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Scalp P Q&A
from Donna J.


Hi Ed. Thank you for this site. I've found some excellent information on it, and I've laughed. Can't beat that with a stick! Anyway, I am 41 years old and have had mild psoriasis since age 12. About 3 years ago I developed psoriatic arthritis.

In the last year, the arthritis has been a battle and my scalp psoriasis is the worst it’s ever been by far. It’s in my ears and has also spread down my forehead some. 

After trying over-the-counter stuff (salicylic acid, cortisone and tar-based products) I went to the dermatologist and she prescribed Derma Smoothie (an oil-based product with Fluocinolone Acetonide in it) 2 times a week. I put the oil on my wet scalp at night, cover it with a shower cap and try to wash it out in the morning. She also prescribed Luxiq, a foam which contains betamethasone valerate. She suggested I use that 2 times a day. 

At first I thought the products were helping. The itching died down a good bit, which was great. Now, after several months of using both, though, I’m pretty frustrated. If anything, my scalp is worse than when I started. Now if I stop using them for several days, my scalp really flares (does this mean they’re "working"?). 

Before I go back to the Derm (who wasn’t that helpful) I wondered if anyone has any advice/help to offer. My questions are kind of simplistic, but here they go:
 
1. Has anybody had luck with the product Derma Smoothie? If so, how exactly did you use it before getting results (how many times a week for how long)? Did the flaking get any better over time? Were you able to finally stop using it after a while?

2. When people have bad scalp P, do they try to AVOID brushing their hair/scalp, or should you brush it to try and loosen up the scales? Right now, if I brush my hair, my whole head turns white from all the scales (pretty picture, huh?). For awhile I get a little less flaking. If I don’t brush it, the scales get rougher and thicker and the itching and flaking worsen. I know that scratching and/or too intense brushing can’t be good on such tender skin, but what is the right balance here? Anyone use special brushes or combs, for example?

3. Does anyone know about or use products like Luxiq for scalp P? Are they really strong? Is there any risk from long term use?

4. Does anyone know of good products (or other techniques) to get rid of patches on the face? My derm says I can’t use the Luxiq on my face and those patches are steadily getting worse, sliding down from the scalp.

5. Do you develop a tolerance to this stuff over time? Will I have to keep using this stuff the rest of my life only to maintain my current state (which ain’t pretty)?
 
Baffled in Boston, -Donna J.

*****

Ed’s Response: There’s one reference to "Derma Smoothe" in the FlakeHQ archives:  Special Camp Counseling Made Me Feel Lucky, by Michelle P. (read 6th paragraph). I found this in a post on a message board elsewhere on the net:

"We are using a prescription called Derma-smoothie. It is a peanut oil. One small bottle has a slight cortizone (sic) in it for the affected areas only and the other bottle is the straight peanut oil and we are to get wet and put this all over our skin twice a day if we can." -from post on safe2use.com/scabiesboard

Here’s my responses to your questions:

1. Has anybody had luck with the product Derma Smoothie? If so, how exactly did you use it before getting results (how many times a week for how long)? Did the flaking get any better over time? Were you able to finally stop using it after a while?

I’ve not used this product, but I have used a ton of other products on my scalp P with uniformly mediocre results.  My scalp flaked constantly from 1990 until 1999 when I began systemic regimens (first methotrexate, now cyclosporine).  I used a compound formula of salicylic acid and tar custom ordered by my derm and prepared by my compounding pharm to quiet the raging, and between rages I always shampooed with a tar-based shampoo (Pentrax when I could find it, T-Gel most of the time).  But, again, nothing but the systemic medications stopped the flaking altogether.

2. When people have bad scalp P, do they try to AVOID brushing their hair/scalp, or should you brush it to try and loosen up the scales? Right now, if I brush my hair, my whole head turns white from all the scales (pretty picture, huh?). For a while I get a little less flaking. If I don’t brush it, the scales get rougher and thicker and the itching and flaking worsen. I know that scratching and/or too intense brushing can’t be good on such tender skin, but what is the right balance here? Anyone use special brushes or combs, for example?

I’ve read and been told enough to think this is most appropriate:  Gently brush or comb flakes out of your scalp after it is damp from bathing/showering or after a long occlusive session (i.e., first thing in the morning after sleeping with goo under a shower cap).  When the scalp is dry, avoid digging at the scales — try to comb/brush your hair with minimum actual scalp contact.

Dr. Joe (of newsgroup fame) reports having seen a patient whose psoriatic scalp was badly torn up.  When asked how this happened the patient thought perhaps brushing it with a dog brush — wire bristles — was at fault!

3. Does anyone know about or use products like Luxiq for scalp P? Are they really strong? Is there any risk from long term use?

By me.  Have not used Luxiq.

4. Does anyone know of good products (or other techniques) to get rid of patches on the face? My derm says I can’t use the Luxiq on my face and those patches are steadily getting worse, sliding down from the scalp.

Twice daily usage of a prescribed mild corticosteroid cream (e.g., Westcort®) has worked for me.

5. Do you develop a tolerance to this stuff over time? Will I have to keep using this stuff the rest of my life only to maintain my current state (which ain’t pretty)?

I’m told everybody will develop a tolerance for topicals over time (there’s even a Latin name for the phenomenon, which I can’t think of at this moment). I’ve used topicals now for over a decade and combat the tolerance phenomenon through a cyclical regimen; i.e., I vary the topicals so my skin is not exposed to any one product consistently for longer than it takes to use up a single tube. -Ed

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