Questions to ask when changing psoriasis treatments

Psoriasis is an inflammatory disorder that can cause a variety of skin lesions. The most common form is plaque psoriasis, which causes thickened, inflamed patches of skin called plaques.

While the main symptoms affect the skin, the underlying cause of psoriasis is abnormal activity in the immune system. Psoriasis is sometimes described as an autoimmune disease, a disorder where the body’s immune system attacks and damages healthy tissues.

While it has some characteristics of an autoimmune disease, psoriasis is more accurately described as an immune-mediated disease—a disorder where the immune system isn’t necessarily attacking healthy tissues but is also not functioning normally. In addition to the skin, inflammation caused by psoriasis can also affect other tissues and organs.

Psoriasis is a chronic, lifelong condition that requires ongoing treatment. Switching treatments is often part of this process. Below is a look at some reasons a change in treatment might be necessary and questions to ask when starting a new treatment for psoriasis.

Treat-to-target strategies and switching treatments

Psoriasis is a different experience for different people. The condition varies in how much and what parts of the body it affects, how it impacts day-to-day life, and what treatments it responds to. It’s common for a person to try multiple psoriasis therapies before finding a strategy that works.

The National Psoriasis Foundation and the American Academy of Dermatology recommend a treat-to-target approach. The goal of treat-to-target is clear or almost clear skin after three months of starting treatment—psoriasis that affects 1 percent or less of body surface area (about equal to the area of one hand). Seeing a 75 percent reduction in psoriasis or psoriasis reduced to 3 percent of body surface area are also considered good responses during the initial three months.

If there has been some improvement in treatment, the best option may be to give the treatment more time without making any changes. It can take time before you see the full benefit of a therapy or treatment plan.

Also, while clear skin is an important metric when managing psoriasis, it is not the only metric. Quality of life is equally as important when assessing psoriasis severity and when making treatment decisions.

If psoriasis is not responding to treatment, a healthcare provider may recommend increasing the dosage of a therapy, switching to a different therapy, or adding a new treatment.

Other reasons you may need to add or switch treatments

• You’ve experienced a flare and need a medication to get symptoms under control quickly.
• A treatment has become less effective over time. This is fairly common with biologic therapies.
• If you have other inflammatory disorders (like psoriatic arthritis), you may need to switch to a treatment that can manage multiple conditions.
• You’ve changed insurance plans and a different medication is covered under the new plan.
• A newer therapy becomes available that may be a better fit for your treatment needs.
• The current therapy is causing side effects.

In order to get the most out of psoriasis treatment, follow your treatment plan. Skipping doses or stopping a medication can cause psoriasis to flare. Any changes to how you manage psoriasis should always be made under the guidance of your healthcare providers.

What to ask when starting or switching treatments

Here are some questions to discuss with your healthcare provider when switching medications or starting a new one:

• Why is this medication being recommended?
• How does this medication work to treat psoriasis?
• How is this medication taken? How long will I be taking this medication?
• What is the risk of side effects? What do I do if I experience a side effect?
• Are there any serious side effects I need to watch for? What precautions do I need to take?
• How long will it take before my skin improves? What if symptoms do not improve?
• How do I care for my skin while taking this medication?
• Are there any medications, foods, activities, or habits I need to avoid?
• How do I minimize my risk of infection?
• What does this medication cost? Who can I talk to if I have concerns about the cost of this medication?
• What other treatment options do I have if this medication does not work?

It’s important that your healthcare providers know about all medications you are taking, including medications for other conditions, over-the-counter medications, and any supplements, including herbal supplements.