Can My Psoriasis Go into Remission?
Psoriasis is a chronic condition, meaning many people live with it forever. But everyone experiences it differently, and for some, there is hope for remission.
“Psoriasis is an unpredictable skin disorder in the sense that it does sometimes spontaneously remit after long periods of flare-ups,” says board-certified dermatologist Todd Minars, M.D. of Minars Dermatology in Hollywood, Florida. “In other words, it can wax and wane over the years—with good times and bad times.”
What Does Remission Mean, Exactly?
Just as psoriasis can take various forms and appear on any part of the body, remission can mean different things to different people. For some, it means they attain clear skin, with no physical symptoms of the disorder. Others may experience enough of a reduction in their symptoms to have a positive impact on their physical and mental health that they call it remission.
“For patients with mild psoriasis, symptoms may come and go, with flare-ups depending on the trigger,” says Tanya Nino, M.D., a board-certified dermatologist with St. Joseph Hospital in Orange County, California. Common psoriasis triggers include stress, cold weather, alcohol, smoking, and hormonal changes.
Nino says some patients truly go into remission, meaning that their symptoms subside even though they’re not on any medications for psoriasis. However, she says, these cases are few and far between, and are more likely to be mild in nature to begin with. “Many of these patients may have flare-ups later in life, depending on what triggers they encounter,” she adds. “Remission can last from months to years, but unfortunately, psoriasis will often return in one way or another.”
For patients with more severe, widespread skin involvement, systemic therapy is often required to keep their psoriasis suppressed, Nino says—and their skin might never clear completely. Systemic therapies (prescription drugs that work throughout the body) include oral medications and injections called biologics, both of which suppress the overactive immune system, which is causing symptoms.
Do Any Treatments Induce Remission?
While many people with psoriasis see great results with certain treatments, most don’t result in remission.
“Generally speaking, most psoriasis treatments can work really effectively while you’re using them, but once you stop, you'll typically see psoriasis gradually return over time,” explains Minars.
However, there is one exception: narrow band UVB (ultraviolet B) light therapy, which exposes the patient to a specific range of wavelength of UVB light for a short period of time usually two or three times a week. Once patients achieve clear skin, treatment is gradually tapered off and patients may go into remission for some time.
“A patient who completely stops or reduces UVB frequency to once a week or less, can still remain clear—or at least satisfactorily clear—for several months thereafter,” says Minars. So it could be said to provide short-term remission.
UVB applied to localized psoriatic plaques in the form of an excimer laser (also known as an exciplex laser) can also be very effective, he adds. But it’s important to be aware that this type of remission will only be possible for patients who respond to the treatment in the first place. Like with any treatment, some patients will fail to respond to UVB, Minars points out.
“No psoriasis treatment is a permanent cure,” he notes. “Any ‘remission’ with psoriasis still implies ‘temporary.’”
Should Remission Even Be a Goal?
We might not have a cure for psoriasis yet, but there are many treatment options available that can help—a fact that Nino likes to focus on when treating her own patients.
“I will often tell them that we can't truly cure their psoriasis, but that we will be able to manage and control the symptoms,” Nino says. “I have had patients with more than 50 percent body-surface area covered in psoriasis go on to have completely clear skin when put on the right medication.”
Nino adds that some of these patients have such persistent psoriasis that if they stop their medication, the skin plaques come right back. “So, I don't know if remission is the correct word for these patients,” she explains. “I think of it more as disease control.”
How to Bring Up Remission with Your Doctor
If remission is your goal, the first step is to see a board-certified dermatologist. “There are so many safe, effective treatments out there, which your dermatologist will discuss with you,” Nino says. “They’ll go over the risks and benefits, and assess the severity of your disease, your age, risk factors like kidney or liver problems, pregnancy status, and other medical problems you may have.”
Nino always asks her patients about their quality of life—the more impact the psoriasis has on it, the more likely she is to recommend a systemic treatment to help control the disease and improve their daily life. “It may take a few weeks after initiating treatment to see a response,” she says. “But the improvements can be dramatic and can greatly help improve a person's lifestyle and comfort in their own skin.”
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