time for systemic therapy?

[rmd27]

I'm a 20 y/o male and have been dealing with psoriasis for the last 4 years. Once the topical stuff stopped working, I moved onto UVB therapy, which I've been receiving off and on (mostly on) for the past 2 years. Most recently, I've been getting narrow-band UVB thrice weekly. Narrow-band UVB was great for the first 2 month and my psoriasis greatly improved. However, I've been flaring pretty severely for the past two weeks, and I'm pretty much back to square one (40% coverage). I'm sick of trecking to a doctor's office three times a week, and am greatly discouraged by this most recent flare. Anyhow, I feel like I should take a break from phototherapy if it is losing its efficacy. I'd like to try some systemic medication (methotrexate, maybe), but I'm worried that my derm will be overly conservative (as he usually is) because I am still relatively young. Should I pursue a systemic option vigorously, or should I heed the doctor's warning not to start such a powerful drug at a young age? Just looking for opinions/experiences, etc. I'm hoping that dependance on a systemic medication won't last a lifetime as these new therapies gain fda approval. Thanks.

-riley

[David1]

Riley, You have a tough decision to make. I'm 44 and have suffered with a mild to moderate case(maybe 20%) since my early twenties. I had the best results with PUVA treatments which I did for about 1 to 2 years while in my thirties. The results were so astounding that I decided to stop the treatment after most of my lesions completely cleared but it was also becoming an inconvenience having to drive 30 miles one way to the doctors office twice a week. So since then I have lived with a mild case(elbows,knees and one shin) using Dovenex and other topicals. I bought a tanning bed but all it did was give me a tan. Late last year after a bad flare up I visited my derm and we discussed MTX. My derm is "out of network" now so I must pay for these visits and PUVA is too expensive. I am taking 15 mg/week and after 14 weeks the results aren't as good as the PUVA but no more flaking. My condition is better but the side effects(fatique) seem to outweigh the benefits. I didn't really feel my age until I started the MTX. Well, I hope this helps you with your decision. Your young age might be a serious consideration but if monitored properly I think it is a viable option for you. E mail me at dwalt57@hotmail.com if I can answer any other questions. Might suggest using the NPF resources as well if you havn't done so yet. Good luck whatever path you choose.

[rosee_posey]

Hello Riley,

As far as your consideration about MTX goes, the most significant thing that comes to mind is...babies!!

You haven't told us what your marital status is (you don't have to), but I can tell you that my dermy said that MTX affects sperm, and if you are planning to conceive, you gotta be off the stuff for at least 90 days (and make sure you <ahem> "rotate the stock" a little, eh?) ha ha ha ha

To be perfectly honest - MTX is a safe and inexpensive systemic alternative. It has been around in use longer than you and I have been alive. Yes, you may have side effects, yes, you have to get your blood drawn every month, and yes, they do have to keep their eye on you, but there is also a chance you may not have any side effects with MTX (I am one of those lucky ones). So I say, talk to your doctor and at least consider it. If you hate it, you can always stop, right?

Hope this helps,
Take Care,
- rose