Psoriasis is a chronic, lifelong inflammatory skin disease. That means it can’t go away on its own. However, psoriasis can go into periods of remission in which the symptoms disappear. Remission is followed by periods known as a relapse, rebound, or flare-up in which the symptoms of psoriasis get worse again.
“I had a few good days and I allowed myself to be optimistic that remission might be occurring. Then I woke up this morning and BAM! Flare city,” stated one MyPsoriasisTeam member.
In the treatment of psoriasis, the main goals are to clear the skin from the characteristic itchy, scaly lesions and to increase the length of remission periods. Besides treatment, other factors may also influence your likelihood of remission.
Some factors are associated with longer or shorter remission periods.
|Read: How biologics can help achieve skin clearance in psoriasis|
There are several treatment options for psoriasis, and remission length may vary based on your type of treatment. Changes in treatment types may also contribute to ongoing cycles of remission and relapse.
According to a report published in the American Journal of Clinical Dermatology, taking oral psoralen coupled with ultraviolet A rays (a therapy known as PUVA) prolongs the remission period in plaque psoriasis compared with narrow-band UVB rays and topical treatments like gels, moisturizers, and ointments. PUVA may have a long-lasting effect even after discontinuation. However, PUVA has an increased risk of squamous cell carcinoma and possibly melanoma.
Biologic agents target specific areas of the immune system (as opposed to systemic drugs, which affect the entire immune system and response). Biologics are usually recommended for moderate to severe psoriasis that does not respond to other treatments such as light therapy (phototherapy) and systemic therapy.
When it comes to biologics, psoriasis relapse occurs mainly within the first six months after a person stops taking the medication. According to one study of 184 people with psoriasis, the time to relapse was the longest in people who stopped taking a drug called alefacept, in which the average time to relapse was nearly 30 weeks. The average time to relapse was 22 weeks for ustekinumab, 19.5 weeks for infliximab, 18 weeks for adalimumab, 12 weeks for etanercept, and approximately 10 weeks for efalizumab.
The types of psoriasis include plaque psoriasis (also known as psoriasis vulgaris), guttate psoriasis, psoriatic arthritis, inverse psoriasis, nail psoriasis, and pustular psoriasis. Among all these types, guttate psoriasis typically has a longer remission period, researchers have found. However, if poorly treated, guttate psoriasis may progress into plaque psoriasis.
Inflammation in the body, also known as systemic inflammation, is believed to promote the development of new skin lesions in psoriasis. Levels of inflammation can be determined by measuring a protein in the blood called C-reactive protein (CRP). High levels of CRP in the blood indicate higher levels of inflammation.
People who have more inflammation tend to have shorter periods of remission. For example, some research has found that people with lower CRP levels had average remission periods of 8.5 months. People with higher residual inflammation tended to have remission periods of just three months.
An anti-inflammatory diet rich in fruits, vegetables, whole grains, seeds and nuts, and omega-3 fatty acids may help keep your inflammation in check.
Overweight (defined as a body mass index of 25 to 29.9) and obesity (a body mass index of 30 or greater) are associated with psoriasis and inflammation in the body. Heavier people also tend to have a poorer response to psoriasis therapy than those with a lower body mass index. Researchers have found that a low-calorie diet leading to weight loss increases the response to systemic treatments in obese people with moderate to severe chronic plaque psoriasis, which may ultimately lead to remission and a decreased need for medication.
According to the Arthritis Foundation, close collaboration with your dermatologist, rheumatologist, or other health care provider is one of the best ways to help achieve low disease activity. These professionals can evaluate your symptoms, examine your laboratory results, and adjust your medication if needed.
It’s generally recommended to treat your psoriasis. Psoriasis has a chronic relapsing nature, and poorly controlled psoriasis may increase the risk of having other types of psoriasis.
However, if someone has achieved complete remission for at least one year, their doctor may recommend stopping therapy with careful follow-up. You should always talk to your health care provider for medical advice if you’re interested in discontinuing your medications.
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