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Occlusive Regimen for Hand P
from Mauri M.

Ed:  I was introduced to a regimen by an Edina (Minneapolis) Derm that has pretty much cleared my nail psoriasis (hands and feet) over the past couple of years. It doesn't work overnight, so ya' gotta be patient:  

Two or three nights a week ( 3 to start, tapered to 2) apply one drop of liquid Diprosone (not Diprolene, which is too strong) to the free edge (end) and top of the nail; apply a generous coating of vitamin-e gel (I like Banana Boat brand) to the affected areas and wear food service gloves (about $4 a hundred) overnight.

On the alternate nights, apply a scant amount of an RX of  0.1% Triamcinolone ointment/2.5% SA/5.0% LCD to the same areas, again wearing the gloves overnight.

The gloves can be pulled & blown inside-out, allowed to dry, and be reused several nights. Obviously, these gloves don't fit the feet (I wish someone made occlusion foot gloves), but a generous coating of the Vit-e Gel seems to occlude the toenails ok.

The Triam compound also works great on the elbows if you occlude with Saran a couple times a week. It worked for me.   -Mauri M.

*****

Ed’s Response:  Sounds similar to the occlusive regimen I must re-enact each time my hand P flares.  My own regimen isn’t as dainty as yours, Mauri.  I will use the stronger Diprolene with occlusion and I don’t alternate nights with a lesser potency formula.  I occlude the Diprolene until the lesions stop flaking and become less red, then occlude a low potency steroid for a few more nights.  

A problem with most topical regimens for nail P is the l-o-n-g-g-g-g time it takes to get results.  You were being kind when you said "ya' gotta be patient."

The best foot occlusion I’ve tried is small (8 gal, unscented) trash bags sealed at the ankles with tape.  This has worked for me; however, my feet can’t tolerate as much occlusion as my hands.  More than a few days and they get tender, making it painful to walk for a few hours in the morning.  

And regarding toenail P:  For me it takes a year, at least, for the big ones to clear up.

Thanks for the tip!  -Ed

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