When my psoriasis was at its worst — before I started a biologic — I was working from home. For me, this was the silver lining of the pandemic. Being at home allowed me to consistently reapply coconut oil to prevent itchy scales, to wear whatever I needed to for comfort (usually 100-percent cotton pajamas that would become stained with coconut oil), and to schedule light therapy appointments in the middle of the day without having to get supervisor approval.

Now that I am back at work in person as an early childhood educator, I wonder how I would cope if my psoriasis escalated to that point when so much of my body was covered with plaques. Given that I have very little psoriasis coverage now, I am able to go to work and remain physically comfortable from a skin perspective. My only remaining itchy areas are my scalp and ears, which I’m able to address via topical steroids.

Recurrent Infections

While my skin symptoms are well controlled, I’ve recently had to explain recurrent absences due to infections to my supervisor. I believe these infections stem from my use of biological treatment for psoriasis. So, while it feels inaccurate to say that psoriasis is negatively affecting me at work at this time, I can say that the secondary consequences of my chosen treatment for psoriasis are indeed negatively affecting me.

There is evidence that people taking biologics are at increased risk of infections. While on my previous biologic, Stelara (ustekinumab), I experienced a severe upper respiratory tract infection and frequent urinary tract infections. Since beginning my current treatment, Taltz (ixekizumab), I have now had my first yeast infection. I recognize that they are quite common and usually easily treatable, but this was not my experience.

My recent infection presented with a less common type of yeast that is more often seen amongst immunocompromised individuals and is harder to treat. I needed to receive extended first-line treatment as well as a second-line treatment to address the infection. Anyone who has experienced a vaginal yeast infection will tell you that they are pretty uncomfortable. I even took a day off of work because the pain and itching were so unbearable and I needed to stay home and soak in a sitz bath for some relief.

Given that I had never experienced an infection like this in the past nor had I had any other recent changes in partners or exposure — plus the known side effect of yeast infections with my current drug — I am confident that this has something to do with my biologic.

If this is a one-time occurrence, I am unfazed and want to remain on my biologic. However, if I continue to experience infections as a result of being on a biologic I don’t know if this trade off is worth it. I will need to choose between the uncomfortable itch of psoriasis and an itchy vagina. Neither is fun nor easy to manage at work.

I feel lucky that I haven’t experienced a particularly threatening infection while on biologics, just annoying ones. However, I am not thrilled at the prospect that this drug has affected the way my immune system works and that I can’t predict what will come of it. In the meantime, when explaining work absences, I’ve simply been saying that “I am experiencing an infection related to my use of an immunosuppressant” and leaving it at that.

MyPsoriasisTeam columnists discuss psoriasis from a specific point of view. Columnists’ articles don’t reflect the opinions of MyPsoriasisTeam staff, medical experts, partners, advertisers, or sponsors. MyPsoriasisTeam content isn’t intended as a substitute for professional medical advice, diagnosis, or treatment.