Sep-Oct '08 | briefing | mail | interviews | articlespsorchat |  don't say this | flaker creativity | flakers' jargon | other places | archives | send mail | ed dewkesearch | acknowledgments | legal stuff | Flake: Confessions of a Psoriatic  | 2008 Ed Dewke

P is Not Just an Immune System Issue
from Deborah W.

I thought you might find this interesting.  I am a 55-year-old female. I've suffered from psoriasis since I was preschool.  Fortunately, I have a mild form of it.  I feel that mine is triggered mostly by hormone fluctuation. When I entered puberty, my psoriasis got worse. When I started taking birth control pills at age 19 it all but disappeared except for my scalp. When I went off birth control in my mid thirties to conceive a child, it started getting worse and continued to get even worse after menopause hit at age 49. I brought this to the attention of my dermatologist and gynecologist, both just stared at me a moment and then went on as if I hadn't spoken. This leads me to believe that psoriasis is not just an immune system issue.  I also tried to track it as a teenager as seasonal changes seemed to affect it. I am an allergy sufferer. I have been treated for endometriosis (another cell overproduction problem like psoriatic cell production). Maybe one day a researcher will look into these as being related to psoriasis. -Deborah W.

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Ed's Response:  I hope, like you do, that someday researchers will be able to put "all this together;" i.e., P, allergies, hormone changes and aging.

I do believe what you suggest, that psoriasis is NOT just an immune system issue. But I also believe we bandy about the expression "immune system" with vague definitions in mind. I've written elsewhere about my search for "immunologists" – which was confusing and unsatisfying. And what little I've learned about the immune system suggests we remain largely baffled by it.

I need to include an "aside" here. Health sciences are big right now. By that I mean a whole lot of attention, money and talent are being devoted to various aspects of scientific research about health. As is usually the case when frontiers are expanding, the language and practices, and structures we've created to contain them, are outgrown or found wanting in some way. The science and practice of medicine is not, I believe, an exception to this phenomenon. Dermatology remains our first recourse in the treatment of psoriasis; but, as many of us have experienced, derms are involving other specialists in our more complicated cases. This growing family of involved physician types includes rheumatologists, immunologists, podiatrists, urologists (and that's just MY list!). Most of the breakthrough science about psoriasis in the past decade has not come from those who focus on the skin, but from those who focus on the immune system, inflammatory diseases (which falls "within" or "under" immune system) and genetics. I'll mention again that my psoriasis treatments over the past three years have been the best ever and none of them were prescribed by my dermatologist. (They were prescribed by my rheumatologist.)

Interestingly, when John O.A. Pagano and others suggested 30 years ago that the effective treatment of psoriasis didn't mean treating the skin he was ignored. Nowadays we consider direct treatment of the lesions on our skin a stopgap measure. Dr. Fish, vacations at the Dead Sea, all potions, unguents and lotions are, at best, palliative. I use them when I must because not to use them seems too much like doing nothing, which makes feeling ugly even worse by adding guilt. Just saying "No" to tomatoes may not be the solution, nor might we be cured through acupuncture, sleeping at an angle or ingesting juice from tropical weeds. But who would have thought, just a quarter of a century ago, that injecting proteins grown in mouse tissue would thwart a bit of wayward lymphocyte behavior in our bodies and thereby stop the flaking? To look at the whole collection of our 'fix it' behaviors from a safe distance, the noise and anarchy of it all resembles no rational plan (no science) and little polite restraint (everybody who's improved wants us to confirm their solution and join them in demonizing all other palliatives).

Those of us like you, Deborah, who have grown up with P, watched it change as the decades passed and bodies aged, are the closest thing we have to real evidence of what goes on. Your email, beautifully concise (I envy that) but full of information (and that, too) is the only kind of research we can count upon — precisely because you DO note the other issues: allergies, birth control, NO birth control, and menopause. Thank you for it. I can't help but believe real understanding of psoriasis is going to be derived from a consideration of all these issues — "tracks and patterns," as my mountain ancestors would have put it.  You got me going, Deborah, and I enjoyed the ride.  -Ed

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