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Occlusion and Too Speedy Doc
from Nikki B.

Dear Ed (and all):  Whew!  Treat this with humor?   What a concept!  I have a sense of humor... but never thought of this as too funny. Now I do!  I have been giggling just at the little guy on the creativity page,  lying on his back, covered in red splotches, scratching.  I haven't smiled about this since I got it just over a year ago!  

I am now in love with all of you!  Ria?  I am ROLFing.  “Sharing a bit of ourselves everywhere we go”!  Tooo wonderful!

Now, I have a question.  The word "occlusion."  I am assuming this is about wrapping your scales after medicating.  Is this a normal or usual type of treatment? 

I have been given some creams that have a warning that scared me to death.  It basically said not to use very much of the product, because the side effects could be severe, up to and including death.  That will give you pause!   I wonder if it is safe to use occlusion in that instance? 

I don't have very good doctors.  I say that, because my dermo has literally thrown up his hands and said, “I don't have hospital privileges. I've done all I can do for you.  Go see this specialist.” 

So, after a 6 month wait for an appointment, I saw the specialist.  He was in the room less than 5 minutes, couldn't wait to get to the next patient.  It's like a game he's playing — trying to beat his "personal best" for the number of patients seen in a day!  He tossed an Rx for this cream and ran.  I asked, “Will you please explain this a bit more?”  “It will be on the med,” he said as he disappeared.   I actually had tears in my eyes when I turned my paper into the billing clerk. I was trying so hard not to cry.  I waited 6 months for this “guru!”

I've never had a remission, and I've never talked to anyone that had psoriasis.  I am immensely grateful to find you here.  I’ll appreciate any feedback.  Even housekeeping tips from an experienced flaker!  I look forward to hearing from you!  Please put "PS" at the beginning of the subject line, so I'll know it's from here.  Thanks all!  -Nikki B.

My email address is [email protected].

*****

Ed’s Response:  Welcome, Nikki.  I want to handle that med label warning first, the one that said the side effects could be severe, up to and including death.  That’s stated so that, in case you die, you won’t sue the manufacturer for nondisclosure.  Frankly, I’m surprised we don’t see the same warning on bottled water.

I shouldn’t make light of it.  Topical corticosteroids can and do have adverse effects, which is part of the reason why derms, in the U.S., at least, insist on meeting with topical therapy flakers every so often.  They may or may not actually look at us, but they are supposed to eyeball the situation to determine if the sun might be shining through those spots we’ve been smearing all this time.  (Thinning skin is one of those nasty side effects of topical corticosteroid over-use.)

Let me put it another way, over-using topical corticosteroids would not be an effective suicide technique.  It allows way too much time for a change of heart.

You’re right about occlusion.  It involves applying the topical medicine then covering the area with an air barrier, usually something plastic or rubber.  Flakers often use plastic wrap of the kitchen variety (e.g., Saran Wrap) to occlude lesions on their limbs.  Scalp P is usually occluded under a shower cap.  So-called “food handlers gloves” are recommended for occluding the hands.  And I use 8 gallon trash bags, taped tight at the ankle, to occlude my feet.  You can buy full-body occlusion suits.  In the illustrations they look like rubber sweats.

Occlusion does tend to make whatever medicine you’re using work as though it were stronger.  For one thing, preventing air flow keeps the base compound (grease or oil) from evaporating.  It can soak into the skin more thoroughly and along with it goes the medicine.  P plaque lesions are thickened, coarse skin usually bearing many layers of dead skin cells.  Sometimes, without occlusion, it’s very difficult for topical medications to be absorbed into the lesion effectively.  Occlusion improves the odds that enough medicine will make it through the scale, down to the living dermis, to actually do its work. 

You share a common complaint amongst flakers — their docs tend to be harried and insensitive, they come off as uncaring or unknowing and unsympathetic.  In January, March, May, July, September and November I side solidly with the flakers.  DERMS ARE JERKS.  (I’ve priced having the bumper stickers printed....)  But then in February, April, June, August, October and December I’m required to speak up for the derms.  Our hands are tied, our knowledge is insufficient, alternatives are limited and outcomes are painfully predictable.  Do you want us to lie, to say we can cure you, to promise everything will be better in the morning? In the next room is a  hapless 19 year old who is checkered with skin cancer from way too many hours in the tanning bed.  Her, I can help. Now, what else can I do for you? It is terrible to be in a no-win situation, but that’s mostly where the derms have found themselves with regard to psoriasis.  They can lead us on with hyped-up optimism about the next thing we haven’t tried, but it would be less than honest of them to let you think the next thing might be The Cure.  For the most part I think derms dread we flakers as patients.  Oh not another one!  And I have unlimited awe for those derms who have made treating P their specialty.  They are Mother Teresa’s of-a-sort.  Mother Teresa must have known she would not stamp out poverty in Calcutta. 

Now, just about the time I talk me self into sort of understanding why derms are jerks, along comes one who is a real Sphincter, if you know what I mean.  Overall, they do tend to make us cry.

Stay in touch Nikki.  Here we laugh at least as much as we cry!  -Ed

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