(January, 1999)

Nail P and Occlusion Therapy
from Kimberly F.

Hi! My name is Kimberly and I've been lurking awhile, but thought that I would put in my 2 cents. I was diagnosed with P about 2 years ago, soon after I had my first (and only, so far) son. My derm diagnosed the P on the second visit, as my son has eczema and he thought it could be that, but as you know, it was not. I don't have it too bad, just on my heels, fingers, and sometimes my scalp. I use a coal tar shampoo a couple of times a month, and also use Dovonex solution on my scalp a couple times a month. That usually clears it right up for me.

My feet also respond quite well to the Dovonex, but my fingers do not. I tried both Temovate and Dovonex, and neither work. I currently use Cordran Tape, and I use it about 3 times a week to clear up my fingers. The only thing it does not work for is my fingernails, which look horrible.

I love your site and visit it regularly! -Kimberly F.

*****

Ed's Response: Hi Kimberly. Thanks for writing! If I were you, I'd ask my derm about occlusion therapy—with your current prescripts, or trying new ones. I say this because it sounds like where you are responding well you are already occluding, in a manner of speaking. Feet lesions will sometimes respond better than others, probably because we "seal" them in shoes and socks after applying the medicine. You can do the same for your hands and scalp—at least overnight—with a tight showercap and food handlers' gloves.

Nail therapy is tough for two reasons. First, it's difficult for topicals to get to the diseased tissue, which is under the nail and in the nail bed under the cuticle. Second, once the disease deforms the nail, you have to wait for that deformed part of the nail to grow out and be replaced by normal nail before they look better. And it can take six months or more for a nail to grow from cuticle to the point where you clip it.

If your despair over the ugly nails is unbearable, there are at least three things you can consider. Compounds are available that soften the nail for a doctor's removal. (In my case, this meant keeping the nail tightly occluded for about two weeks; and it still wasn't successful. But that's MY case.) Of course, if this works for you, you are still going to look weird being nail-less. But I was told a brand new nail would grow out and, in the meantime, I could tackle the P in the nail bed directly with my topicals. Depending on how deformed your nails are, you may be able to flatten them with an emery board or sandpaper. This won't make them look normal, but it may make the P less obvious, especially if you paint them. Also, if you can successfully flatten the nails, you could glue on artificial nails. (Review: 1. Remove nail; 2. Flatten nail; 3. Flatten nail and cover with artificial nail.)

There is another option, which is the one I've settled on. Invent stories to share with people who gawk conspicuously at your ugly nails. E.g., "I see you've noticed my fingernails. I can only say this: Don't EVER use furniture stripper to remove your fingernail polish!" Or, "That darned son of mine. He thought he was being cute by replacing my dishwashing liquid with drain unclogger!" Or, "My fingernails are the only physical manifestation of my recent near-death experience." You get the idea! -Ed

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