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Becoming Psoriatic: The Early Rounds
from Trina E.

Ed:  Just checked out your site, after looking at several sites discussing psoriasis. 

My husband is a Chief Petty Officer in the Navy and, about 2 months ago, started breaking out with a solid red rash around the outside of both lower legs.  At one point, it just looked awful.  It was so red with thick, round scaly scab looking things at the center.  Now it's spreading: back of upper arms, lower back, abdomen, calves ... small areas that resemble ringworm.  Sometimes he itches so bad he can't stand it.  He's been to the doctor, who initially gave him Atarax, Hydorcortisone cream and Benadryl cream.  It stopped the itching, but that's about it.  His last appointment, he was given Dovonex.  He's been on it a little over a week and our primary care physician is sending him to a dermatologist.  Because of our insurance (military) taking so long to get an approval letter for the referral, he won't be able to see the dermatologist for 3 more weeks.  I was a nurse for 14 years, but even I don't know what to do for him.  He uses the Atarax at night to stop the itching so he can sleep.

Is there anything over the counter we can use for bathing, instead of regular soap (i.e. Dial, Dove)?  Should we even worry about something like that?  What changes can we make to help him?

He was on travel for the Navy a few weeks ago, in Australia, and wouldn't go to the beach because of the way his legs looked.

I'd sure appreciate any suggestions.  Thanks, -Trina E.

*****

Ed’s Response:  If your husband is manifesting P, Trina, he’s starting up a long learning curve with few pat answers.  If there were easy answers to your questions, FlakeHQ and other sites like it probably wouldn’t exist.  What your husband needs is a lot of information fast.  Probably the easiest way to get this is to join the National Psoriasis Foundation — there’s no set membership fee, but a cash donation is required — and immediately get their current “textbook”:   Psoriasis: A Patient’s Guide, by Nicholas Lowe, MD, FRCP, Clinical Professor of Dermatology.  I imagine you have already checked out the NPF’s web site.  When you join you get access to many additional on-line resources.

Though I’m no doctor, I do know that the medications your husband is currently using for his skin condition are mild stopgaps for the emerging flaker.  Atarax is a systemic antihistamine used, in his case, as an itch palliative.  He’s advised to take it at night because doses sufficient to calm the itch probably also make him drowsy.  Hydrocortisone and Benadryl creams are tasked to combat the inflammation associated with the lesions (hydrocortisone) and as a topical — non-drowsy — daytime itch palliative.  His derm will probably tell you husband these medications comprise a bottom-rung or starting-point on the progressive fight to control psoriasis.

Dovonex is a topical vitamin D3 derivative directed specifically at psoriasis.  It is supposed to slow the skin regeneration process that has grossly accelerated to create lesions and scale.  In the prescription arsenal, many derms feel Dovonex is a good place to start because it does not have as many side-effects as topical corticosteroids.  If Dovonex achieves satisfactory abatement of your husband’s condition there will be “smiles all around.”  It won’t be surprising, though, if the Dovonex alone is not sufficient.  According to the literature, two to three weeks on Dovonex should be enough time to determine if it’s going to be a good topical for him.

I wish I could end this with good news, Trina, but the best I can say is there is a bright side, and it’s getting brighter.  I’ve been a broiling flaker for 13 years and am still trying new things.  Some flakers have less obstinate conditions, find measures that work and continue working.  Others, like me, slide up and down the scale of severity-of-treatment and find nothing works forever.  The bright side is that there are lots of things to try and more things are in the pipeline, as we say.  While we can’t say a cure for our disease is on the immediate horizon, it does look like we are getting closer to containing the disease and subduing the lesions and other symptoms.  And we are achieving containment solutions that will work better and have fewer side effects.  Believe it or not, all of this is good news!

I hope you and your husband will stay in touch with us.  We’re here to share experiences. -Ed

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