Monday, 7 April 2014

Psoriasis flare up ( 2014 )

So here I am again, just coming out of the tail end of winter looking more like a scaly lizard than a yummy mummy. Desperately wanting to shed my winter clothes in favour of lighter summery tops and dresses but unable to because of the embarrassing scaly bleeding patches on my arms and legs.
My psoriasis has flared up yet again and I am hard pressed to find a sizeable area of normal skin on my body, but thankfully my face has escaped it this time.

So having been back to the dermatologist I am now faced with the decision of what treatment to take. The coal tar lotions haven't been successful over the winter and I'm pretty sure it's because my body has got used to them and built up a tolerance.

So what options do I have?

Topical Steroid Creams
These are just used to treat the inflammation of the psoriasis and don't do anything to actually cure/heal/clear it up. They can only be used for a limited period of time but can be used longer if a rest period is used, for example 4 weeks use then 4 weeks off.

Coal Tar
Coal Tar has been used for more than 100 years to treat dermatological conditions, it can be used both on the body and in the scalp. It too has anti inflammatory properties which is helpful in reducing the redness of the skin. The downside to this treatment is it's very messy and smelly. Who wants to go to bed with a creosote fence? The more commercially available products like Exorex are less messy but still smell and take longer to work because they don't have a high concentration of the coal tar.

Coal tar or fence paint - all smells the same to me!

There's two versions that I know of Lassar's Paste and Short Contact. The Lassar's Paste is mainly used on in-patients but the Short Contact can be used at home.... but with a warning. Dithranol stains both the skin and any clothing or fabric it comes into contact with, and it can burn normal unaffected skin. It comes in various strengths with the idea that you build up to a strength that suits and continue to use until the skin is clear.

Comes in pretty coloured tubes be will leave
everything a nice shade of purplely brown!

Ultraviolet Light Therapy
Sunlight has been shown to help clear psoriasis. There are two treatments available PUVA and UVB. PUVA uses UVA light and a plant extract called psoralen which makes the skin more sensitive to light. Psoralen can be taken in tablet form or in a bath solution.
UVB is used to penetrate the skin and slow down the growth of the affected cells. The treatments need to be monitored and limited to a set number of exposures to the light per year because as with the sun, they can cause burning, premature ageing and increase the risk of skin cancer.

Vitamin D applications
These are not like taking a vitamin D tablet, they have been modified to have a completely different effect. They help to slow down the overproduction of skin cells but still must be used in moderation and as like the steroid treatments should be used on a 4 week on 4 week off rota. These treatments are usually as an ointment so are very greasy to use.

greasy horrible stuff!

There are two main ones that have been offered to me - Methotrexate and Ciclosporin. Methotrexate is used in severe cases and works by stopping the skin cells dividing, it has many side effects and shouldn't be used by men or women who are trying to start a family.
Ciclosporin was first used in transplant patients to stop organs being rejected but doctors noticed an improvement in transplant patients psoriasis and so further research was carried out.

The only time I have ever been truly clear from psoriasis was for the 9 months I was pregnant and about 12 months afterwards. I didn't have one scaly patch on me. Unfortunately I cannot be pregnant for the rest of my life but I do want another child so maybe one day I will get a good 18 months of being clear.

After discussing in great detail with the dermatologist I have declined the immunosuppressants because I need my immune system to be at its best for the foreseeable future with all the problems I've had after my pancreatitis I cannot afford to take any risk. So I've agreed to go back on short contact dithranol and light treatment. It means visiting the hospital 5 days a week.

So I will have UVB treatment on a Monday, Wednesday and Friday, and the short contact dithranol on Monday - Friday.

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