Starting a New Psoriasis Medication? Here’s What You Can Expect

Whether you’ve just been prescribed your first medication for psoriasis or you’re switching to a different one, it helps to know what to expect. When you’re in control of your own treatment plan, you’ll feel more in control of your overall health, and that can help make life with a chronic, unpredictable autoimmune disease a little easier.

The main categories of medications for psoriasis are:

  • Topical formulas containing ingredients like steroids, coal tar and Vitamin D oral
  • Oral medicines such as methotrexate (Trexall), acitretin (Soriatane), and cyclosporine (Neoral)
  • Biologics which may be administered by self-injections at home or via intravenous infusions at the doctor's office

“These all have very different time lines regarding when they take effect, when they achieve the maximum improvement, and how long they sustain the improvement,” says Dr. Cristina Psomadakis, a London doctor and dermatology registrar.

It May Take a While to Notice a Difference

Unfortunately, psoriasis meds aren’t like antibiotics—you can’t expect them to produce results within 48 hours. Give it time.

“There are huge variables at play; including patient-related factors such as the extent, site, and type of psoriasis,” Psomadakis explains. Improvement can be gradual, and people will perceive and notice it differently.

In clinical trials of psoriasis drugs, doctors calculate an individual’s PASI (Psoriasis Area and Severity Index) score at baseline and after a certain number of weeks to measure how well a drug is working. “This gives us data for individual drugs, and we do the same thing when someone comes to a clinic appointment, so we can measure whether it is effective throughout their visits,” Psomadakis says.

Board-certified dermatologist Debra Jaliman, M.D., recommends waiting at least two months before evaluating whether a new psoriasis medication is working, or whether a different one is needed. However, she says many of her patients see results within a few weeks, so there’s hope you won’t have to wait too long.

There May Be Some Trial and Error

You may have to try several different medications before finding one, or a combination, that works well for you. If you’re prescribed a topical steroid, and you don’t see much improvement within three months, go back to your doctor and ask about other topical treatments; or, perhaps, about an oral alternative, recommends Jaliman. “There are many treatments available, and a dermatologist can help you learn what might be triggers for your psoriasis and how to avoid them,” she says. “Sometimes, people do well with a combination of treatments, such as a topical and an oral.”

Psomadakis says that follow-up appointments will be scheduled according to the expected time frame for your particular medication. “This gives the medication enough time to work before reviewing progress,” she says. “If there is no response to a treatment, a doctor will usually recommend changing course and trying something else. This could include an escalation in treatment, such as stepping up to a more intense medicine that might come with greater risks.”

You May Experience Side Effects

Most psoriasis medications come with possible side effects, and these don’t always crop up quickly.

“Some side effects like nausea, headaches and appetite changes can be apparent early on, but things like changes in blood work or susceptibility to infection can be more long-term,” Psomadakis says. “Again, the side effect profiles vary greatly depending on the treatment.”

The most common side effects of topical medications containing steroids are damage to the skin and thinning of the skin.

More severe side effects tend to occur with oral medication. For instance, the major side effects of acitretin include dryness of skin and eyes and temporarily elevated levels of triglycerides and cholesterol (a fatty substance) in the blood. If you’re taking acitretin, you’re likely to require blood tests before starting the therapy and then, periodically, to keep an eye on your triglyceride levels. Other minor side effects of some oral meds include diarrhea and nausea.

Biologics typically have less severe side effects, the most common being redness, pain, minor irritation, or another reaction at the injection site.

“Some treatments make you more sensitive to sunlight, so steer clear of lying out in the sun and going out without sun protection,” Jaliman says.

Your doctor should go over the specifics with you before you even start your new medication to ensure that you’re aware of all possible side effects from day one.

Remember, Medication Is Only Part of the Plan

Experts agree that the best approach to treating psoriasis is holistic. Your medication is at the center of your treatment plan, but there’s more to it than that. It’s important to have a conversation with your doctor about your mutual expectations from the medication and the important time line milestones for the specific treatment (such as when it should start working and when the maximum effect should be achieved), Psomadakis says. As always, it’s important to live a healthy lifestyle. Eat a healthy diet with a mixture of fresh fruits and vegetables, protein, carbohydrates, dairy and fiber. Aim to drink at least two liters of water per day, and do what you can to minimize stress.

You should also be upfront about any other medications or over-the-counter treatments you are taking, and don’t add anything else in without letting your doctor know. “You don’t want to change anything up too much when starting a new medicine because it can be hard to tell what’s to blame for any side effects that crop up,” Psomadakis says. While your doctor should tell you everything you need to know about your new medication, you should also familiarize yourself with the information leaflet given to you at the office or pharmacy, so you’re absolutely clear on what the risks and side effects are.