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Fighting It Without Insurance
from Bekki

Hi Ed.  I enjoy your site very much. I started dealing with this a little over a year ago. I'm a 34 year old female with no previous skin problems. It started mostly as tiny blisters on my fingers with severe itching. Eventually, it pretty much covered my hands. I have both plaques and blisters on my hands/fingers ... and it makes life very NOT FUN. I thank God that I don't have to work right now as it would be about impossible for me. My housecleaning method for a year has been the "lick and a promise" approach.

I also have some plaques (very light) on my legs and arms ... but none on my knees or elbows. I rarely go to a dermatologist because I don't have medical insurance. I've been to a couple when it got really unbearable. I just went to one today and he put me on Prednisone (of course) and triamcinolone ointment and Keflex because the cracks are infected. I expressed my concern about Prednisone and he agreed but said my P was terrible right now — and that was very unhealthy. He mentioned that he would be willing to give me Ultravate, but said it was expensive, so I opted for something less expensive for now. I also used Psorcon in the past and it seemed to do a good job — but again, it's expensive.

The derm mentioned also that I might be better off taking cortisone injections rather than taking Prednisone. He said this was an option we'd look into later if we had to. He said the injections were less harmful ... is that true?  (I kind of doubt that statement.) I also take estratest and aygestin.... these are hormones. I'm wondering if it's okay to take hormones and steroids at the same time. I mentioned this to the derm but can't really remember his answer. I hate fast-talkers. Makes me feel like I'm at a used car lot. "Yes, lil lady! I can have you in this beauty TODAY!" hahaha

Anyway, he explained that my condition was chronic. "Uh ... well ... YEAH!" I already knew that. He said he'd work with me to make sure I was comfortable and that I shouldn't let it get THIS bad again before doing something about it.

He was a lot better than the last derm I went to who was sure I had HIV and even made me get tested.  Scared the poop out of me. He also tested me for Lupus and then said he wanted to order a chest x-ray to rule out tuberculosis. Now, mind you, I had NO symptoms of any of these diseases.  Needless to say, I stopped going to him.

Sorry so long-winded. Thanks for listening. –Bekki

*****

Ed’s Response:  No apology necessary, Bekki.  Your exploits made interesting reading.  P is a tough disease to manage without insurance.  If you haven’t joined the National Psoriasis Foundation, I suggest you do.  As you will battle this disease to defend your pocket book as well as your skin, you deserve all the information you can get — and NPF exists for that purpose.

The derm who tested you for HIV and was hell-bent to rule out every other possibility before diagnosing P might have been “bit” by a misdiagnosis at some earlier point in his career.  It seems to me that derms are in a very precarious position on the “specialty tree” of medicine.  Not only is the skin our largest organ (or so I’ve heard), it’s also our most visible.  Tens of thousands of diagnoses for as many ailments have a “skin ramification” of some sort.  Derms must know a lot about lots of things, not just about skin disorders.  I’ve not heard any statistics, but it would be interesting to know what percentage of patients who first see a dermatologist end up being sent to some other specialist (or GP) because the “skin ramification” indicates an altogether different specialty disorder.

And the converse of this has crossed my mind, too.  The more we learn about P the more we understand it really isn’t a skin disease.  It’s an immune system disease that happens to have some pretty pesky “skin ramifications.”  Might there be another medical specialty more appropriate for treating the root cause of P?

At some point there may be a reshuffling of medical specialties, perhaps more or less divided according to chromosomes and genes ... or the exact opposite may occur.  Practicing doctors may tend to blend back into generalists with access to specialty information enhanced for them by information technology....  As the old saying goes, “Time will tell.”

With regard to steroids, direct intralesion injection versus systemic, the intralesion injections are supposed to be safer because more of the steroid stays in the vicinity of the lesion, less travels through your blood stream to have all those “negative effects” on other parts and processes.  Prednisone has long been used as a “quick fix” for flakers — and a course of treatment with it is often followed by a return to the pre-treatment condition.

I’m surprised that your derm didn’t suggest occluding your hands over night.  You might ask him about this.  Prior to bed you goop up with your topical corticosteroid of choice (but something prescribed, not OTC), then you put on “food handlers” gloves and tape them tight at the wrists.  (Food handlers gloves are loose and not to be confused with latex gloves like those worn by surgeons.  Used as an occlusive dressing, those can do more harm than good.)

Let us know how things progress, Bekki.  -Ed

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