Mar-Apr '04 | briefing | mail | don't say this | flakers' jargon | flaker creativity | articles | other places | archives | send mail | ed dewke | legal stuff | order | search | PsorChat | PsorChat Review | 2001 Ed Dewke

P on Hands and Nails is His Worst
from Richard H.

I just stumbled across your website and it seems to contain a lot of good testimonials and information about P. I was hoping you could give me some suggestions on treatments that may help my type of psoriasis. I have relatively mild to moderate psoriasis, affecting my scalp, a few small spots on my back and legs and my palms, fingers and soles. The most troubling is on my hands. My nails are discolored and pitted.  The skin around them is very thin, red, irritated, dry, and sometimes cracked and bleeding. It has also spread across my palms and is red and raised in some places, and flakey and dry in others.  I have tried various steroid creams without much success.  It really seems to be getting worse and I’d really like any suggestions you may have.  Thanks, -Richard H.

*****

Ed’s Response:  We share this problem, Richard.  Nail P is the toughest to clear, skin P on the fingers and hand is gross and impossible to conceal. 

My story reveals both good and bad news.  Let's get rid of the bad news first.  It has to do with the fingernails.

The only regimens I've found effective at clearing nail P are systemic — methotrexate or cyclosporine.  Both of these powerful immunosuppressive drugs have toxic side effects, so some derms won't prescribe them unless a flaker's condition is severe, and when prescribed the regimen always includes regular (and expensive) blood tests to determine if the toxic side effects are "kicking in."  When and if they DO kick in, treatment is stopped or potency is diminished.

Badly disfigured fingernails take a long time to recover.  This is because the disfigured nail must be replaced by the normal growth of healthy nail.  When we say "nail" in this context we can mean several things, but most frequently the active skin cells disfiguring the nail are either in the mantle (in the skin at the base of the nail) or under the nail in the nail bed.  I get P activity in both places.  (To see how this looks on me, check out “Nail P.” The photographs here were actually taken when my nail was moderate.)  I can tell when nail P is mending by watching the nail growth at the cuticle.  If the emerging new nail looks normal it usually means in about three months I'll have a normal-looking finger again.

Without the systemic medicines I cannot predict when my nail P will come and go.  But I CAN predict that it will wax and wane.  The thumbs, especially, will be awful for a time and then, for no apparent reason, there will be a season of improvement.  I think everyone is different.

The good news concerns the hand P.  Again, my most effective treatments have been the systemic medicines, which have always cleared my hands.  But when I can't take them — like now — I have found occluding a powerful topical corticosteroid on my hands at night is the next best thing.  I use food handler's gloves.  Latex medical gloves are not advised.  Food handler's gloves are the clear cellophane-like gloves you see worn by butchers and deli workers.  I goop up before bed, put on the gloves and tape them tight at the wrists with medical tape or cellophane tape (or any tape I have at hand). 

One word of caution on occluding the topical steroids.  I have noticed if I overuse the topicals on my hands they become tender — especially the pads of the fingers.  Sometimes they get so sore it's difficult to type at a keyboard (and that takes hardly any effort at all).  When this happens to me I have to lay-off the overnight occlusion for a day or two. 

I hope some of this might add to your considerations.  Let me know what luck you find.  Oh, by the way, the topical meds I've found most effective are Temovate and Diprolene.  Both have generic substitutes which are clobetasol propionate and betamethasone dipropionate, respectively.  Good luck!  -Ed

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