This is a vitally important question, and the following answer is for those with moderate to severe psoriasis, not for those whose mild psoriasis can be managed rather safely and easily.
Because psoriasis stems from a malfunction in the immune system, the latest treatments work by targeting pieces of the immune system. But the immune system plays an essential role, protecting us from bacterial and viral infections, as well as cancerous cells and other threats to our health. So there is a danger that in seeking to reverse processes causing psoriasis symptoms, treatments could weaken the protective function of the immune system.
The good news is that 21st century psoriasis and psoriatic arthritis treatments are designed to target limited components of the immune system to stop psoriasis without more broadly impairing the immune system. That being said, these treatments do tend to carry warnings about increased risks of serious infections and some cancers. Others also increase the risk of depression or inflammatory bowel disease. Simply put, these treatments are not to be taken lightly.
But those who have serious problems while on these treatments often have other, serious pre-existing health issues; and if careful pre-screening is done – for example, doing a TB test before starting a new treatment, or consulting a cancer specialist before putting someone with a past history of cancer on a psoriasis treatment – then the risks can be well-managed.
Some people on these treatments have had serious health issues emerge, and some people have died while on them. It is not always clear what actually caused the crisis, but it’s fair to say that the treatments themselves sometimes contribute to these tragedies. We don’t want to unjustly minimize these risks.
In 2009, one expert reported that the the risk of dying from an adverse drug event related to psoriasis treatment was less than 1 in 10,000. Given all the medical community has learned since then and the new treatments that have become available, that risk is probably even smaller now.
In consultation with your physician, you can discuss the costs versus the benefits and make a decision that works for you. Remember that even a tripling of a tiny risk is still tiny. For example, imagine if you heard that a certain serious medical problem occurred in 1 of every 3,000,000 people. If you later learned that a treatment tripled that risk – even though a tripling sounds scary – it would still only occur in 1 of every 1,000,000 people (nothing to lose sleep over). That is why you need to discuss actual risks with your doctor before starting a treatment, so you can decide how much risk you are willing to bear to possibly be free of psoriasis symptoms.
There are now patients who have been on some of these treatments for 10, 15, and even 20 years, without worrisome problems. Given that psoriasis is a lifelong disease, it is essential that treatments can be taken safely not just for years, but for decades. The safety outlook for these treatments is improving over time, not getting worse, and that should give us all a measure of comfort.
[Last updated: 5/14/2020]
