How to manage psoriasis in a 19-year-old?

Question

Hi doctor,

I am worried about my sick son who is 19 years old. His psoriasis is destroying his college life. It started when he was in high school but got worse since moving into dorms. The communal showers and stress from finals made him look like a burn victim. His roommate moved out because he was "uncomfortable" with the constant flaking. In his skipping classes also, people stare at his face patches. He has been taking Methotrexate 20 mg (milligrams) weekly for three months. However, his latest laboratory reports showed a low white count with a WBC of 3.2 and elevated liver enzymes. His joints, especially ankles and wrists, are also swollen. He cannot type his essays. He also notices patches in his private areas too. He is not willing to see a doctor because he is very much embarrassed. His depression is getting worse and he talks about dropping out. What options can we get for a young student?

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

The common side effects of Methotrexate are impaired liver function and lowered WBC (white blood counts) counts that might increase the chance of getting the infection.

Alternatives to Methotrexate:

Leflunomide (Arava) is effective for patients who have failed or are intolerant to Methotrexate. Enbrel (Etanercept), Cosentyx (Secukinumab), and Humira (Adalimumab) are three biologics that are highly targeted with fewer side effects. They act by blocking a protein important to the immune system and thus reducing the immune function. The newest drug in interleukin -17A and interleukin 17-F antagonist Bimekizumab (Bimzelx) acts directly to decrease inflammatory processes in the psoriatic plaques. In 20 to 50 percent of cases, psoriatic patients are 1.5 times more likely to have depressive symptoms and anxiety. It is advisable to see the health care provider and talk to him about ways to feel better. Tremfya(Guselkumab) and Talz (Ixekizumab) can help with the symptoms of depression. Cognitive behavioral therapy (CBT) is a way to manage the feelings that psoriasis brings on. It helps to change and control negative thoughts.