Your Treatment Options
Finding the right treatment for plaque psoriasis can feel both hard and frustrating. After all, what works for someone else may not work for you. What helps is learning about the prescription therapies available for managing this condition — both old and new. That way, you can work proactively with your doctor towards the best plan for symptom relief and clearer skin.
The right treatment — or combination of treatments — will stop skin cells from growing too quickly, remove scales and skin build-up, reduce the negative effects of an overactive immune system, and offer relief from skin pain and inflammation.
You have plenty of options to choose from, from creams and ointments (topical therapies) to light therapy, orals, and injected medicines. Treatments will depend on how severe your plaque psoriasis is and how you previously responded to therapies you’ve tried. Your doctor may have you try different medications or a combination of solutions until you find an approach that best helps you.
Even if you feel confident in your current treatment plan, you may still want to know about advances in the field and how they could potentially benefit you. Psoriasis treatments have greatly improved in the last decade.
It is now very possible for you to have clear or nearly clear skin, as well as improvements to internal symptoms, including fatigue and joint pain.
Let’s talk about the different prescription treatments out there, including their benefits, how they are administered, and side effects they may pose so that you have a full overview of your available options. You’ve likely heard of some but not all of these.
Your Non-Prescription Options
Many times, people with plaque psoriasis also explore over-the-counter treatments and home remedies. OTC options come in many different forms, including moisturizers, bath solutions, shampoos, tars, scale lifters, and more. Many contain two common active ingredients — salicylic acid and tar — which have been approved by the U.S. Food and Drug Administration (FDA) for treating plaque psoriasis.
Home remedies include aloe vera extract, fish oil supplements, oregon grape, essential oils, turmeric supplements, and more. While most have not been proved effective, some tend to be safe and may help with itching and scaling for mild to moderate plaque psoriasis. Others may help manage psoriasis triggers, including stress.
Some but not all of these options can be used together with your prescription medicine. The most important thing to remember is that they are not a replacement for your doctor’s advice and recommendations. Always talk to your doctor before you try something new, and stop using any product that causes irritation or pain or worsens your symptoms.
Overcoming Your Hesitations
At times, making treatment decisions may feel like a significant dilemma. Trying anything new, whether a new medication or a lifestyle choice, can be scary. It is okay to feel this way. After all, there is plenty to think about and consider.
Treatment Benefits: Why It’s Worth It
The reality is that all medications come with pros and cons, and plaque psoriasis treatment is not a one-size-fits-all approach. But you can make decisions that consider your lifestyle, the severity of symptoms, your medical history, what has worked in the past, other health conditions you may have, what insurance will cover, out-of-pocket costs, and more to find the best option for you.
As you consider these factors, you’ll likely encounter some hesitations and may feel overwhelmed. This is normal, too. Know that there are solutions to many of your issues and concerns, and it’s worth exploring them to get the most out of your treatment. Although psoriasis has no cure, it’s still important to explore and get treatment in order to improve your quality of life, reduce risk of comorbidities and complications, and better manage symptoms.
Let’s address a few of the most common hesitations people with plaque psoriasis experience. If you feel any of these, the accompanying tips can help you work through them.
Feeling Like You Have to Compromise to Feel Better
You are not required to push through with or put up with a particular treatment if it is significantly affecting important aspects of your life. For example, if a treatment is keeping your skin clear but keeps you tired all the time, or if infusion therapy doesn’t fit your busy life. It is okay to ask your doctor for a treatment that fits your preferences and lifestyle.
If something about a specific therapy makes you hate using it, be open and provide clear examples of why so your doctor can help you figure out where to go from there. Of course, there might be instances where you have to choose between effectiveness and a treatment that may cause some minor inconveniences, but until you get to that point, you are not required to compromise.
Fear of Needles
Injectable biologics target specific parts of the immune system, making them a popular treatment option for people with plaque psoriasis. Even so, injections can be a daunting task, especially the first time, so it is normal to feel some fear. The good news is that your doctor and their staff can teach you to properly give yourself an injection and even suggest ways to minimize pain and injection site reactions.
If pain is a concern for you, experts suggest numbing the injection site with an ice pack first. And if you are concerned about injection site reactions, pick an easy injection site, such as the top of the thighs or the abdomen, and make sure you are using different sites for future injections. Warming up the injection after taking it out of the refrigerator for at least an hour may reduce both pain and site reactions. Lastly, be patient during the injection and avoid moving the pen or syringe before the needle has finished delivering the drug.
Worrying About Side Effects
While it is okay to feel some concern or worry about side effects, it is important to remember that people respond to treatments differently. Additionally, your doctor has likely suggested a treatment because they feel the benefits outweigh the risks. All prescription drugs undergo years of aggressive study to confirm this. While some medications may get recalled later down the line because of unforeseen side effects, this rarely happens.
Some studies have shown fear of side effects may actually increase the potential for side effects. That is because stress — especially in plaque psoriasis where stress is a known flare-up trigger — plays a part. Awareness of your own fears about side effects can help. Discuss fears and worries with your doctor so the two of you can work together to choose treatments based on fact rather than fear.
Facing Treatment Myths and Misconceptions
Sometimes, a treatment myth can discourage people from trying something new — and they don’t even know it! It’s important to dispel any misconceptions you may currently have. Learning the truth can empower you to move forward and make you feel better about doing so. At the very least, it’ll set up your expectations and help you avoid surprises in the long run.
See if you’re holding on to any of these common psoriasis treatment myths.
Psoriasis treatments usually work immediately. If a treatment is not working right away, that means it won’t work.
Feeling Discouraged Because of “All-or-Nothing” Thinking
There will be times where trying something new and keeping up just does not work out. Even when a treatment seems to be working well, it is possible your doctor may suggest a change because the medication might cause you problems.
These situations will require you to be flexible, open-minded, and patient with yourself and your doctor. Being disciplined in your healthcare routine is the best way to figure out what is working and what is not. With plaque psoriasis, this may involve a lot of trial and error, and any new treatment needs time to work. That means keeping up with a treatment routine, as it may take up to three months for a medicine or other therapy to start improving your condition.
Just remember, every small victory is an accomplishment, and while it can be stressful and frustrating at times, do not ever give up on getting better.
Psoriasis treatments can be expensive. The National Psoriasis Foundation reports that nearly half of the people living with psoriasis have trouble paying for treatment. Not only do alternative treatments, such as phototherapy, add up, but medications can run in the thousands of dollars. For example, a tube of topical medicine may cost up to $600 and a biologic therapy could cost $20,000 or more per year.
Fortunately, there are ways to manage the cost of treatments and lower out-of-pocket costs. Generics can be just as effective as name brand topical creams and can save you some money. If you are worried a treatment may not work, ask your doctor for a sample before you invest in a 30- or 90-day supply. Your doctor’s office may also have manufacturer coupons to reduce the cost of prescription medications at the pharmacy.
If you are struggling with the cost of psoriasis treatments, there are prescription savings programs you may qualify for. Examples of such programs include GoodRx and RxAssist. Your doctor’s office can direct you to many of these resources and so can psoriasis organizations, including the National Psoriasis Foundation.
Additionally, many drug manufacturers have their own financial assistance programs to assist with the costs and co-pays for biologic and systemic drugs. These programs can be helpful to anyone, even those with middle class incomes and health insurance.
Getting Started: Working With Your Healthcare Team
Making any switch — whether it is related to treatment or another aspect of your plaque psoriasis care — starts with a dialogue with your doctor. Discussion will give your doctor a better idea of who you are, how plaque psoriasis affects your health and life, and what goals and expectations you have. If you are keeping the lines of communication open, you and your doctor will be able to develop the best treatment plan for your unique health and lifestyle needs.
You may be used to your doctor asking the questions, but it is okay to take charge by asking the right questions. By being proactive, you can play a big part in managing your condition and taking control of your own life and health. Start by educating yourself about medications, complementary and alternative therapies, diet and lifestyle, and other ways that help you feel better and have clearer skin.
Remember, the time you have with your doctor is limited, so make sure you come to your appointment prepared to ask questions and to talk about what is important to you.
Download this doctor discussion guide to help you narrow down the treatment-related questions you may want to ask. You’ll also find some common vocabulary that’ll empower you in your discussion.
Take Advantage of Telemedicine
The COVID-19 pandemic has opened up new opportunities in telemedicine, including for people who have psoriasis. Many dermatology and primary care practices who previously did not offer telemedicine are now including it as an option. In most cases, medical management of psoriasis can be safely and effectively handled via this medium — which means you can get the care you need, medications you need, and more from the safety of your home.
To get started, contact your doctor's office directly to see what your options are. You may also be able to set up an appointment with a new provider, even if you’ve never seen them for an in-person visit. You can find a doctor who treats psoriasis in the same way that you normally would—from a referral from your physician or by checking with your insurance company.
When is telemedicine a good option? It is especially helpful for a follow-up visit and can work pretty well when you have an exacerbation of symptoms. It's also a good starting point when your disease isn't adequately responding to treatment — you can start a conversation and bring up your questions and concerns, and then decide if you'll need an in-person visit together with your doctor.
When it comes to the actual appointment, you can prepare as you normally would. You'll just need to take a few extra steps to set up your video or voice call, and your doctor's office can guide you in doing that. Some parts — like the physical exam — will obviously be adapted. For example, your clinician may ask to see your affected areas of skin up close on camera, or ask for a smartphone picture. Working together, you can plan your treatment and any necessary follow-ups.
Preparing for Your Visit: What to Ask Yourself
You may also want to take a few minutes to prepare and ask yourself some questions before your appointment, to help think through your thoughts and feelings, especially if you are feeling nervous or anxious. Ask yourself:
- What Do I Want to Accomplish? Planning for your appointment can help you feel more in control of your health and help you to get the most out of the time with your doctor. Start by thinking about how you can achieve these two goals. For example, maybe you have noticed that your psoriasis has recently flared up or more of your skin is covered with plaques. Knowing what you want to talk about and accomplish is helpful in starting the conversation with your doctor.
- What Worries and Concerns Do I Have? Consider what questions you want to ask and write them down. This will ensure you do not forget to ask them or bring up any concerns. While at your appointment, write down what your doctor says, especially if the points are specific to your questions and worries.
- What Does My Current Treatment Plan Look Like? Your doctor will already know what treatments they have prescribed, but you should share information about any other treatments prescribed by other providers, or supplements you are taking. It may be helpful to bring a list. Consider your feelings towards your current treatment plan, whether treatments are helping, and if there are any adverse side effects.
- Do I Know My Options? Your doctor will try to make sure you understand plaque psoriasis and the treatment options available, but it is also helpful for you to read up about treatments before your appointment. And since psoriasis treatments have changed in recent years, you will want to make sure you have the latest information.
- How Am I Feeling? You may want to get in the habit of writing down symptoms and how you are feeling generally. Noting when you experience flares and what causes them are two important pieces of information for your doctor. You may also want to include photos of your plaques so that your doctor can see how your skin has changed between visits.
- How Much Time Do I Need? If you find you cannot ask as many questions as you would like, feel rushed, or have more questions, you may want to book another appointment or ask for a telephone consultation. If you know you will have a lot of questions, you can ask for an extended appointment in advance. Bringing a friend or relative with you is a helpful option if you need emotional support and so someone else can recall information you might forget or take notes.
It is important to have continued conversations with your doctor about how living with plaque psoriasis affects you. Working with your doctor to develop a treatment plan can help you to feel more satisfied and in control of your health.
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