How I Came to Better Control My Psoriasis

From everydayhealth.com

A combination of light therapy and biologics helped the author gain better control of his psoriasis.

                                                     Getty Images; Rafe Swan/Getty Images

When it comes to my psoriasis, I don’t often have good news to share. Today, though, I can say my skin looks and feels clearer than at any time in recent memory. I woke up this morning feeling great and took less time than usual to take care of my skin before heading out to work.
The last time the inflammation on my skin calmed this much I was taking cyclosporine to manage my psoriasis and atopic dermatitis. Cyclosporine effectively controlled my skin conditions at higher approved doses. However, my doctors and I agreed from day one that I should try to find something with fewer and less severe side effects for long-term management.
Treatments I tried over a 12-year period failed to work well enough to allow me to stop cyclosporine completely. Then last summer a new biologic injectable medication called Tremfya (guselkumab) gained U.S. Food and Drug Administration approval, and my doctor and insurance company allowed me to try it. It improved the psoriasis enough to where I could almost stop using cyclosporine.

This August marks the one-year milestone of my trying that new biologic. It also happens to be Psoriasis Action Month. A couple of years ago the National Psoriasis Foundation (NPF) decided to change the month’s focus from “awareness” to “action.” The idea of the new emphasis is to empower those with psoriasis to take control of their disease.
This message resonates with me because there have been times when my psoriasis seemed to be in control of my life. The repeated failure of traditional and complementary treatments left me dejected and willing to settle with more psoriasis. The following tells the story of how I overcame disempowering barriers and took positive steps to better control my psoriasis over the past year.

It Works for Me

I vividly remember a psoriasis magazine column called “It Works for Me.” I enjoyed reading about how certain treatments helped individuals with psoriasis. It also gave me new things to try even if they might not ultimately work for me. I daydreamed about how I would one day share my story in that column.
What became discouraging over the last few years, though, is how new treatments worked for others while none seemed to work for me. When I heard a friend in the psoriasis community share their story of how a treatment cleared their skin, I felt both glad and envious. One time, I told a friend that I was still using cyclosporine. They shook their head disapprovingly and said, “You need to get off that!”
Psoriasis medications and treatments often come with a percentage label indicating its effectiveness. The first biologic injectable for psoriasis, called Amevive (alefacept), became available in 2003. Even though studies showed a relatively low effectiveness rate, it helped a friend at church with psoriasis. Remembering that friend gave me hope to keep trying and encourage others to find what works for them.

Failure Is Not an Option

One of my favourite movies is the 1995 film Apollo 13, directed by Ron Howard. The flight director of the Apollo mission, Gene Kranz, is attributed with saying “Failure is not an option” when the mission goes awry. That phrase represented the Apollo team’s dedication and perseverance to find a solution to save the astronauts. When I wanted to give up on finding a better treatment for my psoriasis, I thought of Apollo 13.
With the rapid flow of psoriasis research findings and treatments available, I reasoned I could eventually find a solution for myself. One treatment I tried midyear, however, tested that enthusiasm. I can’t say for certain that the medication made me feel ill, but I can report that it did not improve my psoriasis during the few months I took it.
My dermatologist and I then set our sights on using the new biologic, which was scheduled for availability a few months later in the summer. In the meantime, I went back to cyclosporine and pondered the next steps. I didn’t give up hope, although I needed a pause. The saying “Failure is not an option” inspired me as I recovered and regained the strength and will to fight on.

Treatments New and Old

The biologic worked as well as any of the four I had tried before, but not well enough. After a few months, my dermatologist declared that psoriasis covered a moderate amount of my skin and that my atopic dermatitis needed better control. I immediately asked if I could go back to cyclosporine. But he suggested I add either narrowband ultraviolet light therapy or another biologic for atopic dermatitis.
Neither of the two options he proposed appealed to me. Light therapy is an old treatment that I first started using at age 9. Since then, I’ve logged over 20 years on various forms of light therapy. I even vowed to never use artificial ultraviolet light again after I sustained a painful skin burn over a decade ago. The idea of taking a second biologic seemed intriguing, but I worried about the side effects and cost.
I opted to purchase a home narrowband ultraviolet light panel, and started using it at a very low dose of light exposure three times a week.
It took a couple of months of trial and error, but the light therapy–biologic combination treatment did begin to clear my psoriasis and atopic dermatitis. I’m hoping that this combination works for a while so I can enjoy the rest of summer with mostly clear skin.
Gaining better control of my skin conditions has taken perseverance, courage, and a willingness to try an older treatment together with a newer biologic. While there is no magic formula that works for everyone with psoriasis, I encourage anyone still struggling to manage their psoriasis well to take action this month. Remember: Failure is not an option!
You can read more about my experiences in my blog for Everyday Health and on my website.

https://www.everydayhealth.com/columns/howard-chang-the-itch-to-beat-psoriasis/how-came-better-control-my-psoriasis/