Here’s why your doctor might prescribe a biologic for your psoriasis

“Luckily, there are a lot of available options,” Shari Lipner, M.D., Ph.D., dermatologist at Weill Cornell Medicine and NewYork-Presbyterian, tells SELF. And a board-certified dermatologist can tailor the treatment plan to what type of psoriasis you have, how much of your body it covers, and if you have any signs of arthritis along with it.

If you’ve tried every topical cream under the sun to treat your psoriasis, you know how frustrating it can be when none of them actually does that much for you. And, sometimes, trying to find the best way to treat your condition can just add to the frustration.

Once at least 5% of your body is affected by psoriasis, you start to qualify for biologic medications, Kyle Cheng, M.D., health sciences assistant clinical professor at the David Geffen School of Medicine and director of the UCLA Psoriasis Specialty Clinic at UCLA Medical Center, tells SELF. These medications, which act on parts of your immune system, may sound a little intimidating, but they can be an effective part of your overall treatment plan. Here’s what you need to know if your doctor suggests one.

Here’s what a biologic actually is.

A biologic is a drug that treats the symptoms of psoriasis by acting on the immune system, SELF explained previously. They can be delivered by IV, but most of them are injected, which you can do at home or in your doctor’s office, depending on how often you need to do them.

There are three main categories of biologics for psoriasis – drugs that target TNF-a, IL-17, and IL-23 – and they act on different parts of the immune system. Essentially, they work by inhibiting parts of the immune system that are overactive in psoriasis. Although older drugs targeted parts of the immune system that worked on the body more broadly, newer ones are more specific and, therefore, tend to have fewer side effects.

Biologics aren’t usually first-line treatments.

For most people with psoriasis, topical creams are the first line of treatment that their doctor will prescribe. If that doesn’t work for you, then they might suggest something like light therapy or a biologic treatment. “I’ll give it a few months of topical treatments, and if that’s not helping, then I’ll go with a biologic,” Dr. Cheng explains.

But if your psoriasis is on a part of your body that’s particularly difficult to treat, like your scalp, hands, feet, nails, armpit, or groin area, your doctor might go straight to suggesting a biologic, Dr. Cheng says. Also, if your psoriasis covers a larger amount of your skin or you’re developing any symptoms of psoriatic arthritis, a topical treatment isn’t going to do much for you, he says. So your doctor might suggest a biologic.

“Someone with one or two plaques on the legs could probably be treated with topical therapy very well,” Dr. Lipner says, “but the biologic therapy is used for more widespread disease or hard-to-treat areas, as well as in patients who may have psoriatic arthritis where you want to be more aggressive.”

Your doctor should also take your quality of life into account, Dr. Lipner says. Even if you have psoriasis on only a small part of your body, it can still cause you to be self-conscious if it’s on a particularly visible area of skin, for instance. So, in that case, your doctor may want to treat it more aggressively.

What should you expect when on a biologic?

Older biologics, like infliximab, can be given via IV. But more recently developed biologics are given as subcutaneous injections (meaning they go under the skin). You may need an injection as often as every week or two, or as little as every few months, depending on your symptoms.

If you need to get them more often, you may be given the option to do them yourself at home, Dr. Cheng says. Generally, the best place to inject it will be a large fatty area of your body, most commonly the thigh, Dr. Lipner says. But you’ll need to be careful to switch up where you inject the medications so you don’t get too sore in one spot, she cautions.

Different biologics produce noticeable changes at different rates, Dr. Cheng says. And, of course, every patient is different. But many people with psoriasis plaques start to see improvement within a month and see their maximum results in another two months.

“Biologics tend to be the quickest out of all the treatments we have for psoriasis, but they do vary,” Dr. Lipner says. For instance, patients with nail psoriasis should give a biologic drug a solid six months to decide whether it’s working, because cell turnover in your nails goes more slowly than other parts of the body.

As with any medication, biologics come with some possible side effects.

The most common side effects of getting a biologic are irritation and soreness around the injection site. But, like any medication that alters the way your immune system works, you will be more vulnerable to pathogens while taking a biologic. In practice, for most patients, that amounts to “about one more cold per year,” Dr. Cheng says.

But it’s a risk that’s worth talking over carefully with your doctor. They’ll likely want to make sure you’re up-to-date on all of your vaccinations before starting the biologic, Dr. Lipner says. Not only does being on a biologic increase your risk for new infections, but in some cases it also increases the risk that latent illnesses in your body might reappear, especially tuberculosis. So, if you show any reactivity to tuberculosis in particular, you’ll need to be treated for that before starting the medication, Dr. Lipner explains.

Once you’re on the biologic, you’ll have to be careful to avoid live vaccines, like the MMR vaccine, Dr. Cheng says. Attenuated (inactive vaccines), like the flu shot, are safe and recommended, though. The one exception is the nasal flu vaccine, which is a live vaccine, Dr. Cheng explains.

And know that biologics are frequently prescribed alongside other types of treatment, like topical medications, UV therapy, and oral medications. So don’t be surprised if your doctor wants to give you some kind of a combination.

However, there are some people who definitely shouldn’t be on biologics, including people who are pregnant or trying to get pregnant. Also, people with Crohn’s disease shouldn’t take certain biologics for psoriasis, but there are some biologics that could help with both conditions.

So, as helpful as biologics can be for some patients, they aren’t right for everyone. And figuring out the right treatment for you can be complex.

Because so many new treatments for psoriasis (including biologics) are coming out so quickly, “it’s a very exciting time in dermatology right now,” Dr. Lipner says. Treatments like these “can really change the patient’s quality of life,” she continues, so it’s crucial to see a dermatologist and find a treatment regimen that works for you.

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