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Why Does Derm Say My P Doesn't Warrant a Biologic?
from Celia M.

I have very gross P on my hands and arms and behind my ears. My nails aren't nails anymore. They look like yours in Nail P. I can't continue my work, which is very public, unless I can clear this up. My current derm, though, says my P isn't severe enough to be treated by biologic. I am so mad! I guess I have to have spots all over to do that. Don't they have any consideration for where psoriasis can be and how badly it can affect a person's life? I am more than ready to switch derms, but should I present my case any specific way to get a better result? -Celia M.


Ed's Response: Thanks for writing, Celia. You're not alone. I've received a few dozen emails from flakers who are stunned by their derm's reluctance to prescribe a biologic. Here are some of the reasons why your derm might not want you on biologics right now:

  • Your medical history records problems with infections (or other things) that could be made worse using a biologic.

  • Other systemics with longer and better-known safety profiles may be what he wants you to try first. (These might include methotrexate, cyclosporine, or Soriatane.)

  • If you haven't tried light therapy, he may want you to try that first.

  • He may operate under a guideline that requires a certain degree of coverage (severity) and you don't meet that criteria.

FDA-required language on the prescribing information of most (if not all) the biologics approved for psoriasis suggests the biologic should be prescribed when other treatments fail.

There are a couple of "general reasons" why derms might not willy-nilly promote the use of biologics. Expense is one of them. Your derm may have a pretty good idea how your insurance company would react to his prescription (from previous contests on behalf of other patients) and feels the cost to him, to you and to the insurance company is prohibitive until you have exhausted all other options. Or, since the long-term safety history of biologics is beginning to unfold some gruesome outcomes (see Mike S.'s email at the top of this month's Mail list), derms may feel that for certain patients those uncertainties are not worth risking.

Before you switch to another derm, try to determine how your current derm feels about the first three bullets in this list. That knowledge may compel you to stick it out for awhile, or help you find another derm who won't share the same sentiments. -Ed

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