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Nail P
from Ruth B.

Dear Ed: I mailed you a few years ago and have only recently re-acquainted myself with your site.

I had quite successful in-patient treatment in hospital for my P about 3 years ago in London. Now my P is as bad as ever, about 40% coverage. For the first time though in ten years of P (I'm 30) I have nail P in all my nails, but really badly in my thumb and fore finger of my right hand. As other people have said, they're yellow, painful and I feel they will fall off without help. I do have an appointment with my P Consultant in six weeks, but would really like to know if any P sufferer's out there have any advice?

Once again - thanks for your invaluable service to us flakers! -Ruth (London UK)

*****

Ed’s Response: Good to hear from you again, Ruth. (Ruth’s previous posting here was PS-98 Doesn’t Work, October ‘99.) I’m sad to hear our common complaint has finally embraced your fingernails. I read your mail and stared at my own fingernails for many seconds. Strange as it seems (to me at least) my nails are almost the first thing to suggest my honeymoon with cyclosporine is ending. All ten are corrupted at this time, and it came on very quickly.

As bad as my nails have been, I’ve never had one fall off. In fact, once my derm tried to remove one unsuccessfully. (That nail was so bad I wanted it gone. I thought no nail would look better than that nail. Also, my derm thought a new nail — hopefully healthier — would grow back quicker if the old nail was removed.)

The problem with fingernails corrupted by P is that nails are not sloughed so quickly as skin. It takes many months for nail tissue to grow and eventually replace what came before.

My derm told me to pay close attention to the new nail as it grew from the quick. If it was not discolored and ridged like the corrupted nail, it would be cause for celebration. Of course, I forgot the old adage about a watched pot and kept too tight a watch on my nails. For the longest time there was no sign of improved tissue. Eventually, the watch became depressing and I let it lapse.

Perhaps forgetting to watch did the trick. I recall now the moment when, through a casual glance, I gradually became aware of the tiniest bit of healthy nail ... first on one finger then, upon checking, on a couple others. It was a marvelous feeling.

Now fast forward. Once my nails corrupted from P, they were never entirely free from that corruption again until I started on the systemic regimens with methotrexate in late 1999. The nails were back to normal by the spring of 2000 ... but it seems I was to enjoy that for less than a year.

No treatments that I’ve heard of for nail P work fast. I’ve heard of some women who have been able to cover corrupted nails with artificial ones. I suppose this possibility depends on how and how badly the original nail is affected.

Stay in touch, Ruth. Don’t lose us for another year! -Ed

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