Communications (October-November, 1997)

From Virus Triggers to Pharmacists
from Ira-Jane

Hi Ed: Thanks for maintaining your web site. Tonight I read quite a few of the communications that I hadn't previously read. It really is nice to get a sampling of people's experiences living with psoriasis. It allows one to fit oneself into the continuum of experiences with psoriasis. Do you have anyone mention flare-ups that are virus related? I first had one of these in '85; just what you would call a cold, runny nose and sore throat; and then all of a sudden ... BOOM ... you turn into a red lobster. The normal lesions begin to produce skin more rapidly; and the rest of you is a light to deep pink everywhere, and you feel quite uncomfortable, and probably worried, too. Next you look for your very loosest clothing.

My dermatologist recommends tepid baths, followed by a mild cortisone ointment, and also antibiotics to kick out the infection. The infection (cold, virus) eventually clears, the red/pink areas that suddenly occurred go back to normal, and you return to where you were before the infection.

This has happened to me at least once a year and now, compared to the first time it happened, I am pretty cool about how I handle it. Also time off work seems to be a must, to relax, sleep, get unstressed and get rid of the "Bug." Well, I have just gone through this again, so that is why it is on my mind. Back to work by Wednesday, I imagine. About one and a half weeks at home for R-and-R.

Sent an email to Glaxo tonight. Thanks for the grass roots suggestion to input the pharmaceuticals so they can hopefully get a Skin-Cap replacement available. Maybe you could locate some other similar companies that I could nudge.

Did I tell you I've been an NPF member for many years now? Hats off to their staff!

The funniest line in "Don't Say This" is the dermatologist: "You don't want....You don't want.... What do you want??" That one really breaks me up as I have sat before dermatologists who expressed just about the same attitude, as if I was purposefully making their life miserable by being fussy about what I was willing to try! -Ira-Jane

*****

Ed's Reply:

Illness—including viral infections—has long been considered a psoriasis trigger. It sure makes sense if psoriasis really is an immune system problem, because combating bacterial and viral infections is an immune system function: Psoriatics already have a somewhat-hyper immune response (even when it isn't necessary); so, add just cause—a virus invasion—and, like you said ... BOOM ... hyper on top of hyper.

When my appendix blew in 1993, I suffered my worst infection ever, was hospitalized for three weeks. My scalp psoriasis got so bad you could have described my hair (which is usually mud-brown) as a pointilist's version of dishwater blonde. I didn't want to be discharged in that condition, so finally coerced my docs into letting me wear the showercap at night (to occlude the scalp cocktail). I remember being wheeled out of the hospital on the morning of my discharge. One empathetic candy striper saw the red indentation on my forehead from the too-tight showercap's elastic band and thought I'd been admitted for brain surgery. "Is he lucid?" she asked my companion. Just to flesh-out the scene, I crossed my eyes, spit up a little and let the drool run down my chin.

I, too, identified strongly with the correspondent who sent me the "You don't want...." one-liner. I imagine most of us who refuse to give up palliating our psoriasis have played this role with our dermatologists at one time or another. Actually, it's a good test of a prospective derm's bedside manner. We must understand that, for the time being at least, derms are in a lose/lose situation with their psoriasis patients. The best they can hope for is discovery of a treatment that garners good results, and then that the patient will move out of town before the treatment stops working. Eventually, patients learn that any derm's arsenal of remedies is finite, and in terms of OTC, climatotherapy, dietary and other homeopathic regimens, the patient is apt to know as much as, or more than, their derm. Patients that hang around for a long-long time—long enough to rotate through the usual litany of temporary fixes—require more from the average derm than they are trained to deliver. Lingerers require sympathy and psychotherapy from their derms. They come to expect to be recognized, their names remembered, their regimens recalled without referral to their file, and they even expect to get Christmas cards and repetitive free samples of new prescription products. Such patients are quite different from the curables.

Derms are people, too. I know that's hard to accept, but I've accumulated a lot of evidence. Eventually I decided to hunt for derms who had the courage (some would say the "insanity") to actually specify psoriasis as one of their specialties. But such masochism can be misleading, too. I learned this when, upon discovering one such derm, the first question out of his mouth was, "Who is your health insurer?" Psoriasis wasn't his "specialty" so much as it was his "bread and butter."

Here's another little tip I learned. A psoriatic's pharmacist can be as valuable (or MORE valuable) that his or her derm. Find a pharmacist who's also a FLAKER and you could be striking gold. -Ed

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