Why Isn’t My Psoriasis Treatment Working? 12 Possible Causes

From healthline.com

Psoriasis is a skin condition with different classifications that all involve an autoimmune response. It can differ in:

• type
• site
• severity

And like other autoimmune diseases and disorders, there’s no one-size-fits-all course of treatment. This can make it challenging to find a treatment that works for you.

You may also find that your treatment becomes less effective over time. This can happen either suddenly or gradually.

Why do treatments stop working?

There are a number of common reasons why a psoriasis medication may stop working or may not be as effective over time at managing your symptoms. They include:

1. Drug tolerance

Your body can develop a tolerance to topical treatments after a period of continual use. Topical treatments are substances that you apply directly on your skin. Tolerance lessens their effectiveness.

It can happen with both corticosteroids and non-steroid topical treatments. This process is referred to medically as tachyphylaxis.

2. Toxicity

Research shows that toxicity can build up in the body and affect its organs with long-term use of conventional systemic drugs to treat psoriasis.

Toxicity has also been linked to the onset of skin cancer after long-term phototherapy. When this happens, you’ll need to consult with your medical provider for alternative treatment options.

3. Anti-drug antibodies (ADAs)

The body sometimes produces antibodies in response to both conventional systemic drugs and the newer biologic medications.

ADAs are chemicals the body produces to attack medications, which reduces their effectiveness.

Biologics are newer medications developed in the last two decades, made from living cells to target specific parts of the immune system.

4. Biologic fatigue

The tendency of biologic drugs to lose their effectiveness with long-term use is known as biologic fatigue.

Medical researchers do not entirely understand why this occurs in some people but not in others and with some drugs but not with others.

5. Biologic side effects

Biologics have a strong effect on the immune system and may create an increased risk for infections to develop. For this reason, they’re generally used after other treatments have been tried first.

The body may also develop a resistance to them over time.

6. Skin infection

Skin infections can slow down treatment progress, and some psoriasis medications can actually make an infection worse. If you have any signs of an infection, such as crust or oozing, see your doctor right away.

7. Misdiagnosis

Infections, eczema, and contact dermatitis can closely mimic psoriasis. If you’re not responding to treatment or your treatment stops working, it’s a good idea to ask your doctor if this is a possibility.

8. Missed doses

There are lots of reasons why you might miss a dose or two of your medication. Some treatments can withstand the occasional skip, but others rely on steady and consistent use.

If you often forget to take your medication, try using an app or calendar tool that sends a reminder when it’s time for that day’s dose.

If cost is an issue, talk to your doctor about drug discount programs or alternative treatment methods.

9. Stress

Stress can trigger psoriasis flare-ups, so finding ways to successfully manage it can make a big difference in your skin — and your life!

10. Combination needed

One drug may not be enough to improve psoriasis. Topical creams often work better along with a vitamin D cream for mild to moderate psoriasis.

Research shows that using the systemic drug methotrexate in combination with biologic drugs is often more effective than either medication alone.

Phototherapy, or light therapy, is often more effective in combination with topical medications.

11. It takes more time

Although topical treatments can sometimes make a difference in days for mild psoriasis, biologic medications can sometimes take weeks, or even months, to have an effect.

Phototherapy can take between 15 to 25 treatments to work, according to the National Psoriasis Foundation. Sometimes, patience is all that’s needed to see improvement from your treatment.

12. It’s time for lifestyle changes

Smoking and drinking can worsen psoriasis symptoms and lessen chances for remission, according to the National Psoriasis Foundation. 

Drinking can lessen treatment response and is dangerous combined with the systemic psoriasis drug methotrexate.

What to do when treatment stops working

It can be frustrating to see your skin improve with a psoriasis therapy, only to have your symptoms return months, or even years, down the line.

This can happen with any psoriasis treatment:

• topical
• conventional systemic
• biologic

What to do depends on what type of therapy you’re using. The first thing to know is that decreased effectiveness is common.

You’ll probably want to consult your healthcare provider for new options. Usually, there are changes you can make to find a treatment that works.

Try the following suggestions to get your treatment back on track.

Check your schedule

Make sure you’re using or taking your medication according to the prescribed schedule. If you’ve missed doses or not been regular in your topical application, that could be why the medication isn’t working.

Consult your healthcare provider

If your treatment stops working, you’ll want to check with your healthcare provider about next steps. They may prescribe alternative or additional treatment and check for toxicity, tolerance, or ADAs.

Double up

Your healthcare provider may recommend combining your treatment with additional therapy. Biologics often work better combined with a conventional systemic medication such as methotrexate.

Skin creams may work better with additional vitamin D therapy. A combination phototherapy treatment known as PUVA can be very effective when combined with a drug called psoralen.

Give it time

Some psoriasis treatments, especially biologics, can take up to several months to begin working. Check with your healthcare provider to make sure your expectations are in line with your medication’s timeline.

Change habits

Smoking and drinking alcohol in excess can affect both psoriasis flares and the effectiveness of treatment.

Healthy lifestyle changes, like quitting smoking and drinking moderately, as well as keeping active, eating a healthy diet, and managing your weight, can help reduce psoriasis flares.

Find a support group

In addition to talking to your healthcare provider, you may want to participate in an online support group for people with psoriasis.

The time when a treatment stops working can be stressful, and others who have dealt with the same issue may be able to help.

When to consider switching treatments

There are many signals that it may be time to switch your psoriasis treatment. Maybe the treatment doesn’t work from the beginning, or it stops working after a period of successful use.

Maybe there are safety concerns about toxicity, or your body begins producing ADAs.

There may be side effects that are more uncomfortable than you want to deal with or maybe you just don’t like some aspect of the treatment, such as daily injections or time-consuming cream applications.

There’s no single set of symptoms that say it’s time to switch and no general timetable for when to switch.

Each therapy differs in:

• safety concerns
• how long it takes to work
• when it might stop working

Every person is different, too. For reasons medical researchers don’t entirely understand, the same medication can affect different people differently.

Here are seven signals that it may be time to talk to your healthcare provider about switching your psoriasis treatment.

1. Your treatment doesn’t work

Not all treatments work for everyone. Some treatments may not work for you. Topical creams may not help your skin clear up, and some systemic treatments may not bring improvement either.

If you’ve administered your treatment regularly and given it enough time to work, and you still don’t see improvement, it may be time for a change.

2. Your treatment stops working

Everything was great at first. Your skin started clearing up. Then, weeks, months, even years later, symptoms returned. This is an all-too-common story with all types of psoriasis therapies.

With topical treatment, the body may develop a resistance to the medication over time.

With conventional systemic medications, as well as biologics, the body may produce ADAs that limit the drug’s effectiveness after months, or even years, of treatment.

The reason that a drug stops being effective is not entirely understood. ADAs may not tell the whole story.

A 2013 study published in the British Journal of DermatologyTrusted Source only found a connection between ADAs and decreased treatment response in participants taking two of the four biologics studied.

Whatever the reason, when your treatment stops working, it’s time to consider switching. Some doctors recommend switching even before it stops working to avoid the return of symptoms.

3. Your psoriasis progresses

The progression of psoriasis is unpredictable and not totally understood.

Research published in the Journal of Drugs in Dermatology in 2018 points out that some cases of psoriasis can remain stable for years.

In other cases, the condition can advance quickly to involve organs, including the heart, liver, kidney, and intestines, as well as joints and muscles.

If your psoriasis advances, it may outpace your current treatment, which then becomes less effective. At that point, you’ll want to talk to your healthcare provider about alternative treatments.

4. Toxicity or side effects develop

Both conventional systemic drugs and biologics can have severe side effects.

Liver toxicity has been associated with long-term use of the conventional drug methotrexate, while kidney toxicity has been associated with long-term use of cyclosporine.

Because of this risk, conventional systemic drugs like methotrexate, oral retinoids, and cyclosporine are typically only given for a short time.

Biologics also have side effects. Because they affect the immune system, they can increase the risk of infections, such as tuberculosis and pneumonia, as well as staph and fungal infections.

If your healthcare provider finds that any of these toxicities or serious side effects occur, you’ll probably need to change treatments.

5. Other conditions develop

According to the National Psoriasis Foundation, people with psoriatic disease have a greater risk for other diseases and disorders, which are known as comorbidities.

Comorbidities, or co-existing conditions, that have been associated with psoriasis include:

• cardiovascular disease
• depression
• kidney and liver disease
• osteoporosis
• diabetes
• various cancers, including lymphoma and melanoma

Even a relatively safe treatment, like phototherapy, may increase your risk for skin cancer if your skin is sensitive to light or you have a family history of skin disorders.

If you develop an additional condition, you’ll want to be sure your healthcare provider coordinates your psoriasis treatment with your new treatment. It may involve changing your psoriasis treatment.

6. You’re pregnant or breastfeeding

Psoriasis itself won’t affect your pregnancy or your baby, but some of the medications can.

Some biologic and systemic medications, as well as coal tar and some other topical treatments, should be avoided during pregnancy,

Once you decide to get pregnant, you may need to stop or change some of your psoriasis treatments weeks, or even months, before trying to conceive. Be sure to consult your healthcare providers to discuss your options.

It’ll be easier if you try to get your psoriasis to a point of being well-managed before you get pregnant. That way, you’ll have fewer flare-ups during your pregnancy and less need for medication changes.

7. Your treatment doesn’t accomplish your goals

According to the National Psoriasis Foundation, you can expect to be able to develop a treatment program that clears your skin, has few side effects, and complements your lifestyle — even with moderate to severe psoriasis.

A study published in Dermatologic StudyTrusted Source in 2015 points out that historically this expectation wasn’t always realistic.

Before the development of biologics, people with psoriasis were expected to tolerate some degree of skin issues and a wide variety of side effects from medication.

With the wide range of treatment options now available, you can work to successfully manage your condition.

You can work with your healthcare provider to tailor the effectiveness, side effects, and lifestyle requirements of various treatments to develop a program that meets your personal treatment goals.

This may involve switching treatments multiple times until you find one that works for you.

Takeaway

Finding the right treatment for your psoriasis may take some time, but it’s possible.

Make an appointment with your doctor if you think your current treatment is no longer working.

Discuss the reasons why your treatment isn’t working and which alternative treatment options are a good fit for you.

https://www.healthline.com/health/psoriasis/why-your-psoriasis-treatment-is-not-working?slot_pos=article_1&utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=psoriasis&utm_content=2022-07-26&apid=39239719&rvid=058431b717dcfa59c0cdd27cd0a9313769e8b3dd4ad59d88efd0ded7ddb4774e

6 Best Fruits for Psoriatic Arthritis

From everydayhealth.com

Add these delicious, fresh treats to your PsA-friendly diet this summer. They may help reduce joint swelling and pain 

When you live with an autoimmune disease such as psoriatic arthritis (PsA), you are always looking for ways to help reduce inflammation and oxidative stress (an overabundance of free radicals that can damage fatty tissue, DNA, and proteins in your body). Part of the solution this summer may be no farther than your backyard, farmers market, or supermarket: juicy, refreshing fruits.

Fruits Can Be a Healthful PsA Resource

“Just keep in mind that fruits are in no way a replacement for medical treatment. However, they can be a delicious part of your overall therapy,” says Bonnie Taub-Dix, RDN, author of Read It Before You Eat It: Taking You From Label to Table.

Remember to Read Package Labels

If you’re buying canned, dried, or frozen fruits, read the labels to make sure there aren’t added sugars or sodium. “These can exacerbate your symptoms and make comorbidities like diabetes and cardiovascular disease worse,” warns Taub-Dix.

                       Fight inflammation with fruits like mango, kiwi, and avocado.                                                                    Canva; Everyday Health

6 Fruits That May Help You Stay Healthy

1. Avocado

Avocado is a good source of vitamin C and vitamin E — the latter is not found in a lot of other fruits. These vitamins have an anti-inflammatory effect, which means eating avocados may help decrease joint pain.

Try It Make guacamole, of course, or use avocado as a veggie burger topping. Taub-Dix also substitutes mashed ripe avocados for butter or oil in muffins, using a 1:1 ratio. “That can help decrease saturated fat intake, which is great for some PsA comorbidities such as heart disease,” she explains.

2. Cherries

Cherries — both sweet and tart — have polyphenols (plant-based compounds) and vitamin C, both of which have anti-inflammatory and antioxidant properties, notes a review published in Nutrients in 2018. “Studies have also shown that cherries may help improve the quality of your sleep. If you have PsA, you may be uncomfortable and/or in pain that can disrupt restorative sleep. Cherries can perhaps help with that,” says Taub-Dix.

Try It Cherries are so naturally sweet that if you use them for a cobbler, you don’t even have to add any sugar. (Some canned varieties do have extra sugar and sodium, so watch out for that.) Or serve them frozen for dessert.

3. Berries

Berries are loaded with polyphenols such as anthocyanins, which produces their red, blue and purple colours; quercetin; and various types of phenolic acids that reduce inflammation, according to a review published in Food and Function in 2018. “They are also high in vitamin C, which is important for collagen building in skin and bones,” says Taub-Dix, adding that just eight strawberries have as much vitamin C as an entire orange.

Try It Cut them up and put them into a jug of water in your refrigerator. As you drink water throughout the course of the day, you’ll get the bonus of the berries’ taste and nutrients. Or throw them on a spinach salad with mandarin oranges and walnuts.

4. Pineapple

A traditional symbol of welcome, this hydrating fruit is loaded with vitamin C, as well as manganese, which helps maintain bone health. Pineapples are also a good source of the enzyme bromelain, which helps reduce inflammation and pain while also boosting the immune system. An added bonus: Pineapples may aid in digestion.

Try It Grill pineapple-chicken-cherry tomato kabobs with a little olive oil. Hollow out the pineapple and use the shell as a bowl for a fruit salad. Or core it from the top and use the shell to hold a pineapple fruit smoothie.

5. Mango

Mango contains vitamin C, polyphenols, and carotenoids, which can help reduce inflammation and protect against bone destruction, says Taub-Dix.

Try It This is another fruit that’s yummy when grilled. You can also cut it up and add it to cottage cheese or yogurt. Taub-Dix likes to put a slice in a hot cup of herbal tea. “It naturally sweetens your tea. When you’re done with your tea, you have this warm mango to eat. So good.”

6. Kiwi

This fuzzy fruit is high in vitamin C and antioxidants, which stimulate the immune system. It also contains a healthy dose of dietary fibre, which may reduce the risk of heart disease, a common comorbidity of PsA.

Try It Peel and slice it, then put it on top of a kale salad. Make kiwi chips: Slice thinly (it’s up to you whether you want it peeled or not), place on a baking tray, and bake at the lowest temperature for around 4 to 6 hours.

https://www.everydayhealth.com/psoriatic-arthritis/best-fruits-for-psoriatic-arthritis/ 

Clubbing of the Fingers or Toes

From verywellhealth.com

Finger or nail clubbing can point to an underlying health condition

Clubbing of the fingers, also described as hypertrophic osteoarthropathy (HOA), is an enlargement of the ends of the fingers accompanied by a downward sloping of the nails.

Clubbed fingers by themselves are not harmful, but since it can be a sign of lung cancer, among other diseases, it is important that your medical team identifies the cause and that you are treated for your underlying condition.

This article covers causes and symptoms of clubbed fingers and clubbed nails, along with how clubbed fingers are diagnosed and treated.

Desherinka / WIkimedia Commons / CC BY-SA 4.0 

Also Known As

Clubbing is also referred to as clubbed fingers, digital clubbing, watch-glass nails, drumstick fingers, Hippocratic fingers, Hippocratic nails.

Verywell / Jessica Olah

Primary vs Secondary Clubbing

Clubbed fingers, nails, or toes are typically a sign of severe disease, but not always.

Primary (idiopathic) clubbing is clubbing that occurs alone, without the presence of any underlying disease. Primary clubbed fingers, toes, and nails are a rare inherited trait—accounting for just 3% of all clubbing cases.

Secondary clubbing occurs as an effect of another health problem, such as lung cancer, heart disease, or cirrhosis of the liver. In fact, secondary clubbing is caused by lung cancer or lymphoma in approximately 80% of cases.

Is Finger Clubbing Rare?

The most common cause of secondary finger clubbing is lung cancer, however, only 5% to 15% of people with lung cancer develop clubbed fingers. Primary finger clubbing is far more rare.

Symptoms

Clubbing can involve your fingers and/or toes. It is typically bilateral (affecting both hands and/or feet) and it should be equal in terms of its extent on both sides.

If you or your child has primary HOA, then your fingers or toes may naturally appear large, bulging, and rounded. This will be noticeable during childhood or during the teenage years, and it will not change much over time. With primary HOA, other family members are also likely to have finger clubbing and/or toe clubbing.

Secondary clubbing happens gradually, and it causes a change in the appearance of your fingers and/or toes. With secondary clubbing, which is caused by disease, you would also have other features that are not seen in primary clubbing.

Features of secondary clubbing include:

• Softening of the nails
• Nail beds that soften and feel spongy
• Nails that seem to "float" instead of being firmly attached to your fingers
• Disappearing of the angle between your nails and cuticle
• Enlargement or bulging of the distal portion of your finger (where your finger meets your nail)
• Warm, red nail beds
• Nails that curve downward and look like the bottom of the round part of a spoon

Eventually, the nail and skin around the nail may become shiny, and the nail develops ridging.

Is Finger or Nail Clubbing Painful?

Clubbed fingers or clubbed nails by themselves are usually painless, and many people with clubbed digits are unaware of the issue. Painful clubbing may occur in some people with certain conditions that cause scarring in the lungs.

Causes

Primary clubbing is hereditary, and it is passed down via genes. Hereditary clubbing is simply a physical feature, like the colour of your eyes or your height. Several genes have been associated with primary clubbing, including the HPGD gene and the SLCO2A1 gene.

Secondary clubbing occurs as one of the effects of chronic lung and heart disease. Lung cancer is the most common cause of clubbing. This sign is also associated with a number of other chronic illnesses, including conditions that involve the thyroid gland or the digestive system.

There are a number of health risk factors associated with secondary clubbing, including:

• Lung cancer
• Interstitial pulmonary fibrosis
• Lung abscess
• Pulmonary tuberculosis
• Pulmonary lymphoma
• Congestive heart failure
• Infective endocarditis
• Cyanotic congenital heart disease
• Bronchiectasis
• Cystic fibrosis
• Other types of cancer, including liver, gastrointestinal or Hodgkin lymphoma
• Inflammatory bowel disease
• Liver cirrhosis
• Gastrointestinal neoplasms
• Celiac disease
• Dysentery
• Graves' disease
• An overactive thyroid gland

Can HIV Cause Clubbed Fingers?

People with HIV have a much higher risk of developing chronic lung disease and lung infections, which can inevitably lead to clubbed fingers.

How Clubbed Nails Affects Nail Beds

The medical conditions that can cause clubbing are generally associated with decreased oxygen levels. Experts suggest that clubbing occurs as your body undergoes changes in response to low oxygen.

Several processes affect the nail beds in secondary clubbing. The nail enlargement occurs due to the growth of excess soft tissue beneath the nail beds. The enlargement is associated with inflammation and a proliferation of small blood vessels in the nail beds.



A protein called vascular endothelial growth factor stimulates the growth of blood vessels, and this protein is considered a major factor in the physical changes that occur in clubbing.

Diagnosis

Clubbing can be subtle, so it may be difficult for you and your medical team to verify this change in your digits.

There are a few objective criteria that are used to assess clubbing, and they can help in determining whether you have developed this physical change:

• Lovibond's profile sign: Normally, there is a sharp angle between the nail bed and the cuticle. When you have clubbing, the natural angle is lost as the nail angles down instead of up.
• Distal/interphalangeal depth ratio: The phalanges of your finger are the sections between each bending joint. Your distal phalange, the one that includes your nail, is normally shorter depth-wise than the neighbouring phalange. Clubbing is indicated when the opposite is true.
• Schamroth's sign: The sharp angle between your nail bed and cuticle forms a tiny diamond-shaped hole when you place your hands together with the top of your nails facing each other. When this gap disappears, it is described as Schamroth's sign.

Assessing Underlying Conditions

Often, clubbed fingers or toes develop due to a chronic medical condition that was diagnosed years before the clubbing developed. When you start to have clubbing of your digits, your medical team will evaluate you to identify any underlying disease that could be causing it.

Even if you have an established lung or heart condition, your medical team will assess your condition to identify any progression that could require an adjustment of your treatment.

Tests that you may need in the evaluation of clubbing include:

• A physical examination to assess for signs such as weight loss, difficulty breathing, skin changes, alterations in your pulse, or altered blood pressure
• A pulse oximeter to measure your blood oxygen level
• Pulmonary function tests (PFTs)
• Arterial blood gas test
• Chest imaging tests, such as chest X-ray or chest computerized tomography (CT)
• Blood tests, including complete blood count (CBC), electrolyte levels, liver function tests (LFTs), and/or thyroid tests
• An electrocardiogram (Echocardiogram to assess your heart function
• Abdominal imaging tests such as CT or ultrasound
• A biopsy if there is a concerning lesion noted on an imaging test

Treatment

Usually, the abnormal shape and size of the digits do not cause health problems, but any underlying disease that causes clubbing needs to be medically and/or surgically managed, as appropriate. Treatments may prevent your clubbing from worsening and, in rare cases, can reverse some or all of the physical features of clubbing.

There are a variety of approaches used to treat the underlying cause of clubbing. Your treatment will depend on your situation. You may need management of respiratory disease, treatment of heart disease, or interventional therapy for cancer.

A Word From Verywell

If you notice clubbed fingers or toes, be sure to discuss this with your healthcare provider. Clubbing can be diagnosed in your healthcare provider's office. Although clubbing itself is harmless and doesn't require treatment, it is often associated with health conditions that can worsen without treatment.

FREQUENTLY ASKED QUESTIONS

• Can clubbed fingers go away?

  If the underlying cause of clubbed fingers is treated, yes, they can go away. Heart and lung diseases are the most common problems. These may need to be treated with medication or surgery.
• What are the stages of finger clubbing?

  There are five stages or grades of clubbing:

  • Grade 1: The nail bed becomes soft
  • Grade 2: There are changes in the angle of the nail fold (the skin beneath the cuticle that holds the nail in place)
  • Grade 3: The nail takes on a more obvious curve
  • Grade 4: The end of the finger becomes thicker (club-like)
  • Grade 5: The nail takes on a shiny appearance
    
• How do I prevent clubbing from coming back?

  If you’re at risk for clubbing, you should take steps to avoid conditions that might worsen lung or heart problems. Stopping smoking is essential. You can also lower your chances of catching viruses that cause lung infections by following a healthy diet, getting exercise, and receiving necessary vaccines.
  

• How do you tell if your nails are clubbing?

  You can tell if you have clubbed nails by checking for what's known as the Schamroth's sign. Check for it by pressing the nails of both point fingers together; there should be a small, diamond-shaped space between the nail beds. If there is not, you may have clubbed nails.

https://www.verywellhealth.com/clubbing-of-fingers-914776