Clear Skin Is the Goal: How to Improve Your Psoriasis

This article is for people who have moderate-to-severe psoriasis or anyone who wants to learn more about moderate-to-severe psoriasis. The goal of this patient education activity is to learn more about treatments for moderate-to-severe psoriasis.

You will learn:

• How to discuss your psoriasis with your healthcare team

• How to define your treatment goals

• What medicines are available for moderate-to-severe psoriasis

• What a biologic is

• How to know if your medicine is working

• What to do about the cost of your medicine

Psoriasis is called moderate-to-severe when it covers more than 3% of your skin or is found on sensitive areas of your skin. The plaques, redness, itching, and pain may be more intense. You may find them in more sensitive areas, such as your face and hands, or groin or genital area. These may be where your skin rubs against other skin, such as the inner elbow and back of the knee.

Moderate-to-severe psoriasis can be difficult to live with. It may be hard to go to work or continue your daily routine. You may feel embarrassed in personal relationships or just uncomfortable emotionally or physically overall.

In spite of taking other medicines, you may not be seeing the results you want, and become frustrated and upset.

It’s important to be honest about your feelings with your doctor or healthcare team. Although it might be embarrassing to talk about -- especially if you have psoriasis in your genital area -- you might not get the treatment you need if you don’t talk to your doctor.

It may help to write down some things you want to talk about:

• Do you want your skin to look better or stop itching?

• Do you want to be able to enjoy your favorite activities (like bicycling)?

• Are you tired of being embarrassed in front of your spouse or partner because your psoriasis is in your genital area?

Making a list can help you prepare for a talk with your doctor and help you both start setting a treatment goal.

Treat-to-target means that you and your doctor set specific targets or goals for getting better.

Usually the goal is to reduce the severity (how bad it is) of plaque psoriasis until it covers 1% or less of your body by 3 months after you start taking your medicine. This goal can help your doctor select the appropriate medicine for you.

If you don’t meet the goal after 3 months of treatment, you and your doctor can talk about the next best step for you.

After you have the discussion with your doctor and healthcare team about your treat-to-target goal, you can work with your doctor to find a medicine that will be right for you.

Your doctor will need to know if you:

• Had reactions to previous treatments

• Have other health conditions

• Are taking other medicines

• Are planning to become pregnant

Mild psoriasis is usually treated successfully with topical creams, corticosteroids, cyclosporine, retinoids, methotrexate, and phototherapy. You may have had some of these treatments. They may not have worked for you, and your psoriasis may have even gotten worse.

Because your psoriasis is moderate-to-severe, you need a different kind of medicine called a biologic.

A biologic medicine works on your immune system to block the inflammatory process that causes psoriasis. By acting in this way, a biologic can make your psoriasis get better or go away completely.

There are different types of biologics that target different parts of the inflammatory process. If you have other health conditions, you may not be able to take certain biologics.

You shouldn’t take a biologic if you have a compromised immune system, active infection, recently received certain vaccines, or if you’re pregnant or nursing.

It depends on whether it is a shot or through an IV.

Shots may be given anywhere from 1 to 12 weeks, depending on the biologic. An IV biologic can treat severe psoriasis. It is given about every 4 to 6 weeks and is done in a medical office.

Your doctor will make sure you understand how often you need to take your medicine. Don’t stop taking your biologic without talking to your doctor.

Most biologics come in a form called a “self-injectable” (shot). This means it’s a pre-filled syringe (needle) that is ready to use. It can only be injected into certain parts of the body, including your upper thighs, about 1 to 2 inches away from your belly button, or your upper arm. To prevent scar tissue at the injection site, switch the location each time you give yourself a shot. It may help to keep a list in a diary or calendar so you don’t forget.

The syringes need to be kept cold, so make you sure you store them in a refrigerator. Do not shake them before use.

Your doctor or healthcare team will explain how to handle, store, and use your biologics properly.

Yes. You may feel a stinging or soreness at the injection site, and you may have a rash. These side effects are usually mild and go away on their own. Other common side effects include flu-like symptoms, fatigue, headaches, or nausea.

Other side effects can be more serious. Remember, because the biologics affect your immune system, you have a greater chance of getting an infection. You should let your doctor know if you have:

• Chills or fever

• Chest congestion

• Shortness of breath

• Pain or burning when urinating

You will need to be monitored for any infections and may be tested for tuberculosis (lung infection).

Depending on how severe your psoriasis is and which biologic you take, it could be a few weeks to 2 to 3 months before you notice if it’s working. It is important to be patient and make sure you are taking your biologic exactly as prescribed.

At your follow-up visit, your doctor will review your treat-to-target goal and see if you have met it. You may continue taking the same biologic, change the dose, switch to a different biologic, or try a combination of treatments.

Even if you have healthcare insurance, the medicines may still be expensive. Ask your healthcare team if there is a care coordinator or insurance specialist that can help you with:

• Pre-authorization process: your medicines are approved by your healthcare insurance company before you get them

• Appeals process: in case your healthcare insurance company refuses to pay for the medicines

• Drug manufacturer financial assistance programs: some manufacturers may have a program that will help pay for your medicines

By making sure your insurance paperwork is correct and by getting help through financial programs, you should be able to take the medicines that work best for you.

• What is a treatment goal?

• What are the medicines for moderate-to-severe psoriasis?

• What is a biologic?

• How do I know if my medicine is working?

• Are there any side effects I should know about?

• Are there any programs that could help me pay for my medicines?

• Is there anything I can do to make sure my medicine is covered by my healthcare insurance?

Congratulations!

You have successfully completed the program: "Clear Skin Is the Goal: How to Improve Your Psoriasis"

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View Additional Materials on this topic that you may find useful

National Psoriasis Foundation: Patient Navigation Center

National Psoriasis Foundation: Financial Assistance Resource Center

National Psoriasis Foundation: Genital Psoriasis Quick Guide

National Psoriasis Foundation: Psoriasis and Psoriatic Arthritis: Flare Guide and Weekly Symptom Tracker