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Scalp P in India
from Swarup

Hi Ed. I’ve had the big P for 3 years, only on my scalp. Methinks it was triggered by an allergic reaction to a hair vitalizer. I spoke to a derm who`s 81 years old. He examined me and told me that I would not get P on other parts of my body. He said my P was "damned mild" and he even told me it could be dermatitis. He really gave me a talk and told me not to pay attention to web sites and try to lead a normal life.

The next derm I met said it was P, which is usually localized, and, as I had it for 3 years in my scalp only, I would probably not get it on my body. Derm No.3 said the same thing. But it gets more interesting:

Me : I`ve had scalp P for 3 years.

Derm No.4: Show me

Me: It’s on the back of my scalp.

Derm No.4: Yes I can see it. It seems to be stress related. How the hell did he conclude my P flared because of stress? Do you exercise? No? Do so.

Me : Will the P spread to other parts of my body?

Derm No.4: Left untreated it may. I am dubious, but he goes on: My thesis at Stanford University was about Stress and P. There seems to be a chemical ... blah blah blah. Here, take these lotions and this literature about P.

Me: I`ve got enough of this.

Derm No.4: You`ve been reading a lot of stuff on the Net, eh? Pretty scary.

Me: Is my P bad?

Derm No.4: Its quite severe. This is interesting. At the time he examined me I could swear I did not have a single flake on my head. It was 100% clear. I washed my hair the previous day. I can tell the P was better because my scalp wasn’t itching. Maybe, that day, 4 times I scratched! Imagine how this derm would categorize a really severe case. God, he`d have a heart attack.

Ed, please tell me what you think about this derm. I`m from Bangalore, India and once had great dreams of going to the US for an MBA. But everything collapsed like a house of cards. I was off any Psoriasis medication for 2 years until May 1, 2000. Bye Ed. You’re like a Dad to me, you know. -Swarup


Ed’s Response: Well, Swarup, I would have rather heard that derms in India have their act together and are ahead of the rest of the world in eradicating P ... but it sounds like they have the same too-often-tentative diagnoses and contradictory understandings of our ailment. I was amused that your 81 year old derm told you not to pay attention to web sites. Was he suggesting doing so was abnormal? Well, from the perspective of a 49 year old I must admit that even I occasionally question the normalcy of our infatuation with the web. I do not find it hard to imagine an 81 year old thinking the web just ought to be avoided all together. (I recall my great grandfather who, when I was ten or so, told me dinosaurs were nonsense and all those fossils were just freakish rocks. He was serious.)

I must say something in defense of Derm No.4. Once I went to my derm saying how pleased I was that my scalp flaking had subsided. He examined me and told me not to discontinue the potent tar shampoo I was using because the lesions were still very red (inflamed). Evidently the keratolytics (scale lifter) products I was using—along with my combing and brushing routines—were managing to keep the scale down, but the lesions were still there and as hyper as ever. Your Derm No.4 may have seen something similar on your head.

Having said that, I, like you, wonder what prompted Derm No.4 to consider your case severe? On the other hand, some people argue that the severity of psoriasis is not just a factor of how much skin is affected. This argument contends that the effect of the condition, no matter its extent, is also a factor. For example, someone who may have bad P on their hands but nowhere else should rightfully be considered severe if that P prevents them from using their hands freely. Your scalp replacing itself at 14 times the normal rate might not disable you, but if you were required to wear dark clothes the problem would be more severe. Wouldn’t it? Still, I would like to ask Derm No.4 what he says to the poor souls with erythrodermic P (more-or-less all over their skin). "You have a catastrophic case of psoriasis?’ Or, bigger yet: "You have a quite severe catastrophic case of psoriasis?" I am reminded of the derm who, upon diagnosing a mild case of psoriasis (a few spots) pulled out a photograph of someone with erythrodermic P and said to his victim (er...patient) "This is psoriasis. This is what you have."

Now about that MBA. We don’t like to hear about advanced education plans in the States falling apart like a house of cards. Have you visited the University of Phoenix Online? They offer an MBA on line (don’t tell Derm No.1). I’m sure by now there are many other U.S. colleges doing the same.

Good luck and stay in touch, Swarup! -Ed

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