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from Justin H.
My condition is not severe. I have P on my knees, elbows, scalp and feet (the itchiest). I have tried Dovonex, Tazorac, coal tar, vitamin E, diets, sun, tanning salons, etc. My condition has worsened over the last two years. I've developed tiny little white blotches on my shoulders that don't flake but are scary. Initially I only had it on my feet (the outside, not the soles) but I have developed some on my legs, knees, arms and scalp. It is fairly mild I suppose but the fact that it has gotten worse really upsets me. I am a fairly high strung person so the stress part of it is something I've had difficulty controlling. The sun and saltwater or Epsom salt baths have been effective, as has vitamin E oil. I wonder if you have ever heard of a product called Gator Balm which I hear is sold at health food stores. I heard it was quite a miracle cure though I'm sure it is not. I welcome any advice on treatment for my more mild but persistent plaque. Thank you. -Justin H.
Ed’s Response: Your list of things tried mentions two of the current "favored alternatives" to topical corticosteroids — Dovonex and Tazorac — but it doesn’t mention any topical corticosteroids. Have you tried any of these? According to some derms, topical corticosteroids are "the most overused" P treatment ... but there’s a reason for that: usually they work (at least for awhile). Even for folks with mild P, these topicals are good for obtaining relatively quick clearing and then other stuff — including treatments you listed — are used for maintenance or to thwart rebounds early on.
Gator Balm appears to be a product of African Formula Cosmetics, Inc. (Florida and New Jersey). Gator Balm is described here. It sounds like an emollient mixed with some herbs which, in my experience, is always a crap shoot.
Lately a doctor told me that 1/3rd of the people who try herbal remedies are going to experience some kind of improvement because of the "placebo effect." He said that evidently this, plus sheer market size, is enough to make many questionable concoctions profitable for awhile. The "placebo effect" is not something we can train ourselves not to experience, so any one of us, regardless of our level of cynicism, can experience it. One way to make it less likely (but still not entirely impossible) is to be your own lab by having a "test lesion" and a "control lesion" that are relatively similar. If you have two symmetric lesions (e.g., one on each elbow, knee, wrist, etc.) and they are pretty similar in size and severity, these are likely control/test lesions. If you are currently applying another topical, continue to do so on the control lesion while you try the new stuff on the test lesion (follow directions closely for both products). If you are NOT currently using something else, use petroleum jelly on the control lesion and the new product on the test lesion. Apply the petroleum jelly exactly like you apply the test compound. One word of warning: If you are currently using a topical corticosteroid (which you don’t appear to be, Justin, so this is for the benefit of other readers) stopping this entirely on the test lesion can make it rebound (get worse). For this reason, a fairer test may require you to stop using the topical corticosteroid on both the control and test lesions and use petroleum jelly on the control lesion during your test. How long do you test? If the new product states improvement should occur in a specific time frame, test for that long. Otherwise, try a week or two for smaller lesions (1" in diameter or less), and somewhat longer for larger lesions. If you believe you are experiencing corticosteroid rebound (test and control lesions get worse at first) hang in there for six to twelve weeks—or until the control lesion stabilizes or starts to improve. Whenever the control lesion improves along with, or better than the new product you are testing, you are probably experiencing placebo effect (in the case of mutual improvement), or the new product is not working for you, or both lesions are benefiting only from the emollient qualities.
Good luck! -Ed