By Anne Babcock-Stiner, as recounted by Hallie Levine
I have had psoriasis for almost 5 years. I went through all sorts of medications, from prescription topical ointments to immunosuppressants, until I found a biologic drug that gave me relief.
In early 2018, I fell ill with a sore throat. It was the first time I had had this childhood illness in decades. Then a few days later I noticed a rash. They were small, round, scaly red patches all over my arms, legs and chest. At first I thought it was from the antibiotics, but then they started itching.
I immediately went to my dermatologist who explained to me that I have a type of psoriasis known as guttate psoriasis. While most people think of psoriasis as large, red, shiny plaques, about 8% of people with psoriasis develop guttate psoriasis. It’s usually triggered by an infection, such as the flu or strep throat. It can also be made worse by stress.
My dermatologist prescribed me ciclosporin, an immunosuppressant (it was originally given to people who had organ transplants to prevent their bodies from rejecting their new organ). It is also used to treat severe psoriasis conditions. I was a bit nervous about taking it as it is such a strong drug. It also seemed to cause an almost constant headache. It worked well – the stains went away pretty quickly. I took it for about 16 weeks which is the recommended treatment cycle. But when I stopped taking it, my psoriasis flared up again within weeks.
I stopped taking cyclosporine at the end of May. Over the next month my psoriasis gradually returned. It seemed to be made worse by sweat and heat. It was all over my body, but it was particularly bad in areas where there were wrinkles, like my armpits, groin, and the creases of my elbows and knees.
Finally, around July 4th, I found some relief. I was having a barbecue with my sister and complained about the constant itching. She stormed in and returned with a can of prescription steroid cream which she told me to try. I took it and after a few days it seemed to help.
I went back to my dermatologist who prescribed me two steroid creams: betamethasone for my legs, arms and upper body and triamcinolone for more sensitive areas like my groin and armpits. They helped – the psoriasis never went away completely, but at least it was some relief from the itchiness that was keeping me up at night and preventing me from getting work done. But my doctor wanted me to only use it for a short time – say a week and then a week off – and I couldn’t do it. Once I stopped, the intense itching returned within a day or so.
Last February I had a weekend where I just didn’t feel good. I had persistent headaches and just felt exhausted and out of shape. It went away after a few days and I didn’t think twice about it until a week later when I got out of the shower and saw my upper body was covered in the same telltale little round red spots.
I immediately went to my dermatologist who told me that I had another flare-up of psoriasis. While my strep test was negative, she also did antibody tests that showed I had been recently exposed to the bacteria. Although I was mostly asymptomatic, it was enough to trigger a recurrence of psoriasis.
This time my psoriasis was everywhere. It didn’t just cover my torso and limbs; it was on the soles of my feet and on my scalp. My dermatologist first put me on stronger prescription steroids as well as something called a coal tar treatment. It took me 20 minutes in the morning and 20 minutes at night to apply this ointment all over my body but it didn’t work and it stained all my clothes.
After 2 weeks I went back to their office to discuss options. I didn’t want to go back to immunosuppressive drugs during a deadly pandemic. But I was so unhappy I didn’t know what else to do.
Luckily, my dermatologist had good news. She said to me, “The world has changed since the last time this happened to you, and not just because of COVID-19.” Diseases known as biologics. Like ciclosporin, these drugs would target my overactive immune system, but unlike ciclosporin, they would only calm the part of my immune response that was involved in my psoriasis. As my dermatologist said, “It just takes out all the foot soldiers against all the generals.” This also meant there was less risk of side effects.
She prescribed me a biologic drug that was approved in 2019 to treat moderate to severe psoriasis. The treatment consists of two injections a month apart in my dermatologist’s office and then every 12 weeks. The results were dramatic; it started helping within 5 days. Most of the plaque spots went away — including the stubborn, itchy spots under my armpits and groin — with the exception of spots on my shins. But they almost disappeared after my second shot. The itching is completely gone.
It’s unclear how long I’ll have to take biologics, but I’ll take them for as long as my dermatologist says. It’s a relief not having to worry about sweating, heat, or other environmental factors that would trigger unrelenting itching. I have had psoriasis for less than 5 years and this was enough to show me how debilitating it can be. I’m just relieved to get my life back.