Last updated: Nov 15, 2010
“I describe psoriasis to my patients as a wild animal in a roomand the room is their life,” says dermatologist Andrew Blauvelt, MD, who sees a variety of complex cases as the research director of the Center of Excellence for Psoriasis and Psoriatic Arthritis at Oregon Health & Science University in Portland. “The goal of therapy is to build a good cage for the animal. The animals always going to be there, but an effective treatment will allow the patient to move around the room and live his life.”
- How widespread the disease is on the body
- Whether lesions appear in sensitive areas, such as the face, palms, soles, or genitals
- The patients experience with previous treatments
- The cost of medications and what insurance will cover
- The patients other medical conditions (especially psoriatic arthritis)
- The patients preference for one type of treatment over another
The group of drugs known as biologics have in recent years expanded the number of people who can be treated, says Dr. Lebwohl. They have also pulled some patients away from older systemic (as opposed to topical) drugs often used for moderate-to-severe cases, such as methotrexate and cyclosporine, which patients sometimes need to take in rotation to minimize the risk of cumulative damage to their organs.
It often takes trial and error
On the day he was diagnosed in 1991, Ed Dewke, now 57, of Midway, Ky., remembers his dermatologist saying: “I hope you have good insurance that will pay for a lot for drugs, because youre going to be making a number of pharmacists wealthy throughout the rest of your life.”
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Even the effectiveness of the newer drugs will fizzle after a while for some patients with severe enough psoriasis to warrant them, says Dr. Lebwohl. And after those patients move down the short line of latest-and-greatest treatments, they reach a dead end. “[But] there is literally a steady stream of new drugs coming out,” he says.