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My Experience With Biologics for Psoriasis

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Katya Meltaus
Posted on September 20, 2021

Before resorting to biological treatment, I lived with psoriasis on every part of my body for several months. My psoriasis came on fast. At first, I only had lesions on my lower legs. Then, in the first month of flaring, my scalp was caked in itchy plaques and my legs were completely covered. Within the next month, plaques multiplied on my arms, torso, genitals, hands, feet, face, and ears. I was miserable.

Avoiding Biologics

While I fully recognized that my condition was not terminal, I did not know how to cope with my sudden disfigurement or my physical discomfort, and my body no longer felt like my own. When my psoriasis was at its worst, I went on medical leave from work. I covered all reflective surfaces in my home, coated myself in a thick layer of topical steroids and Aquaphor, and spoke to my therapist every day.

Despite my struggle and the strong advice of my doctor, I could not make peace with biological treatment. I was willing to try anything that could help me before putting something in my body that I didn’t totally understand, which would suppress my immune system during a global pandemic, and that I could be taking long-term as a 29-year-old.

In those several months of having psoriasis all over my body prior to trying a biologic, I faithfully followed the autoimmune protocol diet, received weekly acupuncture treatments, and tried herbal formulations and topicals provided by a doctor of traditional Chinese medicine. When my psoriasis continued to progress, I escalated my therapy and began taking an oral phosphodiesterase 4 (PDE4) inhibitor called Otezla (apremilast). I found taking a pill less scary than the injections, since I already take pills for anxiety. I also started attending phototherapy three times a week. All the while, I was participating in consistent talk therapy.

None of those things made a dent in my psoriasis. If anything, my life had become more stressful with the last two therapies — Otezla completely upset my gastrointestinal system and I needed to get permission to leave work to attend phototherapy. Alas, I arrived at biologics. Unfortunately, that journey is also not a perfect love story.

Starting a Biologic

I’ve been taking my current biologic for six months now. Although the majority of my psoriasis has cleared — no small feat — this reward is not without its consequences. Before sharing my difficulties, I don’t want to diminish what a lifesaver this biologic has been for me. When I was covered from head to toe, I was the most depressed I’ve ever been. Not only was I suffering inside, I was in constant physical discomfort.

Going on a biologic gave me my life back. I was able to feel hopeful again, to stop having itch fits that would leave me dripping in blood, to comfortably have sex again, to be the athlete I once was, to wear clothing other than the loosest 100 percent cotton sweatpants, and to stop slathering myself in steroids to the same extent as before. However, since beginning biological treatment, I have had recurrent urinary tract infections (after never having been prone to them before) and the worst upper respiratory infection of my life.

Pandemic Worries

As an early childhood educator, I am re-entering the classroom for the fall while we continue to navigate a global pandemic. I am vaccinated, but I’m scared because of the infections I’ve had since starting biologics. I worry that I am more likely to get sick. I worry that if I do get sick, then I will be sicker than someone else my age.

I’m not only concerned about the COVID-19 variants that are surging, but about staying healthy in general. I was getting recurrent infections while being isolated at home, and now I’m in a workplace that, although a blessing and a joy, is ripe for germ exchange.

As we learn more about the relationship between immunosuppressant medications and vaccine effectiveness, I will be listening. I will get a booster when it becomes available, and I will try my best to time my biologic dosing accordingly. In the meantime, I will be doing everything I can to bolster my immune system and to protect myself from the host of communicable illnesses and infections that are an inseparable part of us all being back together again. So with that, here’s to face masks and elderberries!

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.

Posted on September 20, 2021
All updates must be accompanied by text or a picture.

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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here
Katya Meltaus is an early childhood educator living in the Bay Area. She has been managing severe psoriasis for the past two years. Learn more about her here

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