Setting (and Keeping) Psoriasis Treatment Goals in the New Year
Stopping and Starting Treatment
At first, I felt angry and upset over her decision to stop treatment. But I quickly realized that her experience is not uncommon. According to an article published in April 2011 in the journal Mayo Clinic Proceedings: “Approximately 50% of patients do not take medications as prescribed.” Another article published in July 2019 issue of The Dermatologistnoted that “poor adherence to treatment is a major issue in the management of chronic skin diseases, such as psoriasis.”
These studies point to the real challenge of reaching treatment goals and keeping up with treatments. A chronic condition like OCD, or psoriasis, presents an added measure of difficulty.
I can take a flu medication for a week or so, or put on an ointment until a small rash disappears. But what if I must take that pill or put on that ointment for what feels like forever? What if I experience side effects that cause me to feel great discomfort? What if the medications are not working that well anymore?
The physician and healthcare system also play a part in patient's following doctor's orders. But certainly I have my part to play as a patient. If I don't like my treatment, or want to change my medication, I need to speak up. That's the situation I find myself in now.
Over the summer, my dermatologist directed me to taper off of one of my medications to minimize its side effects. Unfortunately, my psoriasis and eczema broke out badly after about five weeks. I restarted the medication at the same dose as before hoping to see the same response. But up to this day, my skin is more broken out than before. Simply put, I’m not happy with the effectiveness of my current treatment.
As the new year approached, I felt an even greater urgency to assess, evaluate, and set goals for managing my condition. I might stop one treatment or start another, but I want to do so with a target in mind.
What’s Your Treatment Target?
A study published in December 2019 in theJournal of the American Academy of Dermatologyaddressed the need to establish treatment targets and goals for treating psoriasis. It compiled the current thinking of twenty-five psoriasis experts.
The process revealed the first ever target for psoriasis management in the United States: at 3 months of treatment to preferably have 1 percent or less psoriasis body surface area (BSA). Acceptable response is pegged at either less than 3 percent body surface area, or 75 percent improvement from the baseline.
The National Psoriasis Foundation reported the findings on their website. The part of their report that stuck out to me is the importance of the patient and healthcare provider relationship in working toward goals:
The idea is to allow the patient and their healthcare provider to take greater control of the disease so the patient may achieve lower disease activity and, overall, a higher quality of life. Treatment decisions should be made on a case-by-case basis. Patients and providers can discuss options, which include changing treatment, adding on a new treatment, or in some cases, staying the course on current treatment.
If one percent of body surface area is about the area of the palm of my hand, then I am definitely not at preferred or acceptable treatment levels. At the same time, my case is individual to me and my condition.
What is my treatment goal? Is it the 1 or 3 percent, or even the 75 percent improvement? What is my current BSA? I haven’t asked my dermatologist yet, but I intend to during my next visit later this week.
Building a Plan with Your Doctor
Pablo Picasso is quoted as saying, “Our goals can only be reached through a vehicle of a plan, in which we must fervently believe, and upon which we must vigorously act. There is no other route to success.” I couldn’t agree more with Picasso on the need to have clear plans to reach my treatment goals.
Working with your doctor to build a plan, of course, is an essential part of reaching your treatment goals. My wife’s experience showed me how a barrier between doctor and patient can hinder effective disease management. It wasn’t until she started seeing a new doctor that she opened up about her struggles with taking her medication. They talked about the side effects, and adjusted medication levels together step-by-step.
Today she is doing much better taking her medication and managing her symptoms. She also has a contingency plan six months down the road to stay accountable to her support system and communicate clearly with her doctor.
For my part, I hope to have an open conversation working with my dermatologist on building a treatment plan. For the next three to six months, we’ve been discussing different possibilities such as Goeckerman therapy (light therapy with tar treatments) and a different biologic medication. It’s been hard to tell him, but I’m not excited about Goeckerman as it sounds messy and time consuming. As part of the plan, I’m willing to try it for couple months, but I want to get other options ready in case it’s not working for me.
I don’t like making New Year’s resolutions, but I do want to make this commitment today: to set a treatment goal, set up a plan with my doctor, and follow through with my treatments.
I no doubt will need support from others, like my wife and friends, to continue with my treatments when all those good sounding reasons to stop crowd my mind. I’ll need reminders that reaching my goals will mean a higher quality of life, more energy and time to do what I want to do, and less inflammation that leads to other conditions I don’t want in my body.
As you approach the new year, what treatment goals and plans do you have? Do you need to set up an appointment to discuss these with your healthcare provider?
PHOTO CREDIT: Chayanee Jongthai/Getty Images; Shutterstock
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