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Is P Caused By Toxins from Fungi?
from Brian L.

Ed:  I have been perusing some of your posted emails and responses, and wanted to put my two cents in (it’s in the mail to you as I type…).  I’ll start with your letter from Claudia entitled Fungus and P (Dec 1997).  I was amazed to learn that SkinCap had steroids in it, and that the ‘anitfungal nature of zinc’ has been overplayed here.  In your response, you say “microbes are pretty easy to get rid of…” but if we are talking about a systemic fungal infection/colonization, instead of the localized instance here, it would be quite hard to get rid of.  You allude to this in your response to the email Nail P was Really Fungus by Arty (Aug 1998):  “Well, now you’ve got me wondering all over again.  My reluctance to go on the antifungal regimen is the extraordinarily long time it takes.  One doc told me it could take as long as six months to see an improvement, and a year for all signs of fungus to disappear.”   I have had P for over 20 years … and suffered the entire time.  If it only takes one more year for me to be free of the continuing deformation from P arthritis as well as my skin lesions, I’ll be a happy man!

The following is an excerpt from a Mold-help.org article (http://www.mold-help.org/content/view/633/):

When the World Health Organization convened in 2002, Dr. A.V. Costantini, head of the organization; an internist who claims to be a simple country doctor, listed fourteen diseases wherein fungal (mold & Candida Albicans) forms of microorganisms have been found include the following: atherosclerosis, cancer, AIDS, diabetes mellitus, rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, gout, Crohn's disease, Multiple sclerosis, hyperactivity syndrome, infertility, psoriasis, cirrhosis of the liver, Alzheimer's disease, Scleroderma, Raynaud's Disease, Sarcoidosis, kidney stones, Amyloidosis, Vasculitis, and Cushing's Disease.

You mention in the email from Nail P, is it Forever? that cyclosporine is the only thing that kept your nail P at bay:  “…since then it has been a constant, except when I was on systemic medicines (methotrexate and cyclosporine).”  Were you taking them together?  Did your overall P improve on cyclosporine, or simply the nail P? 

You wrote: “So, if what's happening to my toenails is so similar to what's happening to my fingernails, and fungus isn't a fingernail problem, then isn't it logical to assume BOTH problems are P?” Let’s take it to the next step and ask, “If both problems are P, and there is a fungal link to the toes (obviously a different strain than the common athlete’s foot variety), than might not the underlying problem of P be of fungal origin?”   There is evidence from biopsies that psoriatic tissue, when taken and cultured in sterile environments, yields fungus in culture.  The same can be said for cancer (see link below).

I find it noteworthy to mention that I too lit up like a Christmas tree when going for allergy tests.  It is an interesting commonality of P patients of which I was unaware.  The Dr. told me he’d never seen anything like it, and that it was very rare.  He went on to say there was obviously something going on with my immune system, but after reviewing the blood tests he ordered concluded that I was “As healthy as can be,” and that “Your blood levels look normal, so you shouldn’t have any problems with swelling.”  I held up my club like left hand, barely useful for the swelling and asked “what do you make of this then, Doc?”  He didn’t have an answer, nor did he have treatment to offer, except a very expensive, extensive, lengthy desensitization not unlike what you went through.  Needless to say, I never did go for the “treatments.” 

I find myself at the crossroads you were at back in Sept-Oct ’03.  I am debating the use of a biologic drug, but they are all simply immune system depressants, and as such decrease the reaction we are having to whatever is causing the psoriatic lesions.  They are symptom treatments, not disease killers.  My recent blood work has shown my cytokine levels to be 4 times the normal top level of the scale.  Obviously, something has my innate immune system on high … and according to my Dr, it’s of fungal origin.  Fungal infections are common in those undergoing Chemotherapy.  Oddly enough, the only children with Leukemia that have gone into complete remission are those that got an often fatal (8 in 10) fungal infection that then were treated with antifungal medication.  I wonder if the same can be said for other cancers…?

I am currently on the path exploring these options.  I have been to see a Dr. to treat the ill effects of mycotoxins (neurotoxins) and have had some success in that area.  Treatment is still ongoing.  I have also made arrangements to see a Dr. who specializes in fungal infections.  I am hoping the blood tests he will do will not only show that I do indeed have fungal antibodies, but will isolate which fungus(i) in particular is causing the problem, so we can kill it.  My original research in this area was not P related, but the crossover between my diagnosed biotoxin illness and P is too great to ignore.  I am staying away from the biologics for now.  I am going to play out the fungal scenario as a means to end the disease before committing myself to a regimen of simply treating the symptoms.  With all the immune activity, I don’t think we as psoriatic patients can afford to arrest one part of our immune systems.

One final note:  It has been a very frustrating experience trying to get Dr’s to listen to my concerns.  The overall impression I get is that they know it all, and how could I possibly be onto something that they wouldn’t already know.  Instead of listening intently and asking questions, I am treated politely (sometimes) and dismissed.  I have had to travel to great lengths and long distances to seek out those with an open mind and willingness to listen, learn, and educate.  What should be the norm, is the exception.  Sad, but true.  Sincerely, -Brian L.

*****

Ed’s Response:  Thanks for writing, Brian.  Your "study" has been fascinating and I enjoyed spending some early morning hours following the lines, probing your line of inquiry. 

A part of the diagnostic problem with fungal infections may have to do with their comparative ubiquity.  This long list of diseases you referenced "wherein fungal forms of microorganisms have been found" is almost Shakespearean (in that it "protests too much").  I can't lay facts in front of us, but I'd wager the prevalence of the fungal infection in these diseased patients is less than 100% and probably comparable to its prevalence in the general population (diseases notwithstanding). 

On the other hand, I'm reluctant to be too judgmental based on the Mold-help.org article you hyperlinked.  This pair of sentences JUMPED out at me:

"Dr. Costantini believes that the concept of  'auto-immune' diseases contains a fatal flaw, because no successful species can develop a system of defense which attacks itself. Antibodies that are measured in the blood stream and which imply an autoimmune condition are actually antibodies against ubiquitin, a substance that is present in many species including that of fungi."

Surely the article author is doing some injustice to Dr. Constantini by stripping his inferences from a more reasonable context?  While it's quite possible our current concept of 'auto-immune' diseases is flawed (so are our laws of mechanics and thermodynamics!), the "because" made me laugh: "...because no successful species can develop a system of defense which attacks itself."  Where did THAT law come from?  Evolutionary history is full of unsuccessful species and I've come across no proof that extinction can't be accomplished through self-destructive genetics.  Some people believe ALL species are on a path to extinction, including us, in which case "successful species" should always be qualified by the expression "at this moment in time."  The following sentence, that antibodies that suggest an autoimmune condition are actually antibodies against ubiquitin, a substance that is present in many species ... also left me scratching my head.  Haven't we asserted for decades that P is an autoimmune response to a variety of triggers? 

No, I've never taken methotrexate (MTX) and cyclosporine together.  Cyclosporine remains the only drug that completely clears my skin P — including nail P.  If my P-arthritis is quiescent at the time I start a round of cyclo, the drug can usually keep it that way; however, it has not worked completely at suppressing P-arthritis symptoms when they were raging at the onset of cyclo administration.  My problem with cyclo is typical; after about 9-11 months on a dosage adjusted according to my weight my blood pressure becomes elevated and edema (swelling, mostly in my legs) begins.  This signals my docs to take me off cyclosporine. 

The first time I took methotrexate — for about a year and prior to trying Cyclo — it improved my skin about 95% and completely quieted my P-arthritis symptoms.  (A diary of my first twelve weeks on the drug is here.  My nail P was eventually eliminated (not in the first twelve weeks).  My problem with MTX has been that, after about 12 months on the drug, it begins to lose effectiveness on my skin, even if my docs have been allowing me to continue on a high dose.  All subsequent attempts with MTX have proven less satisfactory then that first exposure — and one of the things it seems to have the hardest time combating, now, is nail P.

You wrote:  “There is evidence from biopsies that psoriatic tissue, when taken and cultured in sterile environments, yields fungus in culture.  The same can be said for cancer...”  To my mind at least, this takes us back to the ubiquity issue.  The fungal issue crops up with such frequency that it sounds more like a trigger than an origin.  Why are only 2-4% of us manifesting these diseases (psoriasis and psoriatic arthritis) if fungus IS the origin and it is so environmentally prevalent? 

Calling fungus a "trigger" rather than an "origin" has some etiological consequences, but it need not deter pursuit of treatments — or further research! — toward the management of fungus as a P-palliative.  If one's P is triggered by fungus, could the fungus be sufficiently diminished or eliminated to eliminate the P?  And would that prospect be more satisfactory (for any number of reasons) than obtaining similar results through other means (like countering an autoimmune response)? 

I still am a believer in a link between P and allergies.  It's pleased me to no end to detect in the literature of late a few more occurrences of the word "allergy."  None of my docs are willing, yet, to concede an association, other than to suggest similarities between P and allergies as reactions to triggers.  I met a new derm this past week (at a seminar, not through a consultation) and asked him when the treatment of psoriasis would be taken away from dermatologists and given to some other specialist (because it's not really a "skin disorder") and rather than baring fangs, he assumed a perplexed expression and reminded me that, once, the practice of treating the skin included syphilis. 

If managing fungal infection thwarts your P, will you be cured?  I'm not being rhetorical, here; I really don't know.  Is there an antifungal medication that obliterates fungus and/or its toxic residue?  Or will you have to be regimental — on-going — about combating fungus, as you must be about any of the palliative approaches to treating P?  I've heard from dozens of people who thwart their P by managing their "leaky gut syndrome," but that management is a way of life — not a singular "cure" as in an eradication of the disease.

I look forward to more reports from you as you proceed.

Your disappointment with doctors IS sad and, unfortunately, not rare.  I imagine many derms are probably off-putting because your ideas are outside their “bag” — meaning what you are proposing is so contrary to what they have to offer they feel charging you for their time is unproductive, perhaps robbery.  You are asking for sushi at a steak house.  Unfortunately, this is sometimes a consequence of taking charge of your disease.  If you manage to thwart the fungus and clear up as a result, please be generous and drop these doctors a note.  Better yet, publish your results at FlakeHQ and send them the URL!  Thanks again for a good read, Brian. -Ed

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