How can I manage psoriasis after my kidney transplant at 41?

Question

Hello doctor,

I am 41 and my psoriasis has taken over since my kidney transplant 3 months ago. The immunosuppressants (Tacrolimus and Prednisone) seem to be making everything worse. I have these weird pustular patches all over my legs and arms that leak and smell funny. My transplant doctor reduced the anti-rejection medicines because of high Tacrolimus levels (18.2) but now I am scared of rejection. The patches around my surgery site are not healing properly and I got this thick yellow crust. My joints feel like they are filled with glass, especially my knees and elbows. The latest labs show my creatinine climbing (1.8) and WBC (white blood cell) is low (2.8). The topical steroids burn like fire and my blood sugar is all over the place (250 to 350). Help me balance this without losing my new kidney.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your situation requires urgent multidisciplinary care. Worsening psoriasis, joint pain, and non-healing patches suggest severe pustular psoriasis possibly triggered by immunosuppressants.

High Tacrolimus levels and low WBC (white blood cell) increase infection risk. So, consider a dermatology consultation to explore systemic non-steroidal treatments like IL-17 or IL-23 inhibitors, which may balance psoriasis control with kidney safety.

Discuss optimizing Tacrolimus dosing to prevent rejection while avoiding further side effects. For wound healing, evaluate for secondary infections and adjust antibiotics if necessary. Work with an endocrinologist to stabilize blood sugar using insulin if needed.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.