(April, 1999)

Hair Loss and More On Stress
from SteLa

Hello Ed. I'm a 22-year-old girl who had major scalp P when I was 11 years old. Back then, I was too young to give it a name. My mother took me to what seems like a dozen doctors who prescribed horrible lotions that did not work.

While we were visiting one doctor after another, my P got worse and worse. It got to the point where my head was just a big lump of scales that grew bigger and bigger. You would think that I could hide it with my hair, but unfortunately, my P caused hair loss, also. I ended with a nice bald spot covered in white scaly lumps. I thought my entire head was going to be disfigured and that I'd be locked in a mental institution. You must understand I was only 11.

Fortunately, my mom's persistency paid off. We found this doctor who prescribed a tar shampoo and lotion that cleared my P up within weeks, it seemed. I was 100% clear until I reached college! To my disgust, it came back except not as bad. The only explanation I have for it is college stress! Over the summer I clear up, then, when I start school, it comes back.

Recently, I started to minor in computer science and my P has come back. However, not only do I have it on my scalp, I also have it on my arms, belly, and thigh. I haven't had the body lesions before; I guess pressure from classes has made it worse. So, in reply to some letters about stress, I totally believe that stress is a large factor. Most of the medications mentioned here I have tried one time or another. My uncles, who also have P, mentioned a doctor who used needle/injection to cure you of P forever. I highly doubt it and I'm not even going to try it. My scalp P has caused a lot of hair loss for me. Unfortunately, some of the shampoo I have to use to control my P doesn't help much in that area.

Anyway, I would not wish this kind of thing on anyone but I am glad to know I'm not alone. Thanks. -SteLa

*****

Ed's Response: Sounds like you've had a rough go of it, SteLa. My scalp P is persistent, too, and I know how difficult it can be. You didn't mention itching. That's what I hate the most about scalp P. Nor did you mention any kind of occlusion therapy. For me, this is the only thing I've found to quiet down my scalp when it's flaming. My pharmacist compounds a goo he calls "scalp cocktail" that traps salicylic acid and a coal tar extract together in some kind of jelly. I glob this on my head, massage it in, then sleep in a tight showercap over night. Three or four nights of this in a row will usually quiet my scalp P. If you haven't tried this, you should ask your derm about it.

Once I get my scalp P under control, the best shampoo I've found for maintenance is Pentrax. It's expensive and hard to find in Kentucky, though. When I can't find it, I fall back on T-Gel Extra Strength which, unfortunately, is (for me) a very poor substitute. (If, as their television ad claims, T-Gel is the "most prescribed" medicated shampoo for psoriasis, it's got to be because it's the easiest to obtain—not because it's the most effective.)

There is only one P therapy I know about that involves injections, and that's called "intralesion steroid injections." Unless your uncles were referring to a systemic steroid medication (an ugly business, in the long run) this is probably what they were talking about. But it's not a "cure," either; certainly not a "cure forever." Intralesion steroid injection therapy usually involves using needles (sometimes a "gun") to inject small quantities of steroids directly beneath the surface of lesions. It gets around the problem often encountered with topical corticosteroid creams, ointments and gels when lesions become so thick and flake-encrusted the medicine cannot penetrate to the living tissues where they are needed. Many flakers—myself included—have undergone this treatment with very good results. But there is risk involved. The steroids used can cause problems if they get in the blood stream and hence into other kinds of tissues (a process called "systematizing"). So, most derms don't advocate intralesion steroid injections routinely. Furthermore, I've always been told it is an inappropriate therapy for the scalp, because the skin is so thin and rich with its capillary blood network (evidenced by how easily and copiously your head will bleed when nicked or cut). However, I have had correspondents write they have received intralesion injections in their scalp ... so I never say never.

You make a strong case for stress as a trigger in your own case, SteLa ... and you were probably reacting to my "lecture" on the subject in last month's mail (see link at end). Let me come at it from a slightly different angle: If we become convinced that "stress" causes or exacerbates our P, what are we supposed to do about it? To begin, what exactly is causing our stress? Is it an emotion, like fear, loneliness, depression, grief ...? If we suspect it is one of those things, are we supposed to treat that feeling? I believe we have emotions for a reason, that they are a sub-intellect communications system between our environment, our bodies, and our consciousness. It's been my experience that every attempt we make to avoid emotions, good or bad, is probably wrong. Emotions aren't to be avoided, but they are to be responded to. We are, after all, receiving these communications from our sub-intellectual selves for some reason. I believe we should listen to them. Besides, no one has ever demonstrated to me that focusing on stress reduction directly improves their psoriasis. Most of what people tell me is "stress reduction" sounds to me like "stress replacement." They don't like feeling the way they do, so they purposely seek, and sometimes find, ways to make themselves feel differently. Typically, in searching for a replacement feeling (or set of feelings) they change a lot of physical things around them (e.g., take a trip, move, change jobs, change significant others, break habits, start habits...). Sometimes as a result of this proactive stress reduction their P improves. I must ask questions like these. "You moved from Boston to Phoenix to get out of the rat race and it worked, your P improved. You feel less stressed in Phoenix. But you're also in an altogether different climate, a totally different ecosystem, in fact. How much of that might have factored into your P improvement?"

You are a case in point, SteLa. Now in college, challenged to master a new and difficult body of knowledge (computer science), you find your P is flaring. So be it. You did not suggest (thank goodness) that your are physically incapable of being a college student as a result! If you find the prospects of a career in computer science exciting and desirable, earning it demands you pass through this type of gauntlet of stress. What are you supposed to do about it? Deciding this is what causes my psoriasis is a dead end. You either shrug, accept your psoriasis and go on to pursue your goals as a flaking computer scientist; or, you give up on computer science (or college) in an attempt to overcome flaking. Do either one of those alternatives sound desirable or logical? No! You challenge the psoriasis and the stress of mastering computer science as two separate problems. Relating them is unfruitful and a waste of time.

I know a woman, a few years older than you, who hasn't held a job for more than a week (only once), does not go to school, suffers ills millions of others who lead active lives also suffer, but who stays home with her disabled elderly parents and collects cats while she waits for her welfare checks. She is totally unequipped for any kind of life other than life as a recipient of others' care. "Stress" has robbed her of a life. She has no vision beyond what's foretold in this week's TV Guide. She is no more capable of sending me an e-mail than one of her cats. When I think of that poor creature, SteLa, I thank God you are stressed. I really do. -Ed

Change of Life Brought P

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