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Psoriasis is a chronic immune-mediated skin disease with no cure yet, but it’s possible to achieve remission (periods where you have no symptoms). Reaching remission — the goal of many comprehensive treatment plans — can improve the overall quality of life for those dealing with this challenging skin condition. Current treatment options, including topical treatments, phototherapy, and systemic drugs, can dramatically improve psoriasis symptoms such as red, itchy, skin cell plaques. Here’s what remission means and how you can reach it.
Definitions of psoriasis remission vary depending on the type of psoriasis and the level of disease severity. In many cases, therapies aim to reduce the severity, frequency, and length of psoriasis flares (periods in which symptoms like scales crop up). Remission from plaque psoriasis, the most common form of psoriasis, is generally defined as complete skin clearance from red, scaly plaques. Most periods of psoriasis remission last up to 12 months, although this time varies from person to person, from weeks to months to even years in some cases.
Some clinical guidelines specify psoriasis therapy goals based on the change in Psoriasis Area and Severity Index score (PASI) from before and after treatment. A PASI score is a number doctors use to measure psoriasis severity. Scores are based on an evaluation of the redness, thickness, and scaling of psoriasis lesions. Although specific clinical definitions for psoriasis remission do not exist, a treatment plan is considered successful (and should typically be continued) if the treatment leads to a greater than 75 percent reduction in PASI score. With several newer biologic medications targeting inflammatory mediators such as IL-17 and IL-23, treatment plans may soon strive for a 90 percent to 100 percent PASI reduction.
In people who develop psoriatic arthritis (PsA), remission definitions also vary. Some studies say PsA remission is having a very low disease activity (VLDA) score, which indicates a low number of tender, swollen joints with low pain and a low PASI score.
Remission may be followed by periods of severe psoriasis flare-ups. However, close monitoring by a dermatologist as well as an effective treatment plan can help people achieve and better sustain remission. Combination therapy with phototherapy, topical corticosteroids, and systemic medications such as methotrexate or biologics can help improve skin clearance. Newer medications that target the immune system, such as the cytokine inhibitors etanercept, infliximab, and adalimumab, may also increase the likelihood of remission.
The treatment of psoriasis is a complex process. Over time, you may need different medications or therapy options to keep your psoriasis in check. Avoiding triggers such as stress, skin injury, extreme weather, infection, and smoking can help keep the skin clear of psoriasis lesions.
However, it is impossible to predict who will reach remission and how long remission will last. You and your doctor should also weigh potential medication side effects against potential remission benefits. Regular follow-up with your dermatologist may also help you manage psoriasis more effectively. The National Psoriasis Foundation recommends working with your health care provider to find the right combination of psoriasis treatments that can reduce or eliminate symptoms.
Once you reach near or full skin clearance, you may want to stop some or all psoriasis treatments. Depending on your health status, psoriasis history, and treatment plan, however, your dermatologist may recommend continuing therapy unchanged. The doctor may also suggest modifying dosages, or they may suggest stopping particular medications. According to the American Academy of Dermatology, one of three things may happen if psoriasis treatment is stopped:
In general, dermatologists do not recommend stopping biologic therapy. Long-term, continuous therapy is ideal for maintaining remission. Once you reach remission, you should discuss a maintenance plan with your dermatologist. You may need close monitoring and regular adjustments to your treatment plan to help keep your psoriasis under control.
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