In an ideal world, there would be one magical medication to effectively treat psoriasis for each person with the condition. But anyone with an autoimmune disease, including psoriasis, can have varying experiences. There are lots of treatment options to choose from, but finding the best psoriasis medication for you can simply take a bit of time because no two people are alike in their journeys to healthier skin.
“Psoriasis is a really complicated condition and everybody’s situation is slightly different,” Dina F. Bierman, M.D., a board-certified dermatologist at Providence Saint John’s Health Center in Santa Monica, tells SELF. “While there are a lot of different treatment modalities, we really have to tailor it to the individual.”
The severity of your condition also plays a role in which treatments may work for you, Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, tells SELF. “In mild cases, prescription topical creams often are effective,” he explains. “In more severe cases where large body surface areas are involved, systemic medicine may be needed.”
Finding the right medication can be a life-changing process, Dr. Bierman says. That’s why it’s so important to talk to your doctor about switching your treatment if you think your medication isn’t working as well as it should be. But how do you know when it’s time to make the switch? SELF asked board-certified dermatologists to explain the signs to watch for.
1. Your symptoms never truly go away.
Psoriasis is an autoimmune condition that acts in cycles, meaning you will typically have periods when your symptoms flare, which can last for a few weeks to months, and periods of remission when they subside, according to the Mayo Clinic.
If you’ve been taking your medication for a while and you continue to have symptoms without feeling some relief, then it’s worth talking to your doctor about it. “Psoriasis flares are very multifactorial,” Dr. Bierman says. “If you’re not responding to a particular medication, it just may be that it’s not the right one for you.”
Give your medication at least six weeks to see if it’s working for you, Dr. Bierman suggests. However, each one operates a bit differently, so certain types might take more or less time to get to work. For example, topical corticosteroids, anti-inflammatory creams that help with itchiness and redness, can help reduce symptoms in as little as two weeks. 1 Other treatments, particularly systemic medications, can take up to four to six weeks to show signs of efficacy.
If you have severe psoriasis, then your doctor may recommend using multiple medications, Dr. Bierman says, which is another reason why it’s so important to keep an open dialogue about how you feel (good or bad) when you first start a treatment course.
2. You’re only feeling and seeing some improvement.
There are a lot of different psoriasis treatments out there, and some are stronger than others, Dr. Zeichner says. Depending on the severity of your symptoms, your doctor will usually start you on milder medications and build up from there as needed.
That generally means starting with topical treatments, like corticosteroid creams and seeing how things go. “If they work at first, but aren’t keeping the psoriasis plaques under control or you are getting new plaques, then your dermatologist may talk to you about more potent topical options or suggest switching you to a systemic medication,” Dr. Zeichner says.
A systemic medication works to treat the condition throughout your body, rather than targeting a specific area of your skin, for example. “Systemic medications include pills, self-performed injections, or infusions through an IV,” Dr. Zeichner says. “The choice depends on your personal preferences, disease severity, and whether you have associated psoriatic arthritis.” (People with psoriasis are at a higher risk of developing psoriatic arthritis, an inflammatory condition that can lead to stiff, painful joints, according to the Mayo Clinic.) There are even options within your different options. For example, biologic medications, which target the part of the immune system involved with causing psoriasis, have many different classes, so there are many types to consider. “If one class is not working for you, then another one still may,” Dr. Zeichner says.
3. Your symptoms return, even after the treatment has worked once.
Sometimes your medication has seemingly done the job. You have very few or no psoriasis plaques—but then you start seeing and feeling those dreaded symptoms once again. This can happen because you’ve developed a tolerance to a specific drug, so it doesn’t work as well for you after a period of time, board-certified dermatologist Ife J. Rodney, M.D., founding director of Eternal Dermatology + Aesthetics and professor of dermatology at Howard University and George Washington University, tells SELF. “In some cases, your body can produce antibodies that reduce the effectiveness of the drug,” she explains. At this point, you may need to modify your prescription or switch to a different form of treatment entirely.
Marie Leger, M.D., board-certified dermatologist and faculty member at Mount Sinai Hospital in New York City, says that there is no way to know whether your symptoms will come back gradually or suddenly. “I’ll see some patients where they have a little more psoriasis but they feel okay, and then the next time I see them it’s a little bit more,” she tells SELF. “But sometimes, all of a sudden, your psoriasis returns with a vengeance.”
Dr. Leger urges people to talk to their doctor if they notice any of these changes happening, because they can easily switch you to something that can potentially be more helpful. “We are in such a good place with psoriasis medication now,” she explains. “There are so many amazing medications available and you can tailor them to patients.”
4. The side effects are really bothering you.
Every medication has the potential risk of side effects, but it’s important that the benefit you get from taking a drug outweighs the downsides. This is a conversation to have with your doctor even before you start taking a drug, so you’re well aware of both the pros and cons.
Some psoriasis medications, such as steroid creams and retinoids, can cause skin irritation that’s difficult to deal with, according to the Mayo Clinic. While doctors generally recommend that you give these medications some time to take effect, Dr. Bierman says it’s best to immediately talk to your doctor if your skin becomes much worse, like if you develop a distinct skin rash, severe itchiness, or swollen skin. “You might have hypersensitivity to a particular component or ingredient,” she says.
Other psoriasis medications can potentially cause diarrhea, Dr. Leger says. If you’re constantly running to the bathroom—and it doesn’t let up—let your doctor know. While it’s entirely possible that your diarrhea could be due to something else, like a stomach bug, it could also be a side effect of your medication.
5. You’re planning to become pregnant.
Talking to your doctor about having kids might not be one of your first thoughts during your psoriasis appointments. However, some psoriasis medications may increase the risk of fetal birth defects in people who are pregnant, so it’s important to check with your doctor to see if your medication is safe to take if you’re trying to conceive.
“You need to talk to your dermatologist about what the right decision is for you,” Dr. Zeichner says. This includes people of all gender identities, because some medications can be found in sperm and cause birth defects when a partner becomes pregnant, according to the Mayo Clinic. If you’re trying to start a family, your doctor can recommend effective medications to treat your psoriasis that are also safe to use while trying to conceive.
6. Infusion medication doesn’t work with your schedule.
Some biologics are given through an intravenous (IV) infusion, which means you’d need to either go to a medical care center to receive it or pay for a home nurse to come to you and deliver it. That can be tough to make time for if you have a busy schedule. If your circumstances have changed and you’re always rescheduling your infusion visits, then it’s possible your treatment may not align with your lifestyle anymore.
Luckily, Dr. Rodney says there are a lot of biologics that come in injectable form, which means you give yourself a shot at home. “There are very effective injectable biologic medications for psoriasis,” she says. “If you’ve been on an infusion regimen, you can definitely switch to an injectable.”
7. You’re starting to feel joint pain.
About 30% of people with psoriasis will develop psoriatic arthritis at some point, and unfortunately, this can happen at any time, according to the Cleveland Clinic.
“Even if your skin psoriasis is well-controlled on your current medication, you may also experience pain and swelling in your joints,” Dr. Rodney says. So, if your wrists start hurting when you do ordinary activities, like making dinner or brushing your hair, or if you start having really severe knee or ankle pain and can’t walk for an unexplained reason, then you should talk to your doctor. Even if you just have minor pain that’s unusual or bothersome, it’s really important to flag that to your doctor because treating psoriatic arthritis early can help prevent long-lasting joint damage.
If you do have psoriatic arthritis, which is diagnosed via a physical exam and imaging tests like an MRI, then you may need to switch up your medication. “Some injectable medications are better at treating both skin and joint psoriasis than others,” Dr. Rodney says. Your doctor can read through the research on psoriasis and psoriatic arthritis medications to recommend ones that may work best for you.Overall, it’s important to work closely with your doctor if you feel like your psoriasis treatment just isn’t working for you.
It is totally possible to find relief from your symptoms—they’re not something you should just have to put up with because your current medication isn’t cutting it. “I’m always shocked when patients say they have a relative who is suffering from psoriasis,” Dr. Leger says. “We have so many great treatment options available. That should not be the case.”