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Psoriasis Treatments Often Lose Effectiveness Over Time
Experts explain the phenomenon of tachyphylaxis and why it's likely due to poor medication adherence, not drug resistance.
Mar. 12, 2026 at 1:51pm
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In this interview, Dr. Steve Feldman, a dermatology professor at Wake Forest University, discusses the common issue of tachyphylaxis, where psoriasis treatments gradually become less effective over time. He explains that this is likely due to patients using the medications less frequently, rather than the medications actually losing potency. Dr. Feldman emphasizes the importance of improving patient adherence to topical treatments in order to maintain their effectiveness.
Why it matters
Understanding the true cause of tachyphylaxis is crucial, as it impacts how doctors should approach treating psoriasis patients, especially when considering moving on to more expensive non-steroid medications. If the issue is poor adherence rather than drug resistance, the focus should be on finding ways to better engage patients and improve their long-term use of topical treatments.
The details
Dr. Feldman explains that when topical steroid treatments for psoriasis initially work but then gradually lose effectiveness, the common assumption is that the immune cells have become resistant. However, he suggests the real issue is that patients simply stop applying the medication as frequently over time. Studies have shown that when patients are closely monitored and encouraged to use the topical steroids consistently, the treatments regain their efficacy. The problem seems to be one of adherence, not drug resistance.
- The interview was recorded on March 12, 2026.
The players
Dr. Steve Feldman
A professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, North Carolina.
What they’re saying
“Tachyphylaxis isn't 'the more you use the medicine, the less it works.' It's probably the less you use the medication, the less it works.”
— Dr. Steve Feldman, Professor of Dermatology (Medscape)
“It doesn't seem that that the medications stopped working. It seems like our ability to get patients to use the medicine is trailing off over time.”
— Dr. Steve Feldman, Professor of Dermatology (Medscape)
What’s next
Doctors will need to focus more on improving patient adherence to topical psoriasis treatments in order to maintain their long-term effectiveness, rather than immediately switching to more expensive non-steroid medications when tachyphylaxis occurs.
The takeaway
The common phenomenon of tachyphylaxis, where psoriasis treatments gradually lose their potency, is likely due to patients using the medications less frequently over time rather than the drugs becoming less effective. Improving long-term adherence to topical treatments should be a priority for dermatologists in order to help psoriasis patients maintain control of their condition.
