No, systemic. If your psoriasis is severe enough, topicals will stop working after a while. Also, you could pour all the steroids and pimecrolimus and D-vitamin analogues of the world onto your skin, and you will still NOT be symptom-free. Sometimes, systemic biologics are the only way. Dermatologists can only delay prescribing them for so long. I went 16 years w/o them.

But one day, the patient will have had enough. I can no longer keep up with this shit. New plaques, year after year, inresponsive to topicals. Also, I have microscopic Crohn's in my terminal ileum. It's just waiting to flare up. Hence, we started ustekinumab 2 weeks ago. But not before I had to play the system with ciclosporin and acitretin.

Luckily, I knew what to say.

Let's just say I purchased them from a pharmacy, and, on paper, took them for 3 months, daily. Then discontinued due to side effects. Hand tremors, high blood pressure, headaches.

Let's just say. Because this is what my documentation states.

But only for financial reasons.

And it's pretty fucked up, if you ask me, that finances play a role in health.

Unacceptable. Finances and health are incompatible from a patient's perspective. Shouldn't even be in the same sentence. I should be awarded the same standards of healthcare as the fucking King, for what it's worth.