Signs You May Need to Change Your Psoriasis Treatment

Among the many frustrating aspects of living with psoriasis is that the treatment can be as aggravating as the condition itself sometimes. You may find, for example, that a topical medication that worked fine at first becomes less effective after a while. In one study, 50 percent of people with psoriasis who were given a topical treatment stopped using it within 12 months. Some needed to trade up to a stronger treatment, but in other cases, people stopped using the product because they felt it was greasy or hard to use.

According to an article (about a presentation on topical treatment adherence that was given at the 30th European Academy of Dermatology & Venereology Congress), these were some of the main reasons for not sticking to psoriasis treatment: dissatisfaction with topical treatments that are not effective or may stop working after a time; side effects, such as skin irritation; and inconvenience factors, such as staining clothes or sheets.

Continuing treatment can also be an issue for people with psoriasis who are using biologics to manage symptoms. According to a review, only 66 percent of people being treated with biologics continued to stay on treatment after one year, and that number dropped to about 53 percent after two years. The main reasons cited by psoriasis patients for stopping or switching treatment included their medication losing effectiveness and the side effects, such as headaches, skin or upper respiratory tract infections, and reactions at the injection site, according to the review.

Treating psoriasis may come with challenges, but it’s still worth pursuing. Given the array of treatments available, these types of issues can usually be overcome.

When to Speak Up

Self-trust is key to fine-tuning your psoriasis treatment. Don’t second-guess your gut feeling, advises Steven Feldman, MD, PhD, a professor of dermatology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and a member of the National Psoriasis Foundation’s medical board.

Honesty is important, too. Let your doctor know if your treatment plan isn’t working for you. “The more open you are with your doctor, the better,” says Dr. Feldman. “There are endless ‘next steps’ in psoriasis treatment.” There’s no reason you shouldn’t ask about them.

Here are seven signs it may be time to talk to your doctor about new ways to manage your psoriasis.

1. You Can’t — or Don’t Want to — Use Your Medications as Prescribed

Feldman says even medical experts are surprised to learn how few people follow their treatment plan exactly as outlined. And when it comes to the messiest psoriasis treatments — especially thick topical creams, moisturizers, and scalp preparations — some people don’t even fill the prescription.

2. Your Prescriptions Are Too Pricey

Let your doctor know if your budget is limited or your insurance won’t cover your psoriasis medication. Don’t be embarrassed or assume you don’t have lower-priced options. There’s likely an effective treatment approach that won’t force you to choose between managing your psoriasis and paying for other necessities.

3. Ongoing Psoriasis Flares Are Bumming You Out

Your quality of life is more important than your quantity of flares. “Your doctor won’t determine if it’s time to change your psoriasis treatment based on how many skin lesions you have,” Feldman says. “The reason to change treatment is if you’re unhappy with how you’re doing in general.” If your treatment isn’t preventing flares, let your doctor know, and be specific about the problems, such as flares making it difficult to feel your best in professional or social settings.

4. Your Current Treatment Isn’t Working as Well as It Once Did

It’s possible your psoriasis is changing, or perhaps you’ve had life changes that are making it more difficult to control. Either way, another treatment approach may be more effective. Also, there are new treatments being introduced all the time.

5. You’re Unhappy With Certain Side Effects

Talk to your doctor about the benefits and risks of treatment alternatives. “Don’t forget some of the basic psoriasis treatments,” says Feldman. You may, for example, be able to do phototherapy (light therapy) at home. It’s effective for many people with psoriasis and virtually free of serious side effects.

6. You Have Lesions on Body Parts That Were Previously Unaffected

Psoriasis most commonly appears on the elbows, knees, lower legs, and scalp. However, a study identified 26 areas of the body where plaques can form. If you start to develop lesions on previously clear skin, talk to your doctor. (And keep in mind that psoriasis can affect the genitals, buttocks, and skin folds, according to the National Psoriasis Foundation (NPF). So don’t be shy, and show your doctor all of the affected areas of your body to get full treatment.)

7. You’re Noticing Signs of Psoriatic Arthritis

Psoriasis isn’t just a cosmetic issue. It’s also linked to an increased risk of a number of other health conditions. Among the most common of these is psoriatic arthritis, which affects about 30 percent of people with psoriasis, according to the NPF.

According to the Arthritis Foundation, the symptoms of psoriatic arthritis include:

• Stiff, painful joints
• Swelling that causes fingers and toes to take on a sausage-like appearance
• Pain in tendons and/or ligaments
• Skin rashes
• Nail changes
• Fatigue
• A reduced range of motion
• Eye problems
• An increase in flares

Tell your doctor if you begin to experience any of these issues. They may determine that you need a stronger medication, says Feldman.

With the number of psoriasis treatment options available today, there’s no reason to feel you have to live with out-of-control flares or hard-to-use medications. Talk to your doctor and develop a new treatment strategy together that will be more effective at keeping your skin clear and comfortable.