(May, 1999)

P = "Too Much Wine"
from Jenny P.

Hi. I have recently been diagnosed with psoriasis (sounds about like "Hi, I have a drinking problem," doesn't it? <g>) and to date have not been put on a treatment that is working. However that is not the point of this email. I wanted to offer an addition to the "Don't Say This!" list.

Upon telling a good friend that I have psoriasis, he asked me, "Is it from drinking too much wine?"—sclerosis ~ psoriasis? ... :) -Jenny P.

*****

Ed's Response: It's not unusual for people to at first confuse "psoriasis" with "sclerosis" (hardening of the arteries, old age), or the liver disease, "cirrhosis" (one common outcome of alcoholism). [Thanks, HH, for straightening me out on this terminology! Ed on 5/3]

Shortly after I was diagnosed a flaker I started hearing about drinking associated with flaking. This was to be expected in my case for two reasons: One, I was a heavy drinker and everybody associates a heavy drinker's health problems with their alcohol consumption. Two, liver irregularities quickly ruled out available systemic therapies for my psoriasis, and when derms say "you've got to stop drinking before you can take this medicine," people tend to hear "you've got to stop drinking because it's causing your psoriasis." I began to hear stories about flakers who stopped drinking and stopped flaking. An ex-wife actually said I would have to choose between drinking and flaking. Eventually other problems motivated me to stop drinking entirely and I certainly hoped my P would improve as a result. It didn't.

But I hesitate to proffer my story as an excuse for other flakers to keep on drinking. Derms will worry about a patient's alcohol consumption while on systemics (e.g., Methotrexate) whether or not a preliminary blood work-up showed elevated liver enzymes. This is because some of the systemics tend to raise those enzyme levels and alcohol consumption can exacerbate the problem. So, if you don't want to rule out systemic therapies for your P, you may have to curtail drinking. (My own liver enzymes have long since returned to normal levels, but I still won't take Methotrexate or any other systemic P medicine.) Systemics aside, there are other reasons for me not to say your drinking has nothing to do with your psoriasis. I do believe there are flakers who stopped drinking and stopped flaking. Alcohol, though evidently not my P trigger, certainly could be someone else's. Also, alcohol consumption triggers dozens of other physiological and behavioral conditions that could directly or indirectly trigger P.

So, when people ask me, "Why should I stop drinking, Ed? You did and it didn't help your flaking a bit," I respond, "You're right, but you're not me and you won't know if it might help your psoriasis to stop drinking until you try."

I've spent way too much time on what was NOT the point of your e-mail. I'm not surprised nothing much is working for you, yet, Jenny. If your derm is like most, he's starting your treatments towards the mild end and working up. Be patient and keep us apprized. -Ed

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