Psoriasis advice

June 17, 2009 9:27 AM

I have psoriasis and wonder what treatments work if you or someone you know also has it and what your experience has been.

My father has plaque psoriasis and over the last eighteen months or so I have begun to develop it. I had a quick initial onset on my scalp and upper chest, which has since slowly expanded in area affected. A local dermatologist I finally consulted two weeks ago prescibed Derma-Smooth/FS, a suspension of fluocinolone acetonide in purified peanut and mineral oil. I have used the stuff and it has resulted in some clearing of the affected areas but the lesions are persistent and less noticable but no smaller, even thogh the doctor said the would begin to go away. He mentioned some other treatment that he woud use after the fluocinolone did its work.

Dad had a case that was very bad, progressing to that point that it affected large areas of his skin. He spent two weeks at a clinic in another state (The Cleveland Clinic?) for some sort of intensive treatment that failed. The concern as I understand it was that psoriasis in its more extreme manifestaions can result in skin cells replicating so fast that the body's temperature is raised by the accelerated metabolism to dangerous fevers.

Eventually Dad's psoriasis was controlled with methotrexate, which is more commonly employed as part of anti-cancer chemotherapy treatments due to its slowing of cell division. He had to get a liver biopsy before they started using it and subsequent biopsies to check for liver damage.

It worked, and the dosage was decreased over time to minimal levels to maintain the "remission."

The Dermatologist's staff had me fill out a form describing why I was consulting the doctor. By the time the doctor breezed into the examining room I was waiting in, one of about four he has, he already had his prescription pad out. From his seat abot five feet away he glanced at the red patches on my upper forehead near my hairline and said the scalp oil he was prescribing would control the codition. He didn't look at my chest and he spent less than five minutes with me.

I have a follow-up appointmet with this doctor in a few weeks. I did not remember to ask him about arthritis as part of the aouto-immune symptoms associated with psoriasis. My knees hurt.

I understand that immune suppresant chemicals are used sometimes to treat my condition, and well damn, that sounds scary.

Should I consult a rheumetologist on my own?

Any thoughts you may have or experiences you could relate awould be welcome.

posted by longsleeves to health & fitness (23 comments total)

I will just say that I am in the same boat as you, with a similar timeline and experience at the dermatologist, and will be eagerly awaiting responses to this thread. My scalp psoriasis is getting much worse.

The forums at psoriasis.org seem to be populated with an experienced, knowledgeable group.
posted by Roach at 9:36 AM on June 17

Yes, go see a rheumatologist. I have experience with psoriatic arthritis, MeMail me if you want.
posted by Pax at 9:43 AM on June 17

I jumped the gun on automatically recommending a rheum. Depending on what you really mean by "my knees hurt," the derm might refer you there, anyway.
posted by Pax at 9:48 AM on June 17

Try to find a different dermatologist if you can/your insurance will let you. This guy sounds uncaring and awful.
posted by lolichka at 9:54 AM on June 17

I recommend "Healing Psoriasis: The Natural Alternative" by Dr. John O. A. Pagano.

Any treatment you receive from a dermatologist will be about suppressing the symptoms of psoriasis and not curing it.

I've lived with psoriasis for the last 30 years and following Dr. Pagano's program is the only relief I've found.

Good luck.
posted by torquemaniac at 10:59 AM on June 17

One of my friend's babies had a similar issue, and I made a bath oil with cherry oil, evening primrose oil and lavender essential oil, in about equal amounts, and her baby has been happy and non-itchy since we started using it.

She puts a little in the bath water, but the way she mostly uses it is to sort of coat the baby with oil when she comes out of the bath, and then dries her off with a supersoft towel, by patting, rather than rubbing.

I realize it's purely anecdotal, but I'm more than happy to turn you on to some reputable suppliers if you want to give it a shot.
posted by dejah420 at 11:40 AM on June 17

Don't have psoriasis, but I have two good friends who do - and I have a lot of experience with MTX. It's not as scary as it seems. Feel free to ask any questions.
posted by clarkstonian at 11:42 AM on June 17

If you have any concerns about involvement beyond skin (like your joints), rheumatologist is the way to go.

As far as topical medications go, Taclonex is very impressive. It's goopy and a mess to put on your scalp, but it can pretty much clear everything up in a couple of days -- and you might then be able to back off onto something that's easier to manage once it clears some.
posted by davidnc at 11:49 AM on June 17

I would try to track down a dermatologist who specializes in psoriasis. It seems that a lot of derm's are not very good with it in my experience. The wide variety of treatments (and the wide variety of responses to them) doesn't seem to help any.

I'm fairly lucky and respond fairly well to topical corticosteroids, but a lot of people do not. Talconex is what I currently use.

I was briefly on methotrexate. It did eventually work enough to cause a brief remission (6 months or so). But given the other dangers I'm not sure it's worth it, especially if you have any liver issues or on any drugs that affect liver function.

I have never had any success with any natural or OTC medications. Aside from just getting more sun, which does seem to help me. Kind of a catch-22 though (it can be kind of embarrassing to get sun where you need it).

You will learn to keep an eye on it. Mine at least is a good indicator of any sickness. I can tell when I'm getting a cold/flu from the way the psoriasis reacts before I start getting other symptoms. Not quite as useful as a bad knee that tells you when to grab an umbrella, but a small plus.
posted by alikins at 12:26 PM on June 17

Many thanks to all who have responed so far.
posted by longsleeves at 12:38 PM on June 17

Responded, that is.
posted by longsleeves at 12:39 PM on June 17

Hi, I have had psoriasis for a long long time now and it has never ceased spreading. I don't think that I do have arthritis, or at least not until now. So I consider that I only have a light sort of psoriasis, even if it's a little annoying since it has spread on my hands, arms, face, etc...

I don't want to overgeneralize on the grounds of my own experience here, and I'm also pretty sure that the same symptoms might have completely different causes. The thing is that I think that my own psoriasis is largely influenced by psychological issues. It was triggered by a traumatic experience or two, and I can see the ebb and flow of it following good and bad times, with a certain delay. I've been given something to put on the affected regions to make it disappear, but after a while, I felt like a pressure cooker and strange feelings and fears popped up. I had trouble to stay indoors, but was frightened as soon as I was outside, I needed to stay in a darkened room etc... The fact that I was trying to make the symptom go away just broke the balance that it was a part of.

So my own advice, provided that you do not have one of the most severe forms, is to - among other things - look for quietness and peace of mind. Treatment may include therapy, meditation, long walks, telling people what you want to tell them etc...

I don't want to imply that you're not ok and that you really need all this... It is maybe completely irrelevant. In my own case, I know that I definitely need more tranquillity.
posted by nicolin at 1:29 PM on June 17

I had a certain amount of psoriasis that was treated with Synalar (fluocinolone acetonide) from one doctor which I used in small quantities - it would clear up and go away then come back. When I moved, my current doctor thought that Synalar was too high grade and suggested hydrocortisone, which is on the low end of the scale. Oddly enough, since I've been treating later-in-life-manifesting Crohn's disease with 5-ASA and 6-Mercaptopurine, the issue has gone away. So one or the other or both are enough to clear it up.
posted by plinth at 1:46 PM on June 17

I had just almost completed a long detailed response and hit the wrong key and lost it to the ether. Here's a slightly abbreviated version (and as long as it is, it's probably all for the best that the longer version got lost!).

I've had psoriasis for 27 years and psoriatic arthritis for about 20. I've been on practically every topical steroid with varying degrees of success, but never got total clearance and generally once i stopped it came back (although thankfully I never suffered the rebound affect - where it returns worse than it was before). I'm currently on Enbrel, more for the arthritis than the skin lesions. It is a serious medicine and you are right to be concerned, but I've been on it for 6 years with no ill effects. I don't get sick any more frequently than I did prior to taking it. It works great for my psoriatic arthritis, although recently I've been experiencing some breakthrough pain in my knee and big toe. My psoriasis is not 100% clear, but it remains at the mild level and Enbrel is the one drug that cleared up my fingernails and toenails (NB: pitting fingernails and toenails are one marker that you may have or be me more likely to develop psoriatic arthritis, another is swollen fingers or toes referred to as "sausage digits." I mention this because actually very few people with psoriasis, about 10%?, end up developing psoriatic arthritis. Psoriasis + sore knees doesn't necessarily = psoriatic arthritis). Also my stepmother took methotrexate with good results for over 20 years. We've lost touch after my father died but last I heard she was in her late 70s and doing quite well. She never developed any liver problems in spite of her long term use of this drug. I'm hoping that I have the same luck with the auto-immunes as to me the risk is worth not being in pain and the opportunity to stop further joint damage before it starts.

In addition to the drugs that everyone else has listed, if you have just a few disparate plaques, you may be a candidate for laser. I may try that on the one large plaque on my shin as it has not responded as well as I'd like to the Enbrel or topicals. My derm said we'd give it a go if I hadn't cleared by my next appointment as I mentioned that it makes me very self-conscious and I haven't been able to wear skirts or capris the last 2 summers.

Psoriasis seems to be like depression in that what works for one person does not necessarily work for someone else and what works for you now, may stop or not work when you next flare and need to try it again. Unless you hit it lucky the first time out, finding a successful treatment is very much trial and error

I've found that treatment (whether Enbrel or topical) in conjunction with a relaxing, sun-filled vacation has done the most to clear me up. I haven't had marked success with alternative/natural treatments, but have gotten some relief from baths with sea salt; fish oil tablets; (taken internally for joint pain; I took 5 1000mg capsules and my rheum felt that that was safe for me; and turmeric mixed with aloe and applied topically, but it stains the skin yellow so it's really not practical for long term use. A work colleague swears that her psoriasis totally cleared when she gave up dairy.

Please feel free to memail me if you want more details or have any questions.
posted by kaybdc at 2:25 PM on June 17

One person in my family responded really quickly to UV treatment.
posted by maggiemae at 3:04 PM on June 17

Specific to your recounted experience with Derma Smooth, (but this will apply to other topicals and medications) you need to be a bit more patient. In my experience Derma Smooth takes 3 weeks of nightly use to see marked results, although it certainly provides some immediate relief. Also, I've never had a dermatologist only prescribe Derma Smooth, and never for plaques outside of the scalp area. When I was bothered by scalp psoriasis it would get really bad during the winter months and I needed the Derma Smooth to reduce the thickness of the plaques so that prescribed liquid corticosteroids could penetrate and not just sit on the top.

Finally, please be reassured that psoriasis doesn't necessarily get worse the longer you have it. Although like you it initially presented on my scalp, I haven't had any there for the last 10 years or so. While I've never been 100% clear (yet), I have never progressed to beyond the "mild - to - moderate" stage. Generally I think that I probably have somewhere in the range of 5 - 10% body involvement and it just sort of moves around over the years, aside from one very stressful period when I had significantly more plaques all over my body. As with many conditions, it is exasperated by stress.
posted by kaybdc at 3:17 PM on June 17

My doctor prescribed Betamethasone Dipropionate for a patch of psoriasis that emerged suddenly on my scalp in early May. The patch was about the size of a postage stamp when it began but seemed to be growing when we began applying the liquid. My wife applied it twice a day - because I can't see or reach it accurately - and it's just about gone after 5 weeks. Again, it was a prescription so you will need a doctor. It was expensive - something like $50 for 60 ml. - but my psoriasis is gone.
posted by birdwatcher at 5:59 PM on June 17

Thanks again once again.
posted by longsleeves at 7:57 PM on June 17

responses by memail haz been. Not Anonymousies here.
posted by longsleeves at 8:00 PM on June 17

I have psoriasis on my scalp and in my ears. My father also has it (more severely) over quite a bit of his body.

According to the doctor, my case is mild, though I had it for over ten years before seeking treatment.

I was prescribed clobetasol (a liquid, alcohol base -- it stings like hell when the skin is still broken) for the scalp, which worked wonderfully, and Dovonex ointment for the ears, which also works, but seems less powerful.

I first used them both twice a day until the patches cleared up (which took maybe a couple of weeks total), and now I use them very sparingly when there's any breakthrough patchiness starting.

It's been a few months, and I am much happier and more physically comfortable than I was in the ten years previous, when I was constantly itching or in pain.
posted by peggynature at 7:06 AM on June 18

I use Dovonex which is basically synthetic vitamin D. Check it out.
posted by princelyfox at 9:37 AM on June 20

It is on my hands. The psoriasis.

The following has worked, listed in increasing order of effectiveness:

Dovonex

Vitamin D derivative topical cream. Dovonex sort of calmed the skin down but felt weird, like a hack.

PUVA.

Topical ointment + localized UV light therapy. "Turned down" the psoriasis pretty quickly. Then later, psoriasis came back.

Diet.

PLEASE TRUST ME ON THIS – try changing your diet. It took longer to kick in than the medical therapy, but it was a much more "natural" process kinda. Slowly, the psoriasis went away "from the inside". Very hard to explain but it felt like healing instead of suppression. This is what was recommended to me: No citrus, no gluten. Very little milk. No cheese except "fresh cheese" like cream cheese, cottage cheese. No red wine or red meat. Avoid onion, garlic. Very spicy stuff not so great but still OK. Instead, eat almost anything else. Lots of chicken, fish, vegetables, white wine, apples, some skyr and yogurt, some pasta, lots of rice, potatoes are cool. Take lots of good oils. Butter was OK I think, prefer olive oil, no 'synthetic' fats like margarine. As little sugar as possible, substitute green tea or tea for coffee as much as possible. Don't stop eating the bad things ... instead plan how you can eat only the good things.

Let me know how it goes!

posted by krilli at 12:29 PM on September 16

Argh, I the post all laid out with line breaks. As this advice was very important to me, I'm going to repost the diet cheat sheet, amended, and formatted better.


No citrus, no gluten. This means no oranges. No orange juice. No bread or any breadlike items. Including cakes, hot dogs, hamburgers, all that. All of it needs to go. This is the most important part. It is a tall order that I am very serious about.

Very little milk. No cheese except "fresh cheese" like cream cheese, cottage cheese. No red wine or red meat. Avoid onion, garlic. Very spicy stuff not so great but still OK.


Instead, eat almost anything else. Lots of chicken, fish, vegetables, white wine, apples, some skyr and yogurt, some pasta, lots of rice, potatoes are cool. Take lots of good oils. Butter was OK I think, prefer olive oil, no 'synthetic' fats like margarine. As little sugar as possible, substitute green tea or tea for coffee as much as possible.


Don't stop eating the bad things ... instead plan how you can eat only the good things.
posted by krilli at 12:37 PM on September 16