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Finding support for severe psoriasis

A dermatologist helps a patient with psoriasis manage his chronic condition–and navigate a complex insurance process known as step therapy.

Joshua's story

SkinSerious patient story, Joshua Rubin
Joshua Rubin, patient
For more than three decades, I’ve lived with severe psoriasis, a chronic, inflammatory skin disease that affects up to 3% of people in the United States. The now-familiar raised, red, scaly patches first appeared on my fingertips when I was seven years old before emerging on other areas of my body. Because psoriasis was uncommon for children at the time, it took a skin biopsy and other tests to get an accurate diagnosis.

As a child, it was terrifying to not know what was happening to my body. At the time, there weren’t many resources for kids with psoriasis or even for my parents and teachers in helping with my care.

Beyond the physical challenges, the social stigma was incredibly difficult for me. I regularly had to reassure my classmates and even other adults that my skin condition was not contagious and educate them about my disease.

In college, a friend shared resources on psoriasis that I hadn’t seen before. Through this resource, I found board-certified dermatologist Larry Green’s information and scheduled an appointment. I was nervous initially, but when I learned he has firsthand experience with psoriasis, I immediately trusted him in understanding what it is like to live with this condition.

One of the most frustrating parts of living with psoriasis is navigating the medication and insurance processes. Because of drug efficacy issues, treatments typically work for a year or two before I need to start on a new medication. My insurance company requires me to “fail-first” from less expensive medicines before moving to more expensive therapies—despite the fact that I’ve been on nearly every biologic treatment that exists. Dr. Green and his office team are wonderful in managing insurers’ requirements. They seamlessly explain why I need access to the specific drug and help me obtain the drug from the manufacturer’s pharmacy until my insurance covers it, which can take several months.

I’m so grateful to Dr. Green and his team for their ongoing support and care over the past two decades. No kid should ever have to face these challenges to control their psoriasis.

The dermatologist's perspective

Larry Green, MD, FAAD, Aesthetic & Dermatology Center and George Washington University

“Nearly 20 years ago, Josh came to me with one of the most severe cases of psoriasis that I had ever treated at that time. I’m honored he trusts us not only to treat his physical health, but to navigate the complex healthcare system. As Josh’s dermatologist, I look at the pros and cons of the medications available and select what I think will be the best medication for him. Alternative medications will not give Josh the response and control of his severe disease that he deserves. Often, insurance companies make physicians prove that medications they have a better contract for won’t work—even if we know the treatment will be ineffective based on the mechanism of action or the patient’s history. My hope is that patients like Josh won’t have to endure this “fail-first” approach when it comes to getting the care they truly need.”

─ Larry Green, MD, FAAD, Aesthetic & Dermatology Center and George Washington University

Patient & physician stories

Learn how board-certified dermatologists have helped patients with serious skin disease and collaborated with other doctors to enhance patient care.

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