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Smoothe, Luxiq, Diprolene, Olux, Dovonex...
from Michelle M.
Hello again, Ed! I look forward to your posted mail each and every month. I, like many of your "fan club" members, do not personally know anyone else with severe P, so it's comforting to read others experiences and suggestions.
I am writing in response to a letter you posted in February. Donna J.[Scalp Q&A] wrote that she was prescribed Derma Smoothe FS and Luxiq for her scalp P. My derm has taken a different approach to the Derma Smoothe and thrown in a couple of other ingredients, such as salicylic acid and coal tar. Derma Smoothe FS topical oil with a peanut oil base is made by Hill Dermaceuticals, Inc. and is specially formulated for the treatment of scalp P. I also use a compounded lotion for the scalp called Diprolene lotion and my derm has that mixed with 10% Urea. It helps keep the scaling down around the hairline (forehead). I've given up Luxiq foam and switched to a new product called Olux. It is also an aerosol, but is stronger at .05%. I use the Derma Smoothe compound once or twice a week, applied to wet hair and sleep with a shower cap on. The scaling comes back within 24 hours, but the relief is welcome, since the itching subsides for a few days.
Other treatments I currently use are Dovonex ointment at night (approximately 3 times a week) and Temovate in the morning following the use of Dovonex. I also use a compounded cream of Triamcinolone and Eucerin cream on my "off Dovonex/Temovate" mornings. According to my derm, Triamcinolone is a very mild cortisone which cuts down on redness and helps the itchiness.
I have been taking cyclosporine (Neoral) for about 9 months. I started out at the maximum dosage for my body weight, which was 250 mg. daily. My blood pressure soared to an alarming level, so we cut back to 150 mg. daily, which seemed to help somewhat, but ended up at 100 mg. daily with a blood pressure medication (Accupril). I would say that I am much clearer than before the
cyclosporine, but instead of the former solid erythrodermic P, I have pustular spots all over my body. The cyclosporine doesn't seem to have helped the scalp P much. Please note that I do have the required blood work done every 4 weeks. I use a tanning bed twice a week, and notice when I skip a week, I have flare ups, so that must be helping somewhat.
Thank goodness for my derm and my RX card! I hope you, Clara and family are well and surviving the harsh winter months. Although winter seems to be hard on my P, I dread another 90 degree, humid summer coming in long pants and long sleeves. Thank you for your site! -Michelle M. (formerly Michelle P.)
Ed’s Response: Now yours is a derm who seems to think outside the box. I’m glad your letter comes this month as a counterbalance to the derm digging JPH and I have engaged in elsewhere [Flaked for 34 Years and Still Counting — Derm-free For Awhile]. It seems as though all the tweaking of therapies and regimens is narrowing down (or expanding?) what works for you — and that’s a good thing.
I was particularly interested in hearing about your cyclosporine experience. I am glad to read a less-than-maximum dosage, combined with your specific rotation of topicals, is establishing some livable maintenance levels for you. I found than even 25 mgs a day less than the maximum recommended dosage pretty much negated the therapy for me. But, as you also know, at about 6¢ per milligram per day there’s sufficient incentive to compel most of us to try smaller doses! I’ve gained weight on the cyclosporine and experienced a rise in blood pressure. This is somewhat confounding for me because my blood pressure has always seemed to be weight-sensitive; so, did the weight gain cause the increase in BP, or were both the increase in weight and BP caused by the cyclosporine? No matter, I’ve been prescribed Norvasc for the BP and it’s kept the pump working so far (knock on wood).
And about winter and summer I feel exactly like you. Winter is harsh on the skin, but easier for me (the Colorado mountain boy by upbringing) to endure than these humid southern summers. Do stay in touch, Michelle. And by the way, congrats on the new last name (initial!). -Ed