Connecting Skin Lesions and Joint Pain
from Juliana L.

Hello. My name is Juliana, and I just discovered this web site. Amazingly, it may have come at an opportune time since I have dealt with those scaly patches on my skin since I was a teenager. I'm now 58.  I was clueless all my life. Recently I have acquired painful problems with my joints in my hips, and lower back and, though the doctor suspects it may be due at least in part to injuries I sustained in an auto accident this past December, I’m wondering if it may have more to do with psoriasis, about which I’ve recently learned so much on the Internet. 

Anyway, the skin symptoms I have sustained over the years had have included dry, cracked hands (which I’ve long thought was because of being a painter and washing) and scaly patches on my hairline, ankles and elbows. Altogether, enough places on my body to be irritating, if you know what I mean. 

When I was a kid I had lesions on my face, and was prescribed cortisone cream (doctors called my condition Rosacea back then).   But I suspect that since it's gone on for years and shown up on other parts of my body it’s not Rosacea.

The point in my email is this, the combination skin condition and painful joints makes me wonder if my problem isn’t psoriasis and psoriatic arthritis. I intend to mention this on my next visit to the doctor and I’ll probably get a prescription for something at that time. What I am curious about is what can I do from a supplemental standpoint to help support my immune system before I begin taking drugs? Thanks, -Juliana L.

*****

Hi Juliana: You may find that seeking treatment for the aching joints is the best thing you can do for your scaly skin patches, too. In fact, since you’re used to your skin condition (what EVER it is) you may be better off seeing a rheumatologist before you go to a dermatologist. Both might diagnose psoriasis and, if what your skin suffers is psoriasis, both doctors might conclude the joint pain is psoriatic arthritis. For now, though, what the rheumies offer tends to palliate both diseases while what the derms offer, with few notable exceptions, concentrates on the skin alone.

Surprisingly enough, the systemic treatments for both – or either – are intended to suppress the immune system rather than boost it. Psoriasis, you see, is one consequence of an overactive immune system. Fighter blood cells run amuck, so to speak.

If you end up with a dermatologist, ask him to consider your aching joints as probably psoriasis, too, and prescribe something known to work on both skin and joints. There really isn’t anything topical that will do this; however, oral methotrexate is used to treat both and does a good job for many folks.

(Methotrexate, a.k.a. ‘MTX,’ is first and foremost a chemotherapy drug. At the moderate dosages prescribed for psoriasis it is normally safe, but it can damage the liver over time or when using higher dosages. Doctors prescribing MTX will usually require routine periodic blood tests to assess liver function and, in time, a liver biopsy, too.)  For more information about methotrexate, go here:

http://www.webmd.com/drugs/drug-3441-Methotrexate+Anti-Rheumatic+Oral.aspx?drugid=3441&drugname=Methotrexate+(Anti-Rheumatic)+Oral

Some derms prescribe from the short list of the new biologic medicines for skin psoriasis; almost all rheumies prescribe at least two of the medicines off that short list that work and are formally indicated for both skin psoriasis and arthritis (rheumatoid arthritis as well as psoriatic arthritis).  These are Enbrel and Humira. 

With regard to supplements, the only thing I’ve heard prescribed to BOOST immune system response when taking an immunosuppressant is folic acid while using MTX. The biologics affect such a small pieces of the immune response that, I guess, overall compromise of immune response isn’t an issue. The universal warning about greater risk of infections may or may not be helped by using dietary supplements suggested to boost immune response. Perhaps other readers at FlakeHQ will have suggestions.

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