The doctor's perspective
Be aware of what your doctor has to consider before prescribing a treatment for you. Doctors plan a course of action and take into consideration the following information:
- Your age and gender (some treatments would not be appropriate for some age groups, pregnant women or women who are breastfeeding);
- The location of your psoriasis;
- Its impact on your quality of life;
- Your medical history (some treatments are eliminated because of other medical problems or because you have used other treatments in the past);
- How your individual case of psoriasis comes and goes (for example, it fluctuates with the weather or is triggered by your emotions);
- The extent of the psoriasis present (some treatments are not warranted when psoriasis is minimal or very severe);
- The presence or absence of psoriatic arthritis;
- The kind of psoriasis you have;
- Your response to treatments in the past;
- What is realistic for you to fit in your daily routine (an hour to apply topical medications, or a three-times-a-week drive to phototherapy treatments?);
- Your ability to pay for treatment (many treatments are expensive and are needed over a long period of time);
- Your insurance coverage;
- Your willingness to accept the risks of treatment.
Justifying treatments
Sometimes it is easier for doctors to treat the difficult cases. For example, the doctor works with someone who has 80 percent body surface coverage and gets the patient to 5 percent or 10 percent coverage; the patient has progressed from having extensive body coverage to having limited psoriasis. "This patient is likely to be pleased," says Robert Stern, M.D., of Boston's Beth Israel Deaconess Medical Center. "When I have a patient with very debilitating psoriasis, both of us are willing to take the risks of the more effective treatments.
"On the other hand, if you have a patient with 2 percent of the body involved, and you get them to 1 percent, they've still got little patches that are bothersome. They may be unhappy with their results."
Long-range thinking comes into play, the doctor adds. "Lots of patients would like to be completely clear, and so I am thinking not only about what I can do for the patient now, but what I can do for the patient over the years to follow," Dr. Stern notes. "Plus, I consider the patient's chances of developing long-term side effects."
The disease's effects on your quality of life must also be taken into consideration. It is important to share your symptoms with your doctor, so he or she knows how your psoriasis affects your daily activities. Quality of life may be an important determining factor in choosing a treatment for you.
When psoriasis treatments appear to fail, disappointment is a common reaction – typical for psoriasis patients whose hopes for clearance can be frustrated by recurring flare-ups or ineffective treatment. The disappointment is understandable and often interpreted as the doctor's fault; however, a lack of knowledge can foster a patient's unrealistic expectations as to what can be done about psoriasis. As patients become better educated about psoriasis and its treatments, they will feel empowered to work with their doctor to find treatment options that work.
According to John Y. M. Koo, M.D., of the University of California at San Francisco, the key to deciding on a course of treatment is to arm yourself with knowledge. "Read, study, and read more," he says. "Also, don't jeopardize yourself by limiting your own choices or by jumping to conclusions – that is, by saying you'll never try a particular therapy."
The fine print on medication labels can be scary, but before you discount that medication as an option for yourself, make sure you weigh the pros and cons. For many people, it boils down to which is worse: your psoriasis or the possible side effects that you may or may not experience.
"Don't give up hope," Dr. Koo adds. "Be aware that even though psoriasis is not curable, it is treatable. In other words, don't take 'no' for an answer. There's a good chance that the right treatment option for you exists out there, and it's just a matter of finding it."
Updated October 2005
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