How One Woman Found Relief After Severe Psoriasis Left Her In Constant Pain & Itching: ‘Ninety-Five Percent Of My Body Was Covered’

Psoriasis is an autoimmune condition in which the immune system becomes overactive, triggering inflammation and causing skin cells to multiply too quickly. This rapid cell buildup can lead to raised, scaly patches known as plaques. These areas may cause itching, burning, or stinging sensations and can develop anywhere on the body, though they commonly appear on the elbows, knees, lower back, and scalp.

By January 2022, Michelle noticed a buildup on her scalp that she initially suspected to be dandruff [a mild and common, manageable issue that often causes white flakes on the scalp].

After assuming the symptom was minor, she said she tried treating her scalp with oil rather than seeking medical advice.

She eventually became concerned as the condition continued to worsen. She described increasingly heavy flaking, redness on her scalp, and irritation that started extending to her ears and the back of her neck.

Michelle chose to contact her doctor in February 2022, sharing photos of the flaking and rashes, only to be given a prescription lotion and spray which didn’t help.

After noting that she had also tried an oral medication, Michelle said she still saw no improvement in her symptoms.

“The rashes are spreading all over my body except my face. So I went to a dermatologist,” she recounted. That was when she learned she had “a case of severe psoriasis.”

Michelle, who described the initial stages of her condition as extremely painful and uncomfortable, said that after doctors determined biologic treatment was the best option for her, she began seeing noticeable improvements.

According to the National Psoriasis Foundation, biologic treatments target specific parts of the immune system and are given by injection or IV infusion.”

It’s important to note there are three main categories when it comes to treatment options for psoriasis:

• Topicals which include creams and ointments
• Phototherapy or light therapy
• Systemic treatments which include injectable treatments

Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System, told SurvivorNet in an earlier interview that there’s a broad range of treatment options ranging from topicals to systemics.

“Within systemic, you can have oral molecules or pills, or you can have injectables,” she said.

Most of the injectable treatments for psoriasis are something known as biologic drugs or biologics. These drugs target the immune system to help alleviate some of the symptoms of psoriasis. The drugs can be referred to as “systemic” treatments because they target parts of the immune system, as opposed to something like an ointment which can be used for symptoms on just specific areas of the skin.

Recently, a drug called Sotyktu (deucravacitinib) was also approved for people with plaque psoriasis who prefer an oral option over an injectable.

There are several drugs available to help alleviate symptoms of psoriasis, including injectable drugs that target different proteins in the immune system. They work by targeting and blocking molecules in the body that could be causing outbreaks.

“All of these are injections which are approved for psoriasis … some of them are also approved for psoriatic arthritis,” Dr. Khattri explains. Psoriatic arthritis can cause swollen, painful joints and other symptoms that are typical of arthritis, alongside more typical symptoms of psoriasis.

Biologic medications, also known as biologics, are typically prescribed after first-line treatment for psoriasis fails. Although they’re considered to be safe, patients should still be monitored regularly as they carry a risk of suppressing the immune system and causing infections. Furthermore, investigational studies should be carried out to determine their long-term safety

What is Psoriasis? Understanding the Different Types and Symptoms of This Rare Skin Condition

Michelle encourages others facing similar challenges, “You are not alone. We need to acknowledge that it’s more than just a skin condition.

“We need to take care of ourselves.”

Understanding The Treatment That Helped Michelle

Michelle’s symptoms finally subsided after she was introduced to biologics. It’s unclear the specific type she was give, but it’s helpful to understand there are three main categories of biologics used to treat psoriasis, according to Dr. Khattri.

These include:

• Injections that target and block TNF, a pro-inflammatory molecule that the body may be producing too much of when a person has psoriasis (includes drugs like Humira, Cimzia, and Enbrel)
• Injections that target and block IL-17, another pro-inflammatory molecule that could trigger psoriasis symptoms (includes drugs like Cosentyx, Taltz, and Siliq)
• Injections that target IL-12 or IL-23, which are also proteins linked to psoriasis symptoms (examples of these drugs include Tremfya and Ilumya)

Even though biologics have proven to be very effective in treating patients with moderate-to-severe psoriasis and psoriatic arthritis, the biggest concern remains with the increased risk that patients can develop serious infections while being on the medication (including Tuberculosis).

Other side effects can include the following:

• Allergic reactions on the skin as a result of the injection
• Headaches
• Flu-like symptoms (like fever, chills, cough, sore throat, fatigue, and runny nose)
• Urinary tract infections
• Upper respiratory tract infections

Nevertheless, it’s important to note that each of these biologics will come with a list of specific side effects that need to be discussed by your doctor first before initiating treatment. You should also share with your doctor any side effects, discomfort, or questions that you may have.

Psoriasis: How to Make Treatment Decisions

Additionally, due to psoriasis being a chronic condition, injectables to treat the disease are not a “one and done” thing, as Dr. Khattri puts it. How often you need to take the drugs will depend on what type you are getting, your symptoms, and some other factors like your overall health.

Some injectables must be administered by a doctor at their office, while with others, patients can be taught how to inject themselves at home. Obviously, administering the drugs at home is easier, but seeing a doctor regularly for injections does have other benefits — like giving the doctor the opportunity to monitor symptoms and side effects.

Moreover, these injections can be administered by either getting a shot or through an intravenous (IV) infusion.

How Long Can You Stay on Biologics Treatment for Psoriasis?

According to the American Academy of Dermatology Association, it’s generally acceptable to stay on biologics treatment indefinitely as long as you follow up with your doctor regularly to monitor and manage your condition.

Dr. Khattri explains, “These injections are something that you’d have to be on as long as it’s needed or as long as it’s efficacious for you in terms of treating your psoriasis. Different biologics have different injection schedules. You have some that are every week, others that are every other week, and then you have some that are once a month or every three months.”

Other Psoriasis Medication Injections

Aside from biologics, other types of psoriasis injectables can be used to reduce the inflammatory effect brought on by the immune system, decrease pain, and help keep damaged tissues to a minimum. These include the following options:

Steroids: These injections have a very good chance to alleviate pain, tone down flare-ups, and improve function due to their resemblance to the cortisol hormone which provides anti-inflammatory functions in the body. Examples of these injectable drugs include cortisone, prednisolone, and methylprednisolone.

How Will Psoriasis Affect Your Social Life? The Importance of Friendship & a Strong Support System

Steroids can either be taken as an oral medication or administered through injections, they can also be taken alone or combined with other treatments. Your doctor will decide whether you should take steroids or not and will know the appropriate dosage and form that’s best suited for your case.

As with any drug, steroids have some risks and benefits that will doctor can help explain to you.

Some side effects that can be caused by steroids injections:

• Infections
• Allergic reactions
• Bleeding
• Skin changes
• Bone weakness and tendons

Methotrexate is a strong medication that’s used to treat adults with severe psoriasis by combating the overbearing effect of the immune system which causes symptoms of psoriasis and psoriatic arthritis. It comes in many forms like injections and pills, and typically shows improvements between 4 to 6 weeks. However, they don’t work for everyone.

They can cause the following side effects:

• Loss of appetite
• Hair loss
• Headaches
• Fatigue or tiredness
• Mouth sores
• Decreased urination
• Swelling of gums
• Serious effects on major organs (liver, lung, or kidneys)

Additionally, pregnant, and breastfeeding women are prohibited from using methotrexate. Thus, it’s important to ask your doctor whether methotrexate is the best treatment for you.

What are the Different Types of Psoriasis?

There are several different types of psoriasis, with plaque psoriasis being the most common. The types differ in how they present and what they are caused by.

• Plaque psoriasis: This is the most common form of the disease and causes dry, raised skin patches that may be covered in scales. The patches may be itchy and tender.
• Nail psoriasis: This disease can affect fingernails and toenails and might cause nails to loosen from the nail bed.
• Guttate psoriasis: This disease typically affects young adults and children and is often caused by a bacterial infection, like strep throat.
• Inverse psoriasis: This type of psoriasis mainly affects skin folds, so it will often present in areas such as the groin, buttocks, or breasts, and can worsen with friction or sweating.
• Pustular psoriasis: This is an atypical (rare) form of psoriasis that causes pus-filled blisters to develop in widespread patches across the body.
• Erythrodermic psoriasis: This is also a rare form of the disease. It can cover the entire body with a red, peeling rash that may itch or burn intensely.
• Psoriatic arthritis: With this form of the disease, joints may become swollen, irritated, and painful. Sometimes, joint pain is the first or only symptom, while other times other symptoms like nail changes will occur for some people.

Questions to Ask Your Doctor

• Are injectables a good option for my particular type of psoriasis?
• Can the drugs be administered at home, or will I need to come to your office?
• Is it safe for me to take biologics?
• How long will I need to take biologic treatment?
• What side effects should I be aware of?
• Are there other treatment options that may be more effective?
• What do you recommend I should do to improve the quality of my life with this condition?
• Is there anything I should or shouldn’t do to better manage my condition?
• How often should I follow up with you about my condition?

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

---