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Why Your Psoriasis Treatment Is Not Working

Medically reviewed by Mohamed Jalloh, PharmD on July 5, 2016Written by Jennifer Abayowa on December 10, 2015

Natasha Nettles is a strong woman. She’s a mom, a makeup artist, and she also happens to have psoriasis. But she doesn’t let this one part of her life take her down. She doesn’t let it control who she is, what she does, or how she describes herself. She is much more than her autoimmune disease. Go inside Natasha’s life, and watch how open and comfortable she is in her own skin in this documentary-style video.

Psoriasis is a skin condition with different classifications. It can differ in type, site, and severity. Your treatment should be tailored to your unique needs and condition.

Here are some current psoriasis treatment options, and some reasons why they may or may not be working for you.

Topical treatments

Topical treatments are best for treating mild to moderate psoriasis. They include corticosteroids and non-steroid treatments.

Topical corticosteroids

When used alone or with vitamin D, topical corticosteroids are effective in treating localized psoriasis. One downside of using corticosteroids, and possibly why they aren’t working for you, is that psoriasis symptoms may return if therapy is stopped. There are several types of topical corticosteroids, so talk to your doctor about which one may be right for you.

Non-steroid topical treatment

Non-steroid treatments include retinoids, coal tar, and vitamin D analogues. These treatments may be effective, but are typically less effective than corticosteroids.

Topical retinoids can help reduce inflammation and how often skin cells develop and regrow.

Coal tar is an ancient treatment, and has been used to treat psoriasis for more than 80 years. It’s not as appealing as other treatments because of its strong odor and staining properties.

Dithranol

Dithranol is a popular topical treatment for psoriasis. You can apply it as a mixed paste or directly for short contact in higher concentrations. Only a few side effects are possible, including skin irritation and staining.

Phototherapy

When done consistently, phototherapy can be successful in treating psoriasis. Phototherapy options include ultraviolet B (UVB), ultraviolet light A (UVA), and laser treatments. UVA can be very effective when combined with a drug called psoralen. The combination treatment is known as PUVA.

Systemic treatments

Systemic or prescription medications include methotrexate, oral retinoids, and cyclosporine.

Methotrexate

Methotrexate is FDA approved to treat many diseases including psoriasis. It can be very effective and is not as expensive as other treatments. One potential side effect is liver toxicity. Your doctor might start you on folic acid to reduce your risk of such toxicities. 

Oral retinoids

Oral retinoids are prescription drugs. Currently, acitretin (Soriatane) is the only FDA-approved oral retinoid for psoriasis. Acitretin isn’t recommended for women who are pregnant or may become pregnant within three years after treatment.

Cyclosporine

Cyclosporine (Sandimmune) is an oral medication that’s most effective when used short-term. Long-term use is connected to increased risk of hypertension and kidney toxicity.

Biologics

Biologics are target-specific drugs that act by blocking certain inflammatory cytokines. Currently, there are seven biologics that are FDA approved to treat moderate to severe psoriasis:

Biologics are generally a last resort for treatment, so talk to your doctor about if they’re right for you.

Other options

If the above treatments aren’t working for your psoriasis, you may want to consider small molecules or JAK inhibitors.

Small molecules

According to a preclinical study, small molecules can treat psoriasis in people who aren’t responding well to traditional treatments. Apremilast (Otezla) is a new small molecule pill that can help control active psoriatic arthritis or plaque psoriasis.  

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.

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