Choosing the Best Treatment for Your Psoriasis
While there’s no one-treatment-fits-all approach when it comes to psoriasis, the good news is that numerous options are available to help manage this autoimmune disease. My last post was about the five kinds of psoriasis - plaque, guttate, inverse, pustular and erythrodermic - and today’s will be about specific treatments you may want to consider trying based on the type of psoriasis you’re experiencing and its severity.
Mild, Moderate or Severe? Consider the severity of your psoriasis when talking with your dermatologist about treatment options. Those of us with psoriasis on less than 3 percent of our bodies are considered to have a mild case. If you have anywhere from 3 to 10 percent of your body affected, it’s considered moderate psoriasis. Anything greater than 10 percent is considered severe. A good way to determine percentage of skin affected: the surface area of the hand equals about one percent of the skin.
I will always remember what one dermatologist told me shortly after my diagnosis at age 14 when I asked his opinion of my psoriasis - was it bad? Did he have other patients who had it worse than me? “I’d say it’s mild at this time, Heather, but most important is how YOU see it. After all, what may seem mild to one person is moderate or severe to another. It’s all relative.” I’ve often thought about this through the years. I believe what he really was saying to me was that psoriasis is such a personal experience, one that takes its toll both physically and emotionally, and it really is up to an individual to determine with his or her doctor how best to manage it to live the best life possible.
Types of Treatments. Oftentimes, moderate to severe psoriasis responds well to a combination of treatment strategies. For example, you may be prescribed a topical treatment - a cream, ointment, lotion, foam, shampoo - or use an over-the-counter treatment along with phototherapy, which is also known as light therapy. This combo approach has proven to work well for me, both when my psoriasis is moderate and when it’s flared. Another option: combining phototherapy and/or topical treatments with systemic medications, including biologic drugs. While an in-home light box unit has been my go-to treatment when my psoriasis has flared, I did turn to the biologic drug Enbrel for several months following a particularly rough guttate flare.
This was something I thought long and hard about, talking at length with my dermatologist so that I was educated about possible side effects given it was an injection I’d give myself at home and was medication that essentially suppressed my immune system. Enbrel worked well for me, though others haven’t had the same success. Other biologic drug options include Humira, Remicade and Stelara, the latter of which is the newest biologic on the market.
Keep in mind that working with your dermatologist is very important. Let him or her know if you aren’t comfortable with your treatment(s), or feel that you need to explore another option; psoriasis experts have found that a critical component in ensuring success using any treatment is a patient’s willingness to follow a consistent regimen. In other words, make sure you’re confident any treatment you and your doctor choose can successfully be incorporated into your daily life - there’s no point in getting a new medication if you don’t end up using it consistently because it’s too time-consuming, messy or inconvenient in some other way.
Heather wrote for HealthCentral as a patient expert for Psoriasis.