At 33, are long-term biologics safe for my plaque psoriasis?

Question

Hello doctor,

I am a 33-year-old woman with chronic plaque psoriasis for the last seven years. My skin lesions have worsened recently despite using topical steroids and vitamin D creams. My scalp and elbows are most affected, and I also have joint pain in my fingers. I have heard about biologics like Secukinumab, which can be useful. Please tell me,

How safe are they for long-term use?
Will I need screening for infections before starting them?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I understand how distressing worsening psoriasis and joint pain can be, especially when topical treatments are no longer effective.

Please find the key points below:

Chronic plaque psoriasis involving the scalp and elbows is common. Your finger joint pain raises concern for psoriatic arthritis, which requires early evaluation and systemic treatment to prevent joint damage. However, at this stage, topical therapy alone is usually insufficient.

Biologics such as Secukinumab (an interleukin-17 inhibitor) are used for moderate to severe psoriasis and psoriatic arthritis. It is effective for both skin clearance and joint symptoms. Many patients use it safely for long-term treatment under monitoring. It does not affect the liver or kidneys like some oral systemic drugs.

Biologics are generally well tolerated. You can experience symptoms like mild upper respiratory infections and candidiasis. In your case, a regular follow-up is required.

Yes, screening for infection is mandatory before initiating therapy. This usually includes:

Tuberculosis screening.
Hepatitis B and C screening.
HIV (human immunodeficiency virus) testing.
Baseline complete blood count and liver function tests.

I am recommending the following things to you:

Consult a dermatologist or rheumatologist for evaluation of possible psoriatic arthritis. If confirmed, biologic therapy is a very appropriate next step.
Early treatment helps prevent permanent joint damage.
Biologics like Secukinumab are considered safe for long-term use when properly screened and monitored. Given your worsening symptoms and joint involvement, systemic therapy would be reasonable to consider.

I hope this information helps you.

Feel free to ask further queries.

Thank you.