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Living with a chronic skin condition can be difficult, but you don’t have to navigate it alone. Psoriasis affects over 7.5 million people in the United States, so we at Allure have talked to some of the top experts in the field about how to get the best treatment there is for this confusing (but treatable!) condition, from inside out. Check out what we’ve put together here.
If you’re one of the 7.5 million people in the United States living with psoriasis, you know how important it is to have a treatment plan in place with your doctor. The goal of any psoriasis treatment is to clear up your skin and keep new psoriasis plaques from forming. If you have mild or moderate psoriasis and have been trying topicals for several years without seeing results, your dermatologist might bring up biologics. Those with severe psoriasis, defined as lesions on more than 10 percent of your body surface, may already be familiar with these drugs, which have been a total game-changer in terms of how doctors treat chronic inflammatory conditions, including psoriasis.
But before you get started with any medication, it's important to understand the wider implications. Here are some of the common misconceptions doctors say that their patients sometimes have about biologics for psoriasis.
Biologics are a class of drugs derived in part from organic materials. For the time being, these medications are injected or administered intravenously, although there are some oral biologics being studied. All biologics work by suppressing your body’s natural immune response.
Psoriasis is a disease of inflammation. When you have a psoriasis flare, your immune system is sending your body a signal to boost its inflammation levels. Biologics are considered more targeted than traditional medications, and they work by zeroing in on your inflammation to help reduce the signs and symptoms of psoriasis.
That means that biologics don’t only treat the visible symptoms of psoriasis you can see on your skin, but also the underlying inflammation in your body that can lead to psoriatic arthritis, explains Marisa Garshick, MD, a board-certified dermatologist in New York City. She says that controlling the inflammatory response in your body in the short term may even protect you from some of the long-term complications psoriasis is linked to, such as heart disease.
Psoriasis is a chronic condition that doesn’t have a cure, even with biologic treatment. “I think a lot of patients are shocked to learn that they’re not going to get one shot of this medicine and be good to go,” says Danielle Baruch, MD, a board-certified dermatologist who practices in Baltimore, Maryland. “When we put people on these medications, the idea is that they will be on them forever.”
Of course, there are circumstances where you may need to taper off of biologics or switch to another treatment. When you get started, you should understand that you’re committing to this treatment method indefinitely. But the good news is that for many people, it means a permanent reprieve from symptoms, too, which makes keeping up with the regimen worth it. “It’s not one and done, but the hope is that while you're on the biologic, you're really not dealing with the same degree or extent of the disease that you were when you were off of it,” says Dr. Garshick.
Some people are tentative about starting biologics because they don’t want to commit to a lifelong immunosuppressant. But the idea that today’s biologics shut down your entire immune system is a misconception.
“We used to have to really suppress the immune system to treat psoriasis. Now, with some of the newer biologics, we're really able to fine-tune the branch of the immune system that we're targeting with these medications,” says Dr. Baruch.
With that being said, if you have a cold, the flu, or any viral illness, such as Covid-19, you will have to wait to start biologics until you are fully recovered. You’ll also need to talk to your doctor and get any recommended vaccines beforehand so you’re not putting extra stress on your immune system. And after treatment starts, you’ll need to let your doctor know if your body shows signs of an infection.
The process of starting biologics takes time. For one thing, you’ll need to get bloodwork to test for hepatitis B and tuberculosis before you get started. And even after you have your first appointment, you might not see any improvement for the first few weeks. “It's kind of tricky because each of these biologic medications has […] a different time period when you would expect them to be effective. Some of the newer ones work really fast, and some of the other ones kind of take a few months to really see if they start to work,” says Dr. Baruch.
It varies from drug to drug, but nearly all biologics start with several treatments spaced closely together over the span of four weeks to three months. After that initial jump-start, you’ll transition to a maintenance phase where your treatments are monthly, bi-monthly, or every three months.
By Aliza Kelly
By Liv Holland
By Allure Staff
“You may need to give it about three to six months to see how it’s working because everyone responds so differently,” notes Dr. Garshick. She notes that even if someone hasn’t seen complete resolution, it may help to supplement with topical and other treatments before throwing in the towel and trying a different class of biologics.
It may take some trial and error to figure out which class of biologics is going to give you the best result. Emphasis on may, here: Switching between these medications isn’t as easy as, say, swapping Tylenol for Advil. “You don't really want to keep jumping around from different ones because we don't know if doing so will eventually limit their efficacy,” says Dr. Garshick.
Dr. Baruch says your dermatologist will ask lots of questions about your symptoms, your family history, and other health conditions that you have before getting you started. Your answers will help your doctor have a good chance at getting the medication right the first time.
There are no specific lifestyle changes you can make to increase the efficacy of biologics. Either a drug works for you, or it doesn’t. But keep in mind that there are some habits that your doctor might recommend to keep your psoriasis under control. “Anything that's going to help your whole body to be healthier is going to help your psoriasis,” says Dr. Baruch.
Eating a healthy, nourishing diet, decreasing stress where you can, limiting alcohol, and abstaining from smoking have all been shown to help with psoriasis treatment — with or without biologics in the picture.
Both Dr. Baruch and Dr. Garshick hesitate to generalize about what the side effects of biologics will be like. Temporary redness and irritation at the site of your injection are pretty common, but the other side effects are harder to predict and distinct to the medication.
It’s good practice to ask your dermatologist specific questions about side effects so you know what to expect. “You should ask everything you want to ask so that when you inject this medicine into your body, you feel like you know what’s going to happen,” advises Dr. Baruch. “Ask about how common certain side effects are, and ask about interactions with other medications.”
With all that being said, some side effects you should be aware of include:
With any biologic treatment, Dr. Garshick encourages her patients to think in terms of risk versus reward. In many cases, controlling your psoriasis isn’t just about your skin. It also might help reduce joint pain and improve your mental health; things that can add years to your life in the long run. For many people, the potential side effects pale in comparison to the chance at stopping their psoriasis from progressing.
Visit SELF's My Way to Well information hub for more on Psoriasis.
