Written by Anne Babcock Steiner, As Told to Haley Levine
I have had psoriasis for almost 5 years. I cycled all sorts of medications, from prescription topical ointments to immunosuppressants, until I found a biologic that put me at ease.
In early 2018, I had a sore throat. This was the first time I had this childhood illness in decades. Then, a few days later, I noticed a rash. They were small, round, scaly red spots all over my arms, legs, and chest. At first, I thought it was antibiotics, but then they started to itch.
I saw my dermatologist right away, who explained to me that I had a type of psoriasis known as guttate psoriasis. While most people think of psoriasis as large, red, shiny plaques, about 8% of people with psoriasis develop guttate psoriasis. They are usually caused by an infection, such as the flu or a sore throat. It can also be exacerbated by stress.
My dermatologist prescribed cyclosporine, an immunosuppressant (originally given to people who have had organ transplants, to prevent their bodies from rejecting their new organs). It is also used to treat severe psoriasis. I was a little nervous about taking it because it’s such a strong drug. It also seems to cause a headache almost always. It worked fine – the spots disappeared fairly quickly. I have been taking it for about 16 weeks, which is the recommended course of treatment. But when I got off it, my psoriasis recurred within weeks.
Diligent search for relief
I was off cyclosporine in late May. Over the next month, the psoriasis gradually returned. It seemed to be exacerbated by sweat and heat. It covered my entire body, but was especially bad on areas that had wrinkles, like my armpits, groin, and the creases of my elbows and knees.
Finally, around the Fourth of July, I found some relief. I was at a barbecue at my sister’s house and was complaining of constant itching. I rushed in and came back with a bowl of the steroid cream she prescribed me to try. I took it, and two days later, it seemed to help.
I went back to my dermatologist, who prescribed two steroid creams: betamethasone, for my legs, arms and torso, and triamcinolone, for more sensitive areas like the groin and armpit. They helped me – my psoriasis didn’t completely go away, but it was at least relief from the itch that kept me up at night and kept me from getting my work done. But my doctor only wanted me to use it for short periods – a week after that, for example, then a week off – and I couldn’t do it. Once I stop, the intense itching will return within a day or so.
Last February I had a weekend where I didn’t feel well. I had constant headaches and just felt exhausted and exhausted. Two days later, it was gone, and I didn’t think of anything else about it until a week later, when I got out of the shower and saw my torso covered in those same little round red spots.
I saw my dermatologist right away, and he told me I had another bout of psoriasis. While my bacteria test was negative, I also had antibody tests which revealed that I had been exposed to the bacteria recently. Even though I was basically asymptomatic, it was enough to cause my psoriasis to come back.
This time, my psoriasis was all over the place. Not only did it cover my torso and limbs; It was on the bottom of my feet and my scalp. My dermatologist initially put me on stronger prescription steroids, plus something called a coal tar treatment. It took 20 minutes in the morning and 20 minutes at night to put this ointment all over my body, but it didn’t work, and it stained all of my clothes.
Two weeks later, I returned to her office to discuss options. I didn’t want to go back to immunosuppressive drugs during a deadly pandemic. But I was so miserable, I didn’t know what else to do.
Fortunately, my dermatologist had some good news. She told me, “The world has changed since the last time this happened to you, and it’s not just because of COVID-19.” Over the past few years, there has been an increase in a new type of medication to treat psoriasis, known as biologics. Like cyclosporine, these drugs will target my overactive immune system, but unlike cyclosporine, they will only calm the part of my immune response that was involved in psoriasis. As my dermatologist said, “It just takes out all the foot soldiers versus all the generals.” This means it had less risk of side effects as well.
She put me on a biologic medication that was approved in 2019 for moderate to severe psoriasis. Treatment includes two injections spaced each month at a dermatologist’s office, and then every 12 weeks thereafter. The results were exciting. It started helping within 5 days. Most of the plaque spots – including persistent, itchy spots under my armpits and groin – are gone, except for the spots on my legs. But those almost disappeared after my second shot. The itching is completely gone.
It’s unclear how long I’ll need to stay on biology, but I’ll take it for as long as my dermatologist says I need to. It is convenient not to worry about sweating, heat, or any other environmental factors that could lead to severe itching. I had psoriasis less than 5 years ago and that was enough to make me see how debilitating it could be. I’m just relieved to get my life back.