Psoriasis is a skin condition with different classifications that all involve an autoimmune response. It can differ in:
  • type
  • site
  • severity
And like other autoimmune diseases and disorders, there’s no one-size-fits-all course of treatment. This can make it challenging to find a treatment that works for you. You may also find that your treatment becomes less effective over time. This can happen either suddenly or gradually.

Why do treatments stop working?

There are a number of common reasons why a psoriasis medication may stop working or may not be as effective over time at managing your symptoms. They include:

1. Drug tolerance

Your body can develop a tolerance to topical treatments after a period of continual use. Topical treatments are substances that you apply directly on your skin. Tolerance lessens their effectiveness. It can happen with both corticosteroids and non-steroid topical treatments. This process is referred to medically as tachyphylaxis.

2. Toxicity

Research shows that toxicity can build up in the body and affect its organs with long-term use of conventional systemic drugs to treat psoriasis. Toxicity has also been linked to the onset of skin cancer after long-term phototherapy. When this happens, you’ll need to consult with your medical provider for alternative treatment options.

3. Anti-drug antibodies (ADAs)

The body sometimes produces antibodies in response to both conventional systemic drugs and the newer biologic medications. ADAs are chemicals the body produces to attack medications, which reduces their effectiveness. Biologics are newer medications developed in the last two decades, made from living cells to target specific parts of the immune system.

4. Biologic fatigue

The tendency of biologic drugs to lose their effectiveness with long-term use is known as biologic fatigue. Medical researchers do not entirely understand why this occurs in some people but not in others and with some drugs but not with others.

5. Biologic side effects

Biologics have a strong effect on the immune system and may create an increased risk for infections to develop. For this reason, they’re generally used after other treatments have been tried first. The body may also develop a resistance to them over time.

6. Skin infection

Skin infections can slow down treatment progress, and some psoriasis medications can actually make an infection worse. If you have any signs of an infection, such as crust or oozing, see your doctor right away.

7. Misdiagnosis

Infections, eczema, and contact dermatitis can closely mimic psoriasis. If you’re not responding to treatment or your treatment stops working, it’s a good idea to ask your doctor if this is a possibility.

8. Missed doses

There are lots of reasons why you might miss a dose or two of your medication. Some treatments can withstand the occasional skip, but others rely on steady and consistent use. If you often forget to take your medication, try using an app or calendar tool that sends a reminder when it’s time for that day’s dose. If cost is an issue, talk to your doctor about drug discount programs or alternative treatment methods.

9. Stress

Stress can trigger psoriasis flare-ups, so finding ways to successfully manage it can make a big difference in your skin — and your life!

10. Combination needed

One drug may not be enough to improve psoriasis. Topical creams often work better along with a vitamin D cream for mild to moderate psoriasis. Research shows that using the systemic drug methotrexate in combination with biologic drugs is often more effective than either medication alone. Phototherapy, or light therapy, is often more effective in combination with topical medications.

11. It takes more time

Although topical treatments can sometimes make a difference in days for mild psoriasis, biologic medications can sometimes take weeks, or even months, to have an effect. Phototherapy can take between 15 to 25 treatments to work, according to the National Psoriasis Foundation. Sometimes, patience is all that’s needed to see improvement from your treatment.

12. It’s time for lifestyle changes

Smoking and drinking can worsen psoriasis symptoms and lessen chances for remission, according to the National Psoriasis Foundation. Drinking can lessen treatment response and is dangerous combined with the systemic psoriasis drug methotrexate.

What to do when treatment stops working

It can be frustrating to see your skin improve with a psoriasis therapy, only to have your symptoms return months, or even years, down the line. This can happen with any psoriasis treatment:
  • topical
  • conventional systemic
  • biologic
What to do depends on what type of therapy you’re using. The first thing to know is that decreased effectiveness is common. You’ll probably want to consult your healthcare provider for new options. Usually, there are changes you can make to find a treatment that works. Try the following suggestions to get your treatment back on track.

Check your schedule

Make sure you’re using or taking your medication according to the prescribed schedule. If you’ve missed doses or not been regular in your topical application, that could be why the medication isn’t working.

Consult your healthcare provider

If your treatment stops working, you’ll want to check with your healthcare provider about next steps. They may prescribe alternative or additional treatment and check for toxicity, tolerance, or ADAs.

Double up

Your healthcare provider may recommend combining your treatment with additional therapy. Biologics often work better combined with a conventional systemic medication such as methotrexate. Skin creams may work better with additional vitamin D therapy. A combination phototherapy treatment known as PUVA can be very effective when combined with a drug called psoralen.

Give it time

Some psoriasis treatments, especially biologics, can take up to several months to begin working. Check with your healthcare provider to make sure your expectations are in line with your medication’s timeline.

Change habits

Smoking and drinking alcohol in excess can affect both psoriasis flares and the effectiveness of treatment. Healthy lifestyle changes, like quitting smoking and drinking moderately, as well as keeping active, eating a healthy diet, and managing your weight, can help reduce psoriasis flares.

Find a support group

In addition to talking to your healthcare provider, you may want to participate in an online support group for people with psoriasis. The time when a treatment stops working can be stressful, and others who have dealt with the same issue may be able to help.

When to consider switching treatments

There are many signals that it may be time to switch your psoriasis treatment. Maybe the treatment doesn’t work from the beginning, or it stops working after a period of successful use. Maybe there are safety concerns about toxicity, or your body begins producing ADAs. There may be side effects that are more uncomfortable than you want to deal with or maybe you just don’t like some aspect of the treatment, such as daily injections or time-consuming cream applications. There’s no single set of symptoms that say it’s time to switch and no general timetable for when to switch. Each therapy differs in:
  • safety concerns
  • how long it takes to work
  • when it might stop working
Every person is different, too. For reasons medical researchers don’t entirely understand, the same medication can affect different people differently. Here are seven signals that it may be time to talk to your healthcare provider about switching your psoriasis treatment.

1. Your treatment doesn’t work

Not all treatments work for everyone. Some treatments may not work for you. Topical creams may not help your skin clear up, and some systemic treatments may not bring improvement either. If you’ve administered your treatment regularly and given it enough time to work, and you still don’t see improvement, it may be time for a change.

2. Your treatment stops working

Everything was great at first. Your skin started clearing up. Then, weeks, months, even years later, symptoms returned. This is an all-too-common story with all types of psoriasis therapies. With topical treatment, the body may develop a resistance to the medication over time. With conventional systemic medications, as well as biologics, the body may produce ADAs that limit the drug’s effectiveness after months, or even years, of treatment. The reason that a drug stops being effective is not entirely understood. ADAs may not tell the whole story. A 2013 study published in the British Journal of Dermatology only found a connection between ADAs and decreased treatment response in participants taking two of the four biologics studied. Whatever the reason, when your treatment stops working, it’s time to consider switching. Some doctors recommend switching even before it stops working to avoid the return of symptoms.

3. Your psoriasis progresses

The progression of psoriasis is unpredictable and not totally understood. Research published in the Journal of Drugs in Dermatology in 2018 points out that some cases of psoriasis can remain stable for years. In other cases, the condition can advance quickly to involve organs, including the heart, liver, kidney, and intestines, as well as joints and muscles. If your psoriasis advances, it may outpace your current treatment, which then becomes less effective. At that point, you’ll want to talk to your healthcare provider about alternative treatments.

4. Toxicity or side effects develop

Both conventional systemic drugs and biologics can have severe side effects. Liver toxicity has been associated with long-term use of the conventional drug methotrexate, while kidney toxicity has been associated with long-term use of cyclosporine. Because of this risk, conventional systemic drugs like methotrexate, oral retinoids, and cyclosporine are typically only given for a short time. Biologics also have side effects. Because they affect the immune system, they can increase the risk of infections, such as tuberculosis and pneumonia, as well as staph and fungal infections. If your healthcare provider finds that any of these toxicities or serious side effects occur, you’ll probably need to change treatments.

5. Other conditions develop

According to the National Psoriasis Foundation, people with psoriatic disease have a greater risk for other diseases and disorders, which are known as comorbidities. Comorbidities, or co-existing conditions, that have been associated with psoriasis include:
  • cardiovascular disease
  • depression
  • kidney and liver disease
  • osteoporosis
  • diabetes
  • various cancers, including lymphoma and melanoma
Even a relatively safe treatment, like phototherapy, may increase your risk for skin cancer if your skin is sensitive to light or you have a family history of skin disorders. If you develop an additional condition, you’ll want to be sure your healthcare provider coordinates your psoriasis treatment with your new treatment. It may involve changing your psoriasis treatment.

6. You’re pregnant or breastfeeding

Psoriasis itself won’t affect your pregnancy or your baby, but some of the medications can. Some biologic and systemic medications, as well as coal tar and some other topical treatments, should be avoided during pregnancy, Once you decide to get pregnant, you may need to stop or change some of your psoriasis treatments weeks, or even months, before trying to conceive. Be sure to consult your healthcare providers to discuss your options. It’ll be easier if you try to get your psoriasis to a point of being well-managed before you get pregnant. That way, you’ll have fewer flare-ups during your pregnancy and less need for medication changes.

7. Your treatment doesn’t accomplish your goals

According to the National Psoriasis Foundation, you can expect to be able to develop a treatment program that clears your skin, has few side effects, and complements your lifestyle — even with moderate to severe psoriasis. A study published in Dermatologic Study in 2015 points out that historically this expectation wasn’t always realistic. Before the development of biologics, people with psoriasis were expected to tolerate some degree of skin issues and a wide variety of side effects from medication. With the wide range of treatment options now available, you can work to successfully manage your condition. You can work with your healthcare provider to tailor the effectiveness, side effects, and lifestyle requirements of various treatments to develop a program that meets your personal treatment goals. This may involve switching treatments multiple times until you find one that works for you.

Takeaway

Finding the right treatment for your psoriasis may take some time, but it’s possible. Make an appointment with your doctor if you think your current treatment is no longer working. Discuss the reasons why your treatment isn’t working and which alternative treatment options are a good fit for you.