Why Psoriasis Treatments Can Fail

By

Erin Azuse

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PHYSICIAN CONTRIBUTOR

FAQs About Moderate To Severe Psoriasis

Get to know the basics of psoriasis from a practicing dermatologist.
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Many treatment options exist for psoriasis, a chronic condition that results in thick, itchy and sometimes painful patches of skin.

Since it is considered an autoimmune disease, treatment is aimed at reducing inflammation and slowing the immune system response.

Though patients are often able to find relief, it’s a very individualized process to discover what works best. And even then, many patients have to cycle through different treatments over time.

Treatment for psoriasis generally falls into a few main categories.

  • Topical: Creams and ointments, such as corticosteroids, are often used for mild to moderate cases.

  • Phototherapy: Sunlight or artificial ultraviolet light treatment can help some cases of psoriasis.

  • Systemic: These drugs work to suppress the entire immune system and are usually given in liquid or pill form. They may be given to those who do not respond to topical treatments or light therapy.

  • Biologic: These treatments target very specific parts of the immune system and are reserved for moderate to severe psoriasis. They are often given via injection or an IV.

If you are someone with psoriasis, it can be frustrating to find that a particular regimen doesn’t work, stops working, or simply can’t be tolerated. Let’s take a look at why this happens.

Psoriasis is a difficult condition to live with—and not everyone knows the whole story. Learn how to separate fact from fiction.

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Nov 6, 2015

The Disease Can Cycle Up and Down

Your psoriasis will likely have periods of improvement, as well as times where flare-ups will be more severe. As a result, treatments may need to change. Even if topical medications have always been sufficient in the past, if your psoriasis worsens or spreads, your doctor may suggest switching to a more aggressive systemic or biologic treatment.

You Can Build Up a Resistance

It’s not uncommon when a medication is used for a long period of time that your body starts to develop a resistance to it. You may notice a gradual decrease in effectiveness as this occurs, and it is usually a sign that your doctor may need to try a different line of treatment.

Side Effects May Become Too Severe

The benefit of any treatment for psoriasis must be weighed against potential side effects. For example, certain systemic medications like cyclosporine and methotrexate can be harsh on the kidneys and liver. If at any time the side effects become too unpleasant or too dangerous, treatment will need to be adjusted.

Your Compliance May Have Suffered

When you start any medical treatment, it’s important to follow your doctor’s orders regarding the frequency and duration. Failure to do so can affect the outcome. Was the cream too messy, so you didn’t apply it every day? Was it hard for you to get to the clinic, so you missed several appointments? Were you not seeing the results you wanted, so you stopped taking your medicine earlier than you should have?

If you are finding it hard to adhere to your treatment plan, work with your doctor to develop one that you can stick with.

Your Genes May Play a Role

Though this is still being studied, researchers have discovered several genes that are responsible for making certain people susceptible to developing psoriasis. As we learn more about why and how genes affect the immune system, it’s likely that researchers may see a genetic component to explain why treatments work for some but not for all.

Something Else in Your Life May Have Changed

Many factors contribute to how your body responds to a medication, so it’s important to look at the big picture. Have you had a significant change in weight? Did you start a new prescription or over-the-counter medication that may interact with your psoriasis treatment? Have you been under a great deal of stress? Make sure to address any health or lifestyle changes with your doctor.

While it may not be a straight path to achieving psoriasis treatment goals, don’t give up. With new and improved treatments being developed, patients today are experiencing better psoriasis control than ever.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Feb 21, 2017

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Medical References

  1. Kerdel F, Zaiac M. An evolution in switching therapy for psoriasis patients who fail to meet treatment goals. Dermatologic Therapy. 2015;28(6):390-403. doi:10.1111/dth.12267.
  2. Genes and Psoriasis. National Psoriasis Foundation. https://www.psoriasis.org/research/genes-and-psoriatic-disease
  3. Psoriasis Treatments and Drugs. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/psoriasis/basics/treatment/con-20030838

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