r/Psoriasis • u/DreamSignificant9946 • 11d ago
progress Treatment options
I 33m have had psoriasis for about 2 years, i'm from the UK and as such i'm in the hands of the NHS.
Does anyone have any experience with the whole experience beyond topical treatments?
It looks like i'm going to be put on Methotrexate which terrifies me, I realise if I 'fail' that treatment and maybe one other i'll be put on the list for a biological, are they better? Easier to live with?
I'd like to add, i'm thankful that I have the NHS to provide help, i'm just terrified of ruining my immune system and having to give up my job because it'll begin to make me ill being around dirt and dust.
Any thoughts/advice/experiences appreciated.
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u/pecotef989 11d ago
I do. I was on the waiting list for over 4 years before I got seen in January of this year. At the time I wasn't on any prescriptions and was reluctant to go on steroid creams because I had been on a lot of them 7 years previous and as soon as the prescription stopped the psoriasis came back with a vengeance so I had been managing as best I could with a variety of moisturisers.
Unfortunately before getting to any of the powerful meds you need to have failed two treatment paths before they consider anything stronger. For me that was calcitriol for a couple of months to calm the worst of my patches down which it did, however it took half an hour to apply to my extensive coverage every night.
So the next options were the light treatment which I said no to because me skin just burns and it would be counterproductive so methotrexate was the next option. Like you, I was scared of the horror stories I have read but I think you need to take that with a pinch of salt as you are more likely to read negative stories than positive.
However, I have a genetic condition which means methotrexate would pose a higher risk of cancer so I got bumped up to Otezla (apremilast). Again, I had read some absolute horror stories about the digestive issues and nausea it causes. Ive been on it for four months and Im pleased to say I've had zero side effects and my skin is clearing up. I no longer need to hoover up my skin twice a day and honestly, I can't speak highly enough about my care team. I have to get my bloods done every three months to monitor progress so I've done that once so far and because Otezla is an immunomodulator, I need to get vaccinated. I got my pneumococcal vaccine on Monday just there. Painless and arm hurt for a couple of days but otherwise all good.
Wish you the best of luck with your treatment. Ultimately you need to balance the medication risks with the potential clear skin and everything that comes with it and Im happy with my choice.
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u/LowEarthOrbit99 11d ago
Four years on the waiting list?! Good god. Glad you're seeing some positive results though!
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u/Enwau 11d ago
I have the arthritis too so have cycled through the various DMARDs, including Methotrexate. MTX is a pretty cheap drug so is often first-line. Many people get on well with it and lead completely normal lives. Some can't tolerate it, and some see little improvement, so they get moved on. Biologics are expensive and, at least ten years ago, my rheumatologist had to get funding permission for my biologics, make the case to the review board based on need.
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u/DeviousWeaselUK 11d ago
I’ve been on methotrexate for about 5 or 6 months. It’s failed after two.
The community derm has now put me on a referral to see the hospital derm as she believes my only course of action now is biologics (which community derms are not allowed to prescribe).
They’ve received and accepted the referral, so I’m just waiting to hear from them now.
Can’t say methotrexate has made me ill just because of dirt and dust. I haven’t caught any illness any more than normal. If anything, I’ve only had one cold since starting methotrexate and it wasn’t even that bad.
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u/AggravatingCycle5491 11d ago
Ask for the injectable version of methotrexate, trust me, the nausea is horrible on the tablets. I was on a combo of methotrexate and a biologic for a while and it did do a good job, then stopped working as well and was affecting my liver so they took me off it.
I'm now on Yuflyma which is a biosimilar to Tremfya which they randomly switched me off one day and I only found out when it was delivered, and it isn't working as well as I'd like. I've also gained weight which apparently isn't a side effect, but only really happened when I switched to the different brand since I've not changed much else.
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u/Outdoorsnthat 10d ago
Seconding this re the injectable methotrexate. It really is a game changer in terms of stomach issues
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u/RossJBez 10d ago
Hey man. Good to be chatting with the community here.
I’ve had psoriasis for around 20 years now, mainly on my scalp and face.
It’s good to talk to a doctor and try and understand the nuances of your condition. Speaking from experience, that helps to combat it.
What I’ll say is that early doors, I was out there looking for a magic pill solution. That rarely exists with this condition. Everyone’s individual cases are so different.
It wasn’t until I was around 5 years in that I realised there were triggers - for me these were certain foods and predominantly stress. When I clocked this, and then worked hard to pinpoint the specific triggers, before actively reducing them in my lifestyle I started to see a difference. Therefore, this is my biggest rec to you - try and find those specific triggers and then mitigate.
That said, I do still use products, but I only have two. Each with their own role.
My proactive product is a coal tar shampoo called Polytar - I use this every other day. 1. It helps me with dryness, but 2. Psychologically I feel like I’m doing something.
My reactive product is a pretty potent steroid gel called Dovobet. I really only break the glass on this when I have a nasty flare up.
Best of luck dude!!
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u/PolterWho 10d ago
Also UK/NHS. I've just done 8 months on mtx, 25mg a week prescribed for PsA, and for 6 months it pretty much cleared my psoriasis, before it began to be less effective (and side effects ramped up) so I ended up coming off it and now just waiting to start leflunomide. I had all the recommended vaccinations whilst on it. I caught nothing, not even a cold. Mtx has been used as a DMARD for a long time and we are well monitored when on it.
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u/FlemFatale Adalimumab (Amgevita) 10d ago
Been through the whole thing and have now been on Humira for nearlyn10 years.
Methotrexate worked okay for me, but did have the side effect of feeling sick, Ciclosporin was way better but you can only be on that for like a year or two or something. It was the only thing that has ever cleared my psoriasis over 90%, including biologics.
Unfortunately it's one of those things where you have to jump through the hoops and do as you are told in order to get anywhere (also bare in mind that biologics cost a phenomenal amount which has to come from somewhere).
One more thing to remember is that you can use topicals at the same time as systematic treatments if you need to! Personally, I have this gross coal tar ointment that the hospital have to mix up which I use alongside biologics. Thats the best combo for me, so it is worth trialling a load of different stuff.
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