The Science of Skin: A Journey of Hope and Home

This post, and my travel to the event, was sponsored by AbbVie Inc. Personal opinions and thoughts are my own.

Standing next to my poster at The Science of Skin, NYC

I rushed into the Whitby Hotel in New York City feeling late to The Science of Skin educational event. The stress of navigating a new city amped up my heart rate. I had traveled across the country and didn’t want to miss a beat. 

As I descended the stairs to The Reading Room, I felt transported to a familiar space. I first saw a picture of myself on a poster with a quotation about why I started blogging about psoriasis. Walking in further, I greeted new and old friends.

Indeed, The Reading Room became a special place for those few hours. I might characterize it as a safe place, but it was more than that. I not only learned from doctors and heard fellow patients transparently share their experiences with chronic skin conditions, but I also reflected on my own psoriasis journey.

A Student’s Attitude Toward Psoriasis

Since my diagnosis, my understanding of psoriasis has grown as I have taken the initiative to learn and read about the disease, its causes and the treatment landscape. I don’t claim to know it all, as information and treatments continue to evolve, so I always look forward to opportunities to be a student of psoriasis, which this event afforded.

The Whitby Hotel Reading Room, NYC

During the panel discussion about psoriasis, I recalled instances of people who told me flatly that psoriasis is just a rash. Over 40 years of living with this disease, I’ve seen the science prove them wrong. Now we know that psoriasis is a chronic disease linked to many factors, including an overactive immune system.

When I see those red plaques and lesions on my skin, I now know I’m seeing inflammation that is forcing my body to produce skin cells at a much faster rate than normal. Instead of a 28-day skin cycle, psoriatic skin produces new skin cells in a four to five-day cycle. That faster skin production leads to thickening of the skin as cells build up on the surface. Those skin cells then become the flaky scales and plaques that get all over my bedsheets, clothes, and floor.

In addition to discussing the science behind psoriasis, the dermatologists at the event also addressed other areas of psoriasis research. One even talked about how knowledge gained from developing psoriasis treatments is now helping researchers to develop treatments for other conditions. 

Coming to Terms, Again, With Psoriasis’s Impact on My Life

The Science of Skin event turned out to be more than just a scientific presentation of psoriasis and other chronic skin conditions, but rather, a look at the whole person. The discussions helped me realize that I’m not always as willing to acknowledge the deep impact of the disease on my daily life as I think I am.

I usually wonder if my skin will worsen with the stress of travel. This time I did feel a bit of skin discomfort, but when people asked how I was doing I quickly said “fine.” When speakers started talking about the isolation and shame that some living with chronic skin conditions can experience, I felt challenged once again to stop hiding the impact of psoriasis on my life.

Wonderful seeing Nitika Chopra who presented her experience with psoriasis

A survey conducted by the National Psoriasis Foundation that found 87% of psoriasis patients feel helpless and embarrassed, and 88% believe that psoriasis affects their overall emotional wellbeing, really resonated with me. Psoriasis has never been just skin deep for me, and now I have stats to back it up. The presenters emphasized the physical, psychological, emotional, and social impacts that can come with a visible skin condition—all of which I can attest to in my own experience. 

At the same time, I was glad to hear one dermatologist’s observation of how the psoriasis patient community’s mood has turned more positive as more effective treatments have become available. I’ve experienced that transformation in my life, and the last decade has been the most productive for my advocacy, work, and education. I didn’t settle for “good enough” and asked for more when it came to my psoriasis care. 

Now I want other patients to feel empowered to have an honest discussion with their dermatologists about their treatment goals for achieving clearer skin. As I grew in sharing with my dermatologists how I’m really feeling and thinking, I found myself more involved and satisfied with the decisions that were made for my psoriasis care.

As The Science of Skin event ended, I looked back at The Reading Room one last time.  The event marked a moment where I felt hope again for people living with psoriasis. I confidently stepped back into the city feeling that I could move forward in my journey with psoriasis as I turned toward home.

DisclosureThis post, and my travel to the event, was sponsored by AbbVie Inc., a biopharmaceutical company, and should not be construed to constitute medical advice. Personal opinions and thoughts are my own. I am not a medical professional and am not qualified to give medical advice. Please talk with your doctor about your individual medical situation. 

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Lori’s Story: Watching “Dear Evan Hansen” Inspired Me to Consider My Own Mental Health

In this guest post my wife Lori discusses how seeing a musical on our trip to NYC led her to reflect on her own parenting and mental health journey.


Warning: Spoilers for the musical “Dear Evan Hansen” and sensitive content are included in this blog post. Please read at your own discretion. 

Howard and I had an opportunity to see the musical “Dear Evan Hansen” on Broadway in New York just a couple of weeks ago. Our youngest daughter highly recommended it to us—having seen it herself at the Music Box Theater the previous year. It was an incredible choice. 

I was drawn in from the first minute until the very end. I want to talk about the musical through the lens of a parent as well as my personal experience with depression/suicide as a young person many years ago. 

I Need a Parenting Map

The musical opens with Evan and his mom. It’s the first day of senior year of high school. Evan is nervous about it, but so is Mom. She chatters on, gives him a rousing pep talk, asks about his homework assignment from his psychiatrist, and anxiously hovers over him. Meanwhile we get a peek into Connor Murphy’s morning with his family. Mom is trying to push him to attend the first day of school while Dad and sister Zoe make snide remarks about Connor at the breakfast table.


I was drawn in from the first minute until the very end. I want to talk about the musical through the lens of a parent as well as my personal experience with depression/suicide as a young person many years ago. 


I could relate to the poor moms in this first scene and the opening song, “Anybody Have A Map?” They are trying so hard to keep their sons going—really pushing them through life even though the boys are both struggling with deep emotional issues. It is scary and confusing. They are trying, but at a loss as to how to truly connect with their children. I can relate. Both my daughters have struggled with depression and anxiety. 

As a mother, I desperately rooted around and grasped onto the familiar and found comfort in a daily routine. If my girls could just make it through school that day, then they could build on that day after day and everything would be okay, right? Life works itself out and my kids are gonna be part of that. They are gonna love high school and even thrive there. They are going to overcome personal obstacles and soar above it all. 

Even though I didn’t. 


To hear Lori share her mental health journey listen to the Brainsick podcast “The Lori Special”


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To an Awesome Wife on Valentine’s Day

Lori and I visited Universal Orlando City Walk during the InterVarsity National Staff Conference in early January, 2020.

A big happy Valentine’s Day to my wife of over 25 years, Lori. I’m grateful for not just the quarter century together, but more importantly all the ways we’ve grown personally and relationally since those early days of college.

I shared about how we met on my Everyday Health The Itch to Beat Psoriasis column titled, “How Psoriasis Helped Me Meet My Wife.” An excerpt from the top of the column expresses how connecting through sharing about my psoriasis and her spina bifida led us to develop an inseparable bond:

It was love at first talk. When Lori and I met in our last year at college, we connected immediately. Sure, there was a physical attraction — and we joined the same Christian group at the University of California in Davis. But the ability to talk openly about living with chronic health conditions bonded us from day one.

We still care for each other through the health ups and downs with listening ears and helping hands. I wouldn’t have wanted to share my life with anyone else.


For this our 28th Valentine’s Day together I would like to share a short letter to my best friend:

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2020 Psoriasis Treatment Update: How a Work Leave Might Impact My Skin

Prayer Chapel, Redwood Christian Park, Boulder Creek, California

Lori and I joined a Christian conference for graduate students in the beautiful Santa Cruz mountains. We found this prayer chapel during one of our walks. The trip marked our first weekend on leave from the church.

Happy New Year! I know it is almost mid-February, but it’s my first PsoHoward entry of the year. I’ve been quite busy preparing for a personal leave that started this month. Now that I will be on four-month break I hope to come back to writing regularly.

Today I’ll start with treatment updates.

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Skyrizi Week 16: The Verdict?

The Chang family trip this summer included a trip to Crater Lake, Oregon. I especially enjoyed the trip with improved psoriasis.


This week marks the sixteenth week since I started taking Skyrizi to treat my stubborn psoriasis. I took my first dose of two 75mg injections on May 31st. My second dose came four weeks later on June 28th and anxiously awaited results. Now I’m on every twelve-week dosing with the third dose this week. 

A couple weeks ago I called the Accredo specialty pharmacy to see if they could deliver Skyrizi last Friday in anticipation of taking it this week. With travel to take my daughter to college scheduled at the end of the week I wanted to take it a few days early. My dermatologist agreed. I took the third dose on Monday.

With the third dose injected, and sixteen weeks into the new Skyrizi therapy, what’s the verdict?

I’ll use the same categories to evaluate Skyrizi that I used with Tremfya. Here’s my evaluation:

How well is Skyrizi working for me?

The Verdict: Not as good as hoped, but better than others. 

I did start taking Skyrizi with super high expectations. The dermatologists I talked to recommended it to me. I read about how the effectiveness of Skyrizi topped other biologic medications. No question I wanted to try Skyrizi next with the hope that my psoriasis would magically clear.

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Skyrizi Week 6: Anxiously Awaiting Results

I’ve experienced a steady anxiety about Skyrizi the last few weeks. My expectations changed after I injected the second dose at week 4. With the next injection at 16 weeks, I figured the medication already in me must do the work.

A graph from the Skyrizi website show the percentage of those taking the medication reaching ninety percent improvement tapering off by week 16. For once I want to be part of that three out of four who get fantastic results from a psoriasis medication.

I Want It Gone Now

In my head I know I need to practice patience when it comes to psoriasis. Few medications work as quickly and effectively as I want. I want something like a Tylenol or Benadryl that starts working within the hour. What I typically get with these drugs is more waiting with less than stellar results at the end of months of waiting.

I don’t easily admit my impatience. I see myself as a veteran of these psoriasis wars—I’ve seen it all, and nothing surprises me. Expect little. Set the bar low to the ground. Manage expectations. All these platitudes mean well, but do little to curb the appetite that’s grown for something, anything, to truly knock down my psoriasis. The fact remains I’m no different than anybody with a severe chronic condition—I want it gone now.

Alas, it just doesn’t work that way (if it works at all). I want the rabbit, but many treatments act more like the turtle. Slow and steady wins the race, Aesop’s fable declares. But what if the turtle never makes it to the finish line?

Here are some photos comparing when I started Skyrizi and about six weeks later:

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Skyrizi Week 3: Three Questions Waiting to Be Answered

I can’t believe I finished my third week of taking Skyrizi (Risankizumab). In the coming week I take my second dose. This dose is a loading dose administered at week four. The dosing moves into every twelve weeks thereafter.

The biggest questions I have when I take a new medication are if it will work, when it will start working, and will I have side effects. See below for my updated impressions on these three questions.

Will Skyrizi Work to Clear My Psoriasis?

This is a crystal ball question to be determined in the coming weeks. But if you make me give an answer of what I predict I’ll tend to take the pessimistic view. When a drug claims that X out of 10 people who took it during clinical trials reached PASI 75 or 90, or even cleared, I’m skeptical I would be one of them. 

I’m usually the X out of ten that did not reach any notable level of psoriasis clearance. I know, I know. Past results do not predict future outcomes. Too many variables must play out before making any conclusions. My body changes over time. New medications have different mechanisms of action in my body than others. But I’ve faced disappointment after weeks and months of waiting on a new drug enough times to not get my hopes up.


Follow My Skyrizi Journey!

Starting Skyrizi for Psoriasis Week 0


Skyrizi’s website makes the following claims:

  1. In clinical trials, 3 out of 4 people achieved 90% clearer skin at four months, after just two doses
  2. Of those, nearly 9 out of 10 sustained 90% clearer skin through one year
  3. Also, 8 out of 10 people achieved clear or almost clear skin at four months, after just two doses.

Number 1 and 3 sound like the same results told in two different ways. Number 2 says that those who did respond sustained it after a year. Okay, awesome numbers to be sure. I just hope I’m not the 1 out of 4 or 10 who doesn’t get a great response.

When will Skyrizi Start Working?

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