Psoriasis treatment may not work for several reasons, such as developing a drug tolerance, experiencing side effects, or needing stronger medications.

Psoriasis is an autoimmune condition that causes thick, scaly skin plaques to develop. There’s currently no cure for psoriasis, but treatment may help relieve symptoms and slow the condition’s progression.

Every individual’s treatment plan for psoriasis will be different. Figuring out what works best for you may require some trial-and-error, and your treatment plan will usually involve a combination of options. These may include:

  • topical medications
  • oral medications
  • injectable medications
  • phototherapy
  • at-home remedies

Keep reading to learn more about why your treatment plan may not be working for you.

Your body may develop a tolerance to certain medications with continual use. This process is known as tachyphylaxis.

Research suggests tachyphylaxis may not be a concern with some topical medications for psoriasis. Still, it’s possible to experience withdrawal and possible side effects.

Experts recommend people only use potent corticosteroids continuously for a maximum of 4 weeks and take a 4-week break between treatments.

Toxicity happens when a buildup of toxins from medications negatively affects your body.

Research shows that long-term use of some systemic drugs to treat psoriasis may cause toxicity and affect your organs. For example:

Because of this risk, doctors typically only prescribe conventional systemic drugs for a short time.

It’s important to speak with a healthcare professional about the potential toxicity risks before starting a new treatment.

The body sometimes produces antibodies, known as antidrug antibodies, in response to psoriasis treatments. These chemicals attack medications and may reduce their effectiveness.

This could happen in response to taking biologics. These are newer medications made from living cells that target specific parts of the immune system.

Research from 2013 suggests biologic drugs may lose their effectiveness with long-term use, a process known as biologic fatigue.

Researchers are not entirely sure why this occurs in some people but not in others and with some drugs but not with others.

Biologics strongly affects the immune system and may increase your risk of infections. For this reason, doctors generally only use them after trying other treatments first.

The body may also develop a resistance to biologics over time.

Several skin conditions may look like psoriasis, including:

Speak with a healthcare professional if you’re not responding to treatment. This may be a sign that you received the wrong diagnosis.

One treatment method alone may not be enough to improve your symptoms of psoriasis.

In many cases, people require a combination of treatments, which might include topical medications, oral medications, light therapy, and other options.

For example, a treatment plan may include combining:

  • topical medications and a vitamin D cream
  • the systemic drug methotrexate with disease-modifying antirheumatic drugs (DMARDs)
  • psoralen and phototherapy, known as PUVA

Speak with a healthcare professional if your single or combination treatment plan isn’t working. They could help develop a new treatment plan for you.

Skin infections and injuries may slow treatment progress, and some psoriasis medications can worsen an infection.

If you have any signs of an infection, such as crust or oozing, see a healthcare professional right away.

You might miss a dose of your medication for many reasons. Some treatments can withstand the occasional skip, but others rely on steady and consistent use.

If you often forget to take your medication, try using an app or calendar tool that sends a reminder when it’s time for that day’s dose.

If cost is an issue, talk with your doctor about drug discount programs or alternative treatment methods.

Stress can trigger psoriasis flare-ups. Finding ways to manage stress could make a big difference to your skin.

The Centers for Disease Control and Prevention (CDC) suggests the following tips to help manage stress:

  • do some exercise
  • listen to your favorite song
  • reach out to someone, such as a friend, family member, or healthcare professional
  • write in a journal
  • try deep breathing exercises, meditation, or yoga
  • eat a well-balanced diet
  • get at least 7 hours of sleep a night

An online or in-person support group may also help you relieve stress. Talking with others who have dealt with the same issue may be helpful. Speak with a healthcare professional about options near you.

The duration of your psoriasis treatment may vary widely depending on the type of treatment you’re receiving.

For example, topical treatments for psoriasis may help relieve symptoms within 1–2 weeks but could take up to 6 weeks to take effect.

On the other hand, phototherapy may require 15–25 treatments to work, according to the National Psoriasis Foundation.

Sometimes, patience is all that’s needed to see improvements from your treatment.

Some lifestyle and dietary habits may be triggering or worsening your psoriasis.

For example, smoking and drinking can worsen psoriasis symptoms and lessen the chances of remission, according to the National Psoriasis Foundation.

Drinking alcohol may also increase inflammation and impact your response to treatment.

If needed, healthy lifestyle changes may help reduce psoriasis flares. These might include:

  • quitting smoking, if applicable
  • avoiding alcohol or drinking moderately
  • keeping active
  • eating a healthy diet
  • doing your best to keep your weight within the healthy range for your body type

It can be frustrating to see your skin improve with psoriasis therapy, only to have symptoms return months or years later.

Speak with a healthcare professional if your symptoms worsen, you think your treatment plan is not working, or you experience any of the following side effects during treatment:

According to the National Psoriasis Foundation, you can expect your treatment plan to help clear your skin, cause few side effects, and complement your lifestyle — even with moderate to severe psoriasis.

It’s important to note that this isn’t always the case, though.

Several signs could indicate that it may be time to change your psoriasis treatment, including the following:

  • the treatment doesn’t work from the beginning or stops working after a period of effectiveness
  • you don’t like some aspects of your treatment, such as daily injections or time-consuming cream applications
  • your symptoms worsen or continue to flare up
  • you experience side effects
  • comorbidities (other conditions) develop, like cardiovascular disease, depression, kidney disease, and liver disease
  • you’re concerned about toxicity
  • you’re breastfeeding

Treatment will affect every person differently. This means the reasons for switching or modifying a treatment plan will vary, too.

What if psoriasis is not responding to treatment?

If psoriasis is not responding to treatment, speak with a healthcare professional. They could help modify your treatment plan, such as adding a medication, increasing your current dose, or suggesting alternatives.

What is wrong with my immune system if I have psoriasis?

Psoriasis is an autoimmune condition. It occurs when your immune system goes into overdrive and creates too many skin cells. These build up on the surface of your skin as plaques.

Finding the right psoriasis treatment may take some time, but it’s possible.

Make an appointment with your doctor if your current treatment is no longer working. They can talk with you about why your treatment isn’t having the desired effects and which alternative options might be a good fit for you.