When Psoriasis Treatments Stop Working: How to Cope
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I’m feeling anxious about my current psoriasis treatment.
My biologic continues to do a good job managing my psoriasis symptoms. In fact, it has worked better than I expected for over four years. But my experience tells me that all good treatments eventually come to an end.
For years, I had few effective psoriasis treatments I could safely tolerate. If a medication helped even a little bit, I tried to stay on it for as long as I could. At some point though, like a smoldering wildfire that starts to flare, I would feel existing lesions worsen and new ones emerge.
I came to dread those all too familiar moments. A major skin crisis often followed, leaving me at a loss as to what to do next.
A Long List of Failed Psoriasis Treatments
Over the holidays I met a fellow psoriasis traveler at a dinner organized by a student group I mentor at the local university. When I mentioned I’ve had psoriasis for most of my life his eyes lit up. He said that he’s lived with psoriasis for decades as well.
We quickly compared notes on the various treatments we’ve tried. I started out with coal tar, topical corticosteroids, and light therapy. We covered systemic treatment pills like methotrexate and cyclosporine. We are both currently on biologics, albeit different ones.
I could sense we shared similar emotions about our long lists of failed therapies. Disappointment about a new treatment that didn’t help. Despair over side effects that halted promising treatments. Fear of when the next psoriatic flare might start and how long it would last.
I told him about two years in my thirties when I endured a series of treatments that led to psoriasis covering 95 percent of my body. He shared about giving up on medications before finally trying a biologic.
If you can relate to our psoriasis treatment experiences, then you know that sense of impending doom that comes when your therapies fail.
A 3-Step Plan for Allaying Anxiety
Here are three ways I’ve addressed my psoriasis treatment anxiety.
1. Know Your Treatment Options
“Set it and forget it” is a wonderful innovation for my thermostat, bread-making machine, and pellet grill. I wish I could just “set and forget” my psoriasis treatment. Since that’s not a realistic possibility, it helps to know my treatment options and develop a plan for what’s next.
When I was diagnosed, in the 1970s, psoriasis treatments were so limited that they remind me of what watching TV was like then, when there were only three networks that mostly showed boring reruns.
When biologics became available starting in the early 2000s, the treatment options increased significantly. Innovations continually appear.
I used to tell people I’ve tried every psoriasis treatment. I can’t say that anymore, because new injectable biologics, systemic pills, and topical medications are becoming available every year.
My dermatologist and I have discussed what I can try next if my biologic fails. Having that alternative in place diminishes the anxiety I feel about potentially switching treatments.
If you aren’t familiar with currently available psoriasis treatments, the National Psoriasis Foundation provides updated treatment information. Be sure to talk to your healthcare providers about the options and lifestyle changes that might best fit your needs.
2. Accept That Change Can Be Good
Even though I have an idea of what I want to try next, I’d rather not change medications. Change is hard. I like routine: I shower at the same time each evening, I apply moisturizers and topical medications in the same order afterward, and I inject my biologic at regular intervals.
The anxiety of adjusting to a new treatment routine, while wondering if there will be side effects, is something I’d rather avoid. But like all things in life, change is unavoidable when you have psoriasis. At some point in the future I will need to switch to another medication.
I once had a more adventurous attitude, but maybe I’m getting older and set in my ways. Or I’ve tried enough new things that I’ve come to appreciate the tried and true. Whatever the reason for my attitude shift, I need to remind myself that change can be good.
When I heard about my current biologic, I was on a different one. I took the “if it isn’t broke, don’t fix it” approach to my treatments. Within 18 months, unfortunately, my psoriasis quickly worsened. I knew it was time to switch medications, and I’m glad I did.
3. Take One Day at a Time
The Bible says not to worry about tomorrow, for each day has enough trouble of its own. Concern about my psoriasis treatment failing means worrying about tomorrow.
Worry can be productive when it motivates me to learn about new treatments, talk to my dermatologist, and address negative feelings
But when the worry robs me of my joy, that’s simply fruitless. Focusing on the present allows me to be more attentive to my health, projects, and relationships. I can give energy to what I can control, while giving less oxygen to speculation about what might come.
I don’t know if I’ll ever be completely free from worrying about whether my psoriasis treatments will stop working. I’ve come a long way, though, from the days of being covered with psoriatic lesions and filled with anxiety.
So whatever tomorrow brings, I know I’ll be okay — if I take it one day at a time.
You can read more about my experiences on my website, PsoHoward.
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