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Tough Time Finding Good Treatment for PPP
from Tamara B.

Hi Ed. Have been reading through your archives with much interest, amazing how P sufferers have such a sense of humor. Have to keep from screaming I reckon.

I am a 53 year old woman, first episode of PPP occurred in 1992, which was an awful year where I totaled a car and later that year my grandmother then my father both died. My first occurrence was on my palms, then later I got it on my soles also. Now it is creeping up my ankles. I have been tested for allergies and don't appear to have any.

Went to about a dozen doctors in the greater Detroit area and never heard the term Palmo-plantar pustulosis [PPP] until I learned how to Google. I saw the pictures and it was a real epiphany for me that I wasn't the only one. I did find one terrific dermatologist in Southfield, MI who was willing to help me do combat against it, and always kept me in the back of his head whenever he read medical journals, etc. As you might imagine I had spent hundreds of dollars on topicals, Dr. Singer was the first to try me out on more invasive therapies. We tried the methotrexate which worked dramatically the first month and then the PPP just as dramatically returned. They had just approved Enbrel for use on psoriasis and the program had approved me when Dr. Singer read a study where the patient took Diflucan alternately with an antibiotic (i.e. every other day) and wrapped the hands and feet with topical ointment and Saran Wrap. He thought we should give this a try before we started doing something as drastic as injections of Enbrel. The next time I saw him (2 months later) I shocked the heck out of him as my feet looked so great I had gone and gotten a pedicure and some strappy sandals. I never made a dermatologist so happy. This was in 2002 or 2003 I think.

I lost my job, my benefits, my dermatologist, and moved to another state so I am in a bad way once again (even though I know how to treat it). The doctors here are reluctant to give me more than a couple weeks worth of meds so I can get rid of it for short periods of time but shoot, I can't afford to go to doctors every couple of weeks. I don't drink and they do keep up on the liver tests. I don't want to build up a resistance to antibiotics but I don't want to leave a flaky trail wherever I go either. I think 16 years of this crap is enough.

The nearest dermatologist is 2 hours away and I have made an appointment but I am dreading it as I don't want to go to another well-meaning idiot who wants to give me a jar of tar and send me down the road. I am not willing to waste any more time and money but I am tired of clerks who drop my change to avoid touching my hands.

Thanks, and I hope you have a wonderful holiday season.  -Tamara B. in Kentucky.

*****

Ed’s Response:  Welcome to FlakeHQ, Tamara, and greetings from this fellow Kentuckian.

I’m sorry your location prevents you from being picky about your dermatologist. What you really need is a doctor who has a long history with psoriasis treatments AND is up on the latest and greatest.  Don’t be afraid to call your prospective derm’s office, ask for a nurse on the clinical staff, say you're shopping for a good derm with plenty of psoriasis experience, and ask what they have to offer.

PPP (Palmo-plantar pustulosis) type psoriasis is often successfully treated through light therapies, especially PUVA (the drug named Psoralen taken along with UVA light therapy).  Did your previous derm mention light therapy?  (If hand & foot box lamps end up clearing your PPP you’ll eventually want to own a unit for use at home.)

For a more thorough rundown on how PPP is treated, check on this page at the National Psoriasis Foundation web site (if you haven’t already):  http://www.psoriasis.org/about/psoriasis/pustular.php

Best of luck, and please let us know how it goes with a new derm!  -Ed

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