My first "Treat to Target" experience

| Howard Chang

In the house where I grew up, I fondly remember throwing darts in the garage at a vintage dart board. We tried to hit the bullseye most of the time, but other times, strategy dictated aiming at another spot on the board. 

By keeping score, I knew where I stood, and what I needed to do to win. Knowing the target and goal gave purpose to each throw of the dart. I wish I could’ve done the same with my psoriasis treatments over the years. 

I’ve lived with severe psoriasis for almost four decades. I’ve tried countless lotions, ointments, pills, injections and other treatments with the hope of lessening the impact of psoriasis on my skin and body. 

Who doesn't want to be 100 percent clear of psoriasis? That may or may not be realistic given my situation. Either way, I can’t recall setting a defined treatment target or goal for treating it. Then I read about NPF’s Medical Board’s new “Treat to Target” recommendations published online in the Journal of the American Academy of Dermatology in November 2016. 

The goal is to work with your health care provider to develop a treatment strategy that leads to 1 percent or less psoriasis on your body within three months. An acceptable goal is to have 75 percent improvement in three months. Those goals establish a target to throw the proverbial “treatment dart” at.

Developing a treatment target and plan

At my first appointment of the year, I asked my dermatologist if he read about the recently published psoriasis treatment recommendations. He mentioned he heard of the paper, and knew the author of the study, but hadn’t examined it yet. 

After sharing the published goals with him, I asked him to assess my psoriasis Body Surface Area (BSA). He and his resident conferred for a moment, then said about 10-15 percent BSA. I wrote that down as my baseline number.

We next worked on a strategy to improve my treatment outcome. My situation is complicated by having severe atopic dermatitis (eczema) that sometimes flares with my psoriasis medications. While I am currently taking a systemic pill and a biologic, we decided to stop the pill soon so I can minimize side effects from it. 

In its place, I will start coal tar and phototherapy treatments, which potentially could treat both my skin conditions. With new biologics in the pipeline, we’ll also consider switching to one of those once they are approved by the FDA for patient use later in the year.

With a treatment strategy in place, he asked me to return in four weeks to monitor my progress. By then, I hope to have started the new treatments and report how well I am tolerating them. I might get worse before I get better, so we’ll reserve a full evaluation in three months’ time. 

Other treatment goal considerations

Besides setting my psoriasis target and treatment strategy, my dermatologist and I engaged in a side conversation related to treatment goals. While we agreed it’s a good idea to set concrete goals based on psoriasis skin area, he mentioned that a patient’s treatment goal should also include quality of life considerations. 

He gave an example of one of his patients who switched to a new biologic. The new medication improved his psoriasis more than the previous biologic. But his patient still preferred using the old biologic as he had developed a good routine and experienced fewer side effects with it.

That patient’s story reminded me of the importance of each individual collaborating with health care providers on treatment goal setting. That way, other considerations unique to a person’s situation, such as quality of life and mitigating side effects, will be considered as part of the overall picture of a person with psoriasis’ health and treatment.  While I will aim for either the 1 percent body surface area goal, I also want to see how I’m feeling about the new treatments.

At the end of the productive doctor visit, I felt more confident and relieved knowing I have a personalized treatment plan and goal. I look forward to my next doctor visits and to updating you on my progress.

 

Rev. Howard Chang has lived with severe psoriasis and eczema for more than 35 years, since childhood. In addition to actively blogging and tweeting about skin-related concerns, he is the National Psoriasis Foundation Northern California Division Sacramento Committee Chair.

The opinions expressed by NPF Blog contributors are their own and do not reflect the opinions or positions of the National Psoriasis Foundation. The information posted on the NPF Blog is not intended as, and is not, a substitute for professional medical advice.


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