chronic and relapsing condition,” says Suzanne Friedler, MD, dermatologist in New York City. “There are times when patients do get frustrated with their medications, and they may relapse at those times.”
For example, you might be less inclined to commit to your prescribed treatments if you feel like it’s not working, or if you’re worried about possible side effects. When you and your doctor work together to find the most effective treatment for psoriasis possible, you’ll probably be more likely to stick to your treatment and enjoy the results.
“Typically, when a psoriasis treatment is working, you’ll see a decrease in redness, a decrease in thickness of lesions, a decrease in scale, and a decrease in body surface area,” says Dr. Friedler.
So how *do* you find that effective treatment option for psoriasis? There are a number of factors to consider, such as your type of psoriasis, the severity of psoriasis, and how much the psoriasis symptoms are impacting your quality of life—to name just a few.
“Topical steroids are a mainstay of therapies, regardless if [the psoriasis symptoms are] mild, moderate, or severe,” says Dr. Friedler.
These topical creams and ointments can be very effective at reducing psoriasis plaques, and for some people, this is the only treatment they will need. However, topical steroids aren’t perfect: Some individuals find ointments messy or sticky, for example, and they may enjoy creams or foams instead.
“In moderate and severe patients, we’ll add on other types of therapies,” says Dr. Friedler. Treatment options for moderate to severe psoriasis include phototherapy (or UV light therapy), oral systemic therapy, and biologic therapy.
These treatment options do more than just relieve psoriasis symptoms. “Biologics can have a great role in preventing psoriatic progression onto psoriatic arthritis. It can prevent joint damage,” says Dr. Friedler. If your doctor believes you have a risk of developing psoriatic arthritis, biologic therapies may be a great option.
“Most therapies should show some improvement within two to three months, and most likely by four months,” says Dr. Friedler. “If something isn’t working by three to four months, it may be time for a change.”
Dr. Friedler is a dermatologist and clinical instructor at The Mount Sinai Hospital and St. John's Episcopal Hospital.
00:00:00,960 --> 00:00:02,489
00:00:02,489 --> 00:00:05,070
Psoriasis is a chronic and
00:00:05,070 --> 00:00:07,179
So even when patients
respond to therapies,
00:00:07,179 --> 00:00:10,059
there are times when treatments
may lose their efficacy.
00:00:10,059 --> 00:00:12,912
When patients do get frustrated
with their medications and
00:00:12,912 --> 00:00:14,519
they may relapse at those times.
00:00:14,519 --> 00:00:18,919
00:00:18,919 --> 00:00:22,240
Through consistent use,
we often do see patients improving.
00:00:22,240 --> 00:00:24,390
So finding the right treatment regimen for
00:00:24,390 --> 00:00:27,790
each patient can really
help with the compliance.
00:00:27,790 --> 00:00:30,194
are a mainstay of therapies,
00:00:30,194 --> 00:00:33,390
regardless of if your patient is mild,
moderate, or severe.
00:00:33,390 --> 00:00:37,150
Topical medications can be a challenge for
00:00:37,150 --> 00:00:41,460
Often the vehicles can be sticky and
uncomfortable and patients who aren't
00:00:41,460 --> 00:00:46,319
comfortable dealing with their disease may
not enjoy working with the medications.
00:00:46,319 --> 00:00:51,205
For example, some patients don't like
an ointment, so switching your medication
00:00:51,205 --> 00:00:54,979
to a cream or a foam may alleviate
the struggle of putting it on.
00:00:54,979 --> 00:00:59,406
But in moderate and severe patients,
we'll add on other types of
00:00:59,406 --> 00:01:04,490
therapies such as oral systemic
therapies as well as biologic therapies.
00:01:04,490 --> 00:01:08,490
Biologics can have a great
role in preventing
00:01:08,490 --> 00:01:12,280
psoriatic progression on
to psoriatic arthritis.
00:01:12,280 --> 00:01:14,180
It can prevent joint damage.
00:01:14,180 --> 00:01:19,650
So there is a lot of benefit to those
medications in those subsets of patients.
00:01:19,650 --> 00:01:22,080
Well, typically when a psoriasis
treatment is working,
00:01:22,080 --> 00:01:25,660
you'll see a decrease in redness,
a decrease in thickness of lesions,
00:01:25,660 --> 00:01:29,290
a decrease in scale, and
a decrease in body surface area.
00:01:29,290 --> 00:01:31,990
The goal really varies
from patient to patient.
00:01:31,990 --> 00:01:37,170
Some patients, if you can take
them from a body surface area
00:01:37,170 --> 00:01:42,490
of ten down to nine, or ten down to five,
they can be very happy.
00:01:42,490 --> 00:01:46,060
But for some patients, even if your body
surface area doesn't change but you have
00:01:46,060 --> 00:01:51,910
less erythema, less scale, less thickness,
then patients can be quite satisfied.
00:01:51,910 --> 00:01:56,900
Most therapies should show some
improvement within two to three months,
00:01:56,900 --> 00:01:59,640
and most likely by four months.
00:01:59,640 --> 00:02:03,604
If something isn't working by three to
four months, it may be time for a change.
00:02:03,604 --> 00:02:09,288
Psoriasis treatments. Portland, OR: National Psoriasis Foundation. (Accessed on May 15, 2019 at https://www.psoriasis.org/about-psoriasis/treatments.)What’s tops in, topical steroid treatments? Portland, OR: National Psoriasis Foundation. (Accessed on May 15, 2019 at https://www.psoriasis.org/about-psoriasis/treatments/topicals/steroids/potency-chart.)