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Biologics vs. Light Therapy
from Shaida W.

Dear Ed:  Your website was brought to my attention by the folks at Genetech after attending a seminar on Raptiva.

Many, Many thanks to you and all those who have shared their humor, solutions, and most of all their pain. It takes guts to be vulnerable.
 
My P problem started a year ago following a course of antibiotics and a year after my menopause.  I turn 50 next December.  I do have other problems — high cholesterol, the onset of osteo, and seasonal asthma.  My P is mainly concentrated on my hands and feet with small patches on knees and elbows.  I am alarmed at its rapid progession and on my last visit to the doctor insisted on phototherapy.  I have an appointment for Sept 18, but at this point weighing two options: Biologics or phototherapy?  Any advice?  I should point out that money is not an issue. My insurance would cover both.  I am concerned about the time involved for phototherapy.  I work full time, have a demanding job and an equally demanding 4-year old daughter.  I am also thinking that if my problem is systemic, then phototherapy would not guard against further spreading, but the biologics will.  Am I right?  On the other hand, the biologics are so new and therefore a bit scary.

By the way, one thing I find that keeps my P under control is my asthma meds.  I think if I hadn't gotten off them during the summer, as I usually do, my skin would probably have been in better condition.  As for bathing in the ocean, it didn't work for me.  Then again, I binged heavily on junk foods and wine as always on those vacations.

Would very much appreciate your thoughts.. And once again, thank you for providing this site.  -Shaida  W.

*****

Ed’s Response:  Hello Shaida, thanks for writing and your kind words about our web site. 

I heard the other day that researchers are discovering so-called "adult onset psoriasis" may be subtly different than the life-long version of the disease.  I, like you, fall into the "adult onset" category.  Now researchers are doubting whether or not our form of the disease has an inherited component.  Anyway, I'm trying to find more information on this now.

Meanwhile, regarding your choice between phototherapy and trying a biologic: The various versions of phototherapy are "tried and true" and have helped many hundreds of thousands of flakers over several decades.  Biologics are a few years old and, for the treatment of psoriasis, are still somewhat experimental.  Given those distinctions, a lot of people would encourage you to try phototherapy first.  If it works, and you can accommodate the inconvenience of the regimen, GREAT.  These folks would tell you to consider biologics a "second choice" if and when phototherapy loses its advantage. 

As my tryst with phototherapy was unusually brief — after a handful of visits it became obvious to all concerned that I was NOT a good candidate — I don't have a good handle on the true costs involved.  Obviously you have to factor in more than the fee for use of the machinery and clinic time (e.g., gas to get there and back, your time...).  The costs of biologics, on the other hand, is pretty well established for the moment — and it's HIGH, at about $12,000-$15,000 per year.  You say cost isn't a factor because you know your insurance will cover either regimen.  That would point my consideration back to safety and convenience.  Both phototherapy AND biologics are supposed to be "safe," but phototherapy has the "experience edge."  Biologics, though, win hands down on convenience — especially if you use a biologic that is self-administered by subcutaneous injection (Enbrel, Raptiva, Humira), as opposed to in-office IV infusion (Remicade) or in-office intra-muscular injection (Amevive).  If you are suffering from both skin P and P-arthritis, you best bets among the current crop of biologics are probably Enbrel or Humira, both of which are conveniently self-administered.

Let us know what you decide and how it work!  -Ed

*****

Thank you for your kind reply, Ed.  That's interesting about the "adult onset" version.  However, if I were to consider my family history that in itself could be hereditary.  Both my sister and father were afflicted in later years.

I had my consultation for Phototherapy yesterday.  You're right, the schedule is pretty daunting.  I'm going to try it for a couple of months — at the risk of losing my job and being divorced!  

I should mention that since I last wrote to you, I bought a copy of Dr. Pagano's book [Healing Psoriasis: The Natural Alternative].  I haven't gone full steam on the diet and detox. (Maybe next year I'll take some vacation time and do so.)  However, I've been avoiding some suspicious foods — cheese, the nightshades, and sugary stuff.  The result has been very impressive.  Itching far less. Cracks have healed and no new ones for more than a week!  Small victory, I know. Also I'm still on Flovent (Asthma med) and scared to get off, in fear the wrath of P might descend once again. 

Keeping my fingers crossed and thumping wood! -Shaida

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