How Do You Know If Psoriasis Medication Isn’t Working?

Psoriasis is a long-term medical condition that involves an itchy, scaly skin rash that can come and go for years. This happens when the immune system attacks healthy cells. The specific cause is not known. However, there is a link between psoriasis and stress, as stress can bring on symptoms and make symptoms worse.

While there is no permanent cure, this condition can be treated. However, medications do not always work. For example, some people may not tolerate medications due to side effects. Learn about psoriasis, why treatments may not work, what to do instead, and more.

Signs Psoriasis Isn't Healing

After starting a new treatment, it can take a little while to notice a difference in psoriasis symptoms. For example, medications applied to the skin can take six weeks before improvement is noticed. However, sometimes the treatment doesn't work and symptoms don't improve. Other times the symptoms may improve but the medications can cause negative effects.

People with psoriasis often begin receiving treatment from a primary healthcare provider. Still, they may need to seek care from a dermatologist if initial treatments don't work or if there are side effects.

Medication Side Effects

Sometimes the first red flag that a psoriasis medication isn't a good fit is when there is a side effect. These side effects may be severe enough to prevent a person with psoriasis from continuing the medication because the benefits do not outweigh the negative effects.

For example, a 2013 study found that people taking Soriatane (acitretin) were more likely, compared to people taking other medications, to stop treatment due to side effects. The possible side effects of this medication include allergic reactions with difficulty breathing, depression, and problems with the pancreas that can lead to death. 

Inconsistent Schedule

It is estimated that up to 67% of people with psoriasis do not consistently follow through with their medications. It can be difficult for some people to follow through with a treatment plan for many reasons, including an inconsistent schedule. This is especially challenging with phototherapy treatments that involve going to a hospital or other treatment center multiple times per week. Phototherapy can also take between 15 and 25 treatments to work.

Continued Flare-Ups

Psoriasis can go through phases of increased symptoms called relapse or flare-ups and phases of minor or no symptoms called remission. Additionally, symptoms may return even more severe than previous flare-ups, called rebound.

It can be difficult to determine the effectiveness of medications when the symptoms come and go without any known cause. However, it is a sign that the treatment is not working when the symptoms keep coming back with recurrent relapses or rebounds.

Drug Tolerance

When a person takes the same medication for a long time, it is possible to build up a drug tolerance. This occurs when the medication dose needs to be increased or changed to a new treatment entirely because the body becomes used to it and no longer works. Research shows that people with psoriasis are more likely to develop a drug tolerance to Enbrel (etanercept) and Humira (adalimumab) than other medications.

A unique challenge can occur with biological therapies. Sometimes the immune system makes anti-drug antibodies that attack the medication and prevent it from working. When this happens, the medication becomes less effective over time.

Multiple Prescriptions

About half of Americans who receive treatment for their psoriasis use more than one medication. Treatment generally starts with one medication applied to the skin, and then if the symptoms are not controlled or if they become less controlled over time, more medications are added. Additional medications may be needed initially for more severe cases and to make up for the symptoms of becoming less responsive to medications with long-term use.

Psoriasis Healing Stages

It is normal for skin cells to grow continually, but with psoriasis, they grow much faster and pile up on the skin instead of naturally falling off. When psoriasis heals, fewer skin cells pile up, so there is gradually less and less flaking of the skin over time. Remission happens when the skin is mostly or completely clear of piling skin, and the itching and other symptoms have gone away.

Average Length of Treatment

Psoriasis can come and go unexpectedly. This is different for everyone. The severity of symptoms is different, and the length of time treatment is needed varies by person.

On average, symptoms last a few weeks or months at a time, go away, and then come back. However, that does not mean treatment should be stopped when symptoms go away. It is important to talk to a healthcare provider before stopping a medication because symptoms can rebound, or come back more severe than they were before the medication was started.

Stress Is Another Culprit

Even though medications and treatments can go a long way in helping to control psoriasis symptoms, lifestyle factors can still interfere. This can make it difficult to determine if a medication isn't working or if there are other influences, especially since symptoms can come and go unpredictably.

One of the biggest culprits is stress, which can trigger flare-ups and increase symptoms during a flare. This means that sometimes when it seems as though medication is not working, the symptoms could actually be the result of an increase in stress levels.

Some interventions that can help people with psoriasis relieve stress and improve symptoms include:

• Meditation or relaxation exercises
• Physical activity
• Seeking help from a qualified professional

When to Call Your Healthcare Provider

It is important to seek help from a healthcare professional, such as a primary healthcare provider or dermatologist when there are moderate to severe psoriasis symptoms, when symptoms interfere with daily life, or for a treatment plan that meets your needs.

Additionally, medical support is needed when there are medication side effects or if symptoms become worse. Psoriasis can lead to other health complications, so it is important to receive treatment to prevent the condition from escalating.

Side Effect Red Flags

When starting a new medication, it is a good idea to be aware of the possible side effects to know what to look out for. The healthcare provider prescribing the medications is a good resource to ask. Also, they can help with a personalized treatment plan and provide an idea of how long it will take before a difference in symptoms can be noticed.

For example, it can take six months for psoriasis to go away with a medication called Trexall (methotrexate), but symptoms noticeably fade within six weeks. If more time has passed and nothing has changed, the medication may not be working.

Ruling Out a Misdiagnosis

Psoriasis is similar to eczema, involving a rash that looks almost exactly like psoriasis. Because the two look so much alike, they are sometimes diagnosed as the other. However, there are differences.

Eczema is more likely to appear behind the knees and inside the elbows, and psoriasis occurs when the immune system attacks healthy cells, while eczema is not immune-related. There is a way to confirm a psoriasis diagnosis with a test called a biopsy. This involves removing and examining a piece of skin.

Healthy Habits and CAM Treatment

In addition to medications, psoriasis can be treated with healthy habits and complementary and alternative medicine. Some people with mild psoriasis are able to completely control their symptoms with skin routines that combine home treatments such as moisturizer and warm baths with salts. Additionally, exercise, nutrition, and regular stress relief can help to control symptoms. These approaches can be used alone or with other treatment options.

Summary

Psoriasis is a health condition involving an itchy skin rash that occurs when the immune system attacks healthy cells. There is no permanent cure, and symptoms can come and go for years. Treatment options, including medications, are available to help control the condition and lessen the symptoms. However, sometimes medications don't work or lose their effectiveness over time.

Signs that a treatment isn't working include no noticeable difference after the amount of time it typically takes for symptoms to get better, side effects that outweigh the benefits of the treatment, repeated flare-ups or symptoms that keep coming back, and decreased effectiveness over time. When any of these signs are present, it is important to reach out to a healthcare provider to help find a solution, such as a different treatment or combining multiple treatments.

A Word From Verywell

Suspecting, being diagnosed with, and living with psoriasis can be unpleasant and challenging, especially when symptoms are severe enough to interfere with daily life. If you or someone you know is experiencing psoriasis, help is available. There are effective treatment options, even if the first options tried did not work. Reach out to a healthcare professional such as a primary healthcare provider or a dermatologist, for support.