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5 Reasons Your Psoriasis Treatment Isn’t Working

By Leah Campbell
Reviewed by Allison Truong, M.D.
May 03, 2022

Any time you start a psoriasis treatment plan, you probably have a feeling of hope. You’re ready to find relief and optimistic that this treatment will get you there. So when it doesn’t, it’s normal to experience frustration and feelings of defeat. Not to mention how you may feel if a treatment that has previously worked suddenly stops being effective—likely, all those same negative feelings can come flooding back.

“There are numerous reasons your psoriasis may be resistant to treatment,” says board-certified dermatologist Scott Paviol, M.D., of PHC Paviol Dermatology in Charlotte, North Carolina. “First, you want to make sure you have the correct diagnosis from your doctor, that both of you are confident in.”

If there’s any doubt whether you have psoriasis, your doctor may want to confirm the diagnosis with a skin biopsy, Paviol says. If it’s definitely psoriasis and your treatments aren’t working, there may be several potential explanations—plus, plenty of alternative treatment options you can try to get the relief you deserve.

Here are the most common reasons for a psoriasis treatment not to work effectively.

You Aren’t Taking Your Medication as Directed

For a treatment to work effectively, it needs to be taken as prescribed. But according to one study, about one-third of psoriasis patients don’t adhere to their medication instructions. The most common reasons for this were drinking alcohol, frustration, forgetfulness, and being too busy. If you have any questions about how to properly take your medication, or if you find yourself missing doses or not being able to adhere to instructions, talk to your doctor for prescription clarification or ask for another treatment that may be a better fit for your lifestyle.

You Might Need to Give It More Time

Sometimes, treatment options require a little more time to begin working effectively. When starting a new treatment plan, Paviol says you should work with your doctor to define expectations and timelines, so you know what to expect—and, when to reach out to your doctor if those expectations aren’t met. There’s a wide range of when to expect results with different treatments.

“For example, if you are shooting for 70 percent improvement in the next month, you should be able to compare before and after photos to see if your treatment plan is meeting your expectations,” he explains. With topical treatments, most people should see improvement in less than a month. With systemic treatment, such as orals or biologics, most people should expect results in about three months.

Something May Be Triggering Your Flare-Ups

Chesahna Kindred, M.D., a board-certified dermatologist and founder of Kindred Hair and Skin Center in Columbia, Maryland says some people have specific triggers that may be to blame. For instance, if you’re sensitive to a specific food, it could cause your psoriasis to flare. Changes in weather or taking certain medications can also cause symptoms to appear.

“Oftentimes, I have to adjust my patient’s treatment regimen during the winter and back off again in the summer,” Kindred says. “If the patient started on a beta-blocker or lithium, these medications can worsen psoriasis despite appropriate psoriatic treatment.”

To improve your chances of achieving success on your treatment plan, take a good look at your lifestyle to ensure you’re making healthy choices. “Psoriasis is made worse by smoking, drinking alcohol, and poor diet,” Paviol explains. “Oftentimes, we want a magic bullet treatment, but really we need to be taking good care of our body and if we do, it makes our psoriasis easier to treat.”

You Might Need a More Powerful Treatment

“If you are using your prescriptions in the manner they are prescribed, you may need a more powerful treatment regimen to get things under control before flattening out into your maintenance regimen,” says Paviol. He explains that flare-ups may need combination therapies to calm the condition to a baseline level. Then, you may continue managing the condition long-term with a more simplified regimen.

For example, a patient may be on topical therapies (ie. triamcinolone cream applied twice daily on the weekdays and calcipotriene cream applied twice daily on weekends) with a systemic oral therapy (i.e., methotrexate taken once weekly with folic acid supplementation daily) to keep things under control until the patient gets approved for a systemic biologic therapy such as IL-23 inhibitor, which is given as a subcutaneous injection once every three months.

Unfortunately, insurance sometimes gets in the way, according to Kindred. “We may sometimes have a medication in mind that insurance companies will not cover until the patient has failed other treatments,” explains Kindred.

For example, an insurance company may cover systemic medication only if topicals haven’t worked for you. Those less powerful treatments may be your pathway to getting to something that works better for you. So, Paviol prefers not to think of these attempts as failures, since there are alternatives at the ready.

“Oftentimes, patients will prefer to start with a more moderate treatment plan, and if that isn't sufficient, we have a plan already in place for next steps, so we are set up to succeed,” he says.

You’ve Been Taking the Treatment for a Long Time

On the other hand, sometimes a treatment is successful for a while and then stops being effective. Paviol said there are several reasons a treatment that has helped in the past may no longer be effective.

“Most commonly, the patient doesn't use it as it is intended, the medication has expired, or the condition has changed,” he explains. And sometimes, it just stops working for that person.

“There is a concept called tachyphylaxis where there is a sudden decrease in response to a drug that was previously working,” says Paviol. That’s cause to try something else.

The good news, he says, is that there are a multitude of treatment options for psoriasis—all you have to do is let your dermatologist know your treatment is no longer working, and they can help you find something that will.

If you’ve followed your treatment plan as directed, and you’re still not seeing improvement—it’s time to call your doctor and discuss adjusting you plan.

“We have more treatment options than we’ve ever had for psoriasis,” says Paviol. “Please get help if this is something you are struggling with. Psoriasis can have huge effects on your physical and mental health, and we can help!”

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