(February, 1999)

Hot Soaks are Probably Hurtful
from Susan L.

I've written before and was so glad to hear back from you [see "Nail P Therapy: Lose Nail" in this month's mail]. I'm hooked on the site.

I was told by my derm to avoid contact with hot water on my P fingertips as it would worsen the severity. I'm surprised to hear that many people seem to find a hot soak beneficial. I purposely cooled down my shower temperature to "disencourage " any new starts anywhere else on my body.

At one time I had P spots on both insoles of my feet and the topical cortisone cleared them all up—except for one spot where I had applied heat. I thought I had an insect bite and my father recommended use of a hair dryer for a few seconds to stop the horrible itching. I know this sounds a little nuts but don't we all have our moments? This spot on my insole was my very first spot—just a dot really. And it would appear that the "heat treatment" made it a permanent one. It was dramatically worsened with the heat—raised and inflamed and, no, I didn't burn it. Anyway I wonder if people are aggravating the condition instead of helping it.

Also, in the Archives I read a note where Benedril was proving beneficial. I take Claritin for allergies (cats, food) and found that when I stopped for a few days my P got worse. I tested this reaction by going back on Claritin and stopping again and once again the reaction. I've been told this shouldn't relate but I think it does. Has anyone else mentioned this?


Ed's Response: Your observation about hot water is a good one, Susan. I believe this is the reason your derm recommended you avoid hot water on your flaking fingers: Heat increases blood circulation where it is encountered in/on the skin. It is an external cause of capillary expansion (so I am told, but it makes sense as heat expands most things). On the other hand, cold causes capillary expansion internally in that the body itself expands the capillaries to carry more warm blood to the chilled area of skin. So in either case, cold or hot, blood flow in the skin increases and the skin turns red (or pink). One of the "acts of psoriasis" is a sort of capillary expansion, too—but caused for no good reason. This is why our lesions are red beneath the flakes. In the case of P, the increased blood flow supplies the accelerated skin growth. Corticosteroids (again, I am told) work in part because they restrict this capillary expansion. Have you ever noticed how a flaming lesion is warmer to the touch than surrounding skin? For me, this differentiation in skin temperature between normal skin and my lesions can sometimes be extreme. (I sometimes make my wife feel a flaming lesion on my calf. She, too, can feel the heat. I wink and say, "Feel that heat? That's me burning calories. I'm getting skinny. May I have some ice cream?")

Excess heat or cold applied to lesions can therefore exacerbate the problem. When applying either, you are inducing capillary expansion in areas where the capillaries are already too "expansive."

Nevertheless, we flakers often like to warm up our lesions! (Using hot soaks OR hair dryers, though I've not, personally, tried hair dryers.) I'll tell you why I think this is (this is purely my own notion). I think it's because applying heat displaces the itching, at least for awhile. Think about it: Wherever your skin is burning (or excessively warming), it's not itching! (On the other hand, once a burn site cools down and starts to heal, it will often itch terribly! But not while its burning!) While warming up our lesions certainly does us no lasting good, it provides a temporary relief from the itching.

And so, by the way, do antihistamines like Benedril and Claritin. When you laid off the antihistamines, did you scratch more? (If you're like me, you scratch involuntarily and don't know you're doing it.) Antihistamines aren't really a P palliative, they are simply an itch palliative that indirectly helps P because itching worsens it.

Having said more than enough on the subject, I see it all boils down to this. I think you're right. I agree with you. When we use heat as a part of our P treatment (or mediation) we are probably just aggravating the problem. And now I have to run because—you know what?—a steaming shower beckons me! -Ed

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