Best way to approach the dermatologist

[Crashed]

Hi Guys,

My new years resolution this year has been very different then all the rest I've made and failed at. This one I'm determined not fail at. I've suffered with P since I was 14, I'm now 23 - I've decided this year I will clear up my P at all costs. I've tried all the usual creams to no avail. About 2 years ago I was living down south and my doctor referred me to the derm and I was given 16 weeks of UVB, I thought GREAT (the hospital was next door to where I worked and closer then my doctors was so very easy to attend 2 days a week). Anyway, P cleared however within 2 weeks of finishing treatment P was back and worse then before. I give up on treatment for two years. Moved up north about 3 months ago and I ordered to Dovobet thought I'ld give it a try and it just made my P spread further. Anyway, managed to persuade the Doc to refer me again. He has sent me to Salford Royal, he said that its the best in the country for P treatment.

Anyway, as part of my resolution I have been researching different treatments. I'm no doctor but I'm hoping I can be put on Methotrexate, my question is to anyone who has been put on this medication. In your experience should I come straight out and tell the Derm that this is the treatment I'm hoping for or should I just wait for his suggestions ?

Also, although i've done research it would be good from people who have tried a few systemics as to why you would choose one over the other.

Thanks in advance guys )

D

[Pieman]

hi crashed

salford royal eh?...few members here attend there
they have quite a large derm dept with some big hitters
in the p world...wonder who you get to see?

I would discuss your past history with topicals/uvb and mention
the possibilities of systemic drugs: mtx in particular and be upfront
as well as a physical inspection, a good derm will have a 2way conversation:
ask how you feel, openly discuss and explain potential treatments including
the benefit/risk potentials...and listen to the patient input.

mtx was the first systemic i tried (twice) 1st time clear for 6 months...
2nd attempt - no response! then acitretin (bad hair loss) and fumeric acid esters
(fumaderm FAE) which had limited results.. cyclosporin i'm excluded from.
many prople have different success/failure rates with systemics...it's hit/miss
in finding the treatment that provides remission and best suits you,
but your derm will hopefuly get you there

hope all goes well...good luck.
pie

[Crashed]

Hi Pieman,

Thanks for your reply 

Yeah, Salford isn't the closest hospital for me, in fact its quite far, but my Doc reassured me it would be worth the travel as it's well known for having good results with P.

To be honest I was a little unsure of how to approach as last time I saw a derm he didn't even look at my P, just ticked a box that said UVB and asked me to sign 

I don't know how long it will take to get an appointment, hopefully not too long as I'm having a flare up at the moment, I can cope with the P on my body which I can hide away under layers of clothes but I cant hide the P on my hands and face 

[Crashed]

One question though Pieman, what are you using at the moment and how is your P?

[iky]

Yay I'm not alone! Salford Royal is far! The dermatologist wanted to keep me in for this whole week for daily dressings where they put coal tar all over you, I travel there everyday!

As for methotrexate I've just been on it for just over a month so I can't give you any real advice but I've started on 15mg cos of my severe joint pains and psoriasis covering my whole body accept my face but my rheumotologist upped my dosage just recently to 25mg and it hasn't effected me at all yet. My psoriasis has almost cleared everywhere on it's own (as I tend to get affected cos of cold weather; as temperatures rise, it gets better for me thankfully!). But my rheumotologist told me the MTX has not at all kicked in yet (usually takes 6 weeks) I'm on my 6th week now waiting for it to help my PA! Only thing about MTX that I've found is that it makes me feel really really crappy inside!

PS hope all is well for you, methotrexate is heck of a drug, make sure to read up on the side effects and such before you do anything!.. And if you ever see a spiky haired kid who's limping in pain around the dermatologist department, be sure to come and say hi

[John Boy]

Yay I'm not alone! Salford Royal is far! The dermatologist wanted to keep me in for this whole week for daily dressings where they put coal tar all over you, I travel there everyday!

As for methotrexate I've just been on it for just over a month so I can't give you any real advice but I've started on 15mg cos of my severe joint pains and psoriasis covering my whole body accept my face but my rheumotologist upped my dosage just recently to 25mg and it hasn't effected me at all yet. My psoriasis has almost cleared everywhere on it's own (as I tend to get affected cos of cold weather; as temperatures rise, it gets better for me thankfully!). But my rheumotologist told me the MTX has not at all kicked in yet (usually takes 6 weeks) I'm on my 6th week now waiting for it to help my PA! Only thing about MTX that I've found is that it makes me feel really really crappy inside!

PS hope all is well for you, methotrexate is heck of a drug, make sure to read up on the side effects and such before you do anything!.. And if you ever see a spiky haired kid who's limping in pain around the dermatologist department, be sure to come and say hi

cold tar remember the days 5 months of day care 3 days a week head to toe in tar @ 30%
if you are going down the Mtx route don't have the tabs have the injections so much better

with the tar treatment make sure you never put your feet bear on the ground and wear flip flops in the showers i ended up with loads of verrucas and still have them picked them up from day care unit

[Crashed]

Yay I'm not alone! Salford Royal is far! The dermatologist wanted to keep me in for this whole week for daily dressings where they put coal tar all over you, I travel there everyday!

As for methotrexate I've just been on it for just over a month so I can't give you any real advice but I've started on 15mg cos of my severe joint pains and psoriasis covering my whole body accept my face but my rheumotologist upped my dosage just recently to 25mg and it hasn't effected me at all yet. My psoriasis has almost cleared everywhere on it's own (as I tend to get affected cos of cold weather; as temperatures rise, it gets better for me thankfully!). But my rheumotologist told me the MTX has not at all kicked in yet (usually takes 6 weeks) I'm on my 6th week now waiting for it to help my PA! Only thing about MTX that I've found is that it makes me feel really really crappy inside!

PS hope all is well for you, methotrexate is heck of a drug, make sure to read up on the side effects and such before you do anything!.. And if you ever see a spiky haired kid who's limping in pain around the dermatologist department, be sure to come and say hi

Hi,

Thanks for your reply!!

Sorry to hear how bad you are at the moment, hopefully would will get better soon! I'm lucky, i've never been affected that badly, but this flare up at the moment seems to be getting bad pretty fast. Been readying up on all the first line systemics on this forum, theres so much info on here I could happily spend all day reading up its invaluable. Ive given up so many times in the past on treatment - but I'm determined to find something that works for me so hopefully I can have my first summer this year in a tshirt.

I'm just hoping so much that im not thrown into another bout of UVB as I know after 20weeks of sunburn I'll only get two weeks of remission, and it will be a heck of a way to travel twice a week for me. Ive seen some posts on here where people have been on MTX for 5 years - I cant imagine how life changing that would be for me if it cleared up my P.

Thanks again for your reply - and ild defiantly be sure to say hi if I do see you limping around! lol

[CamoNat]

Hi Crashed

Good resolution you got going there.  I have decided the same, astarted about six months ago with researching as much as possible, looking for nalternatives.

Whathas been working well for me is this; a short summery

- eat no sugar
- eat no flour
- juice vegatables
- 10,000 UI of vitamin d3 a day
- 200 mg og zinc a day
- 2000 mg of niacin a day (I found a great web shop for vitamins, so it isnt expensive)

There are specific kinds of niacin and zinc that work better, I can point you in the right direction if you would like, just let me know

I had my psoriasis nearly cleared away before Christmas doing this.  And then i ate terrible food all month long amd ruined my progress.

So now Im two weeks back on my regime and its starting to clear again.  Im crossing my fingers.

Read up on these things, they seem to be working for me.  :-)

[Crashed]

Hi Crashed

Good resolution you got going there.  I have decided the same, astarted about six months ago with researching as much as possible, looking for nalternatives.

Whathas been working well for me is this; a short summery

- eat no sugar
- eat no flour
- juice vegatables
- 10,000 UI of vitamin d3 a day
- 200 mg og zinc a day
- 2000 mg of niacin a day (I found a great web shop for vitamins, so it isnt expensive)

There are specific kinds of niacin and zinc that work better, I can point you in the right direction if you would like, just let me know

I had my psoriasis nearly cleared away before Christmas doing this.  And then i ate terrible food all month long amd ruined my progress.

So now Im two weeks back on my regime and its starting to clear again.  Im crossing my fingers.

Read up on these things, they seem to be working for me.  :-)

Hi CamoNat!

How bad was you P to start with? And how cleared up did you get? And if you could point me in the right direction that would be great! Do you drink alcohol on this? I've tried cutting out alcohol in the past and to some extent I've felt it has made it worse, though cutting out alcohol doesn't really bother me - hence I'm looking down the MTX rout.

Thanks,

D

[CamoNat]

Hi again Crashed,

Sorry it took me so long to reply

How bad have I had it? Hard to say, I felt horrible about my P.  Wouldnt go swimming, was constantly embarrased and covering up.  Was going crazy from all of the itchy and pain I had from it.  Have it on my head, in my ear holes, a little in my eyebrows, elbows, crotch, butt crack, have had it on my legs a bit too but thats gone now.  Though I know some people have it a lot worse..

I still have P, its just more under control now.  I haven't been back on my regime for very long yet, but I can show you my progress so far. 

The first picture is from January 5th, 2012
The second is from January 18th, 2012

Not sure of the quality, I had to shrink the photos a lot to get to the allowed attachment size

I had nearly cleared myself this way before, but it takes several months, and I had to be super good about what I ate.  Im still not entirely sure what Im doing, just trying to feel it out.  Im considering cutting out dairy products as well now, I think they have something to say. 

Im no doctor, so take my advice with a grain of salt haha, but this is what I do and this is where I buy it;

200mg of zinc per day, 100 in the morning and 100 in the evening
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2000mg of niacin, the pure kind, (it makes you flush, you should read about this before trying) (oh and also, if you get the wrong kind you might not get the flush affect, and you want that)
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10,000 Vitamin d3
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So thats it basically.  Other than that, I have a juicing machine that I use to juice vegtables from time to time, thats supposed to be helpful.  I also take fish oil every day.  And like I said, no flour or sugar.

That place where I but my supplements from is super cheap, if you use the coupon code KIC061 in the coupon section when you check out, then you save some money that way as well.

Good luck sir, its working for me, hope it does for you as well.  But its super hard, I dont think most people would bother to do it.  But my P is in check now and Im much less embarrased and bothered by it, so its worth it for me.  And I feel a lot better as well, from eating better and the supplements.

Hi Crashed

Good resolution you got going there.  I have decided the same, astarted about six months ago with researching as much as possible, looking for nalternatives.

Whathas been working well for me is this; a short summery

- eat no sugar
- eat no flour
- juice vegatables
- 10,000 UI of vitamin d3 a day
- 200 mg og zinc a day
- 2000 mg of niacin a day (I found a great web shop for vitamins, so it isnt expensive)

There are specific kinds of niacin and zinc that work better, I can point you in the right direction if you would like, just let me know

I had my psoriasis nearly cleared away before Christmas doing this.  And then i ate terrible food all month long amd ruined my progress.

So now Im two weeks back on my regime and its starting to clear again.  Im crossing my fingers.

Read up on these things, they seem to be working for me.  :-)

Hi CamoNat!

How bad was you P to start with? And how cleared up did you get? And if you could point me in the right direction that would be great! Do you drink alcohol on this? I've tried cutting out alcohol in the past and to some extent I've felt it has made it worse, though cutting out alcohol doesn't really bother me - hence I'm looking down the MTX rout.

Thanks,

D