COMING SOON: NEW INFORMATION ABOUT PHOTOTHERAPY (NARROW BAND UVB) AND ITS SUPERIORITY TO OTHER THERAPIES IN TERMS OF SAFETY, SINCE DEVELOPMENT OF CANCER AFTER LONG-TERM USE OF IMMUNOSUPPRESSIVE AGENTS REMAINS A RISK AND TACHYPHYLAXIS OCCURS RAPIDLY WITH TOPICAL STEROIDAL MEDICATION.
See below my time-release formula for topical treatment of psoriasis that you can prepare at home. I found the mixture economical and more effective than if using the ingredients separately. Of course, talk to your doctor before using the preparation. My aim is to reduce the need for frequent use of skin-thinning, immune-suppressing steroidal medication.
Psoriasis was once considered to be a "nuisance disease." Modern research has identified this immune disorder to be far more serious than merely an inconvenient scaling of the skin. Psoriasis can rightly be considered as the visible part of a pervasive health problem, including cardiovascular damage, leading to heart failure and pulmonary embolism that can be fatal--it is not unlike systemic Lupus. For example, inflammation of the arteries can dislodge plaque in atherosclerosis, which can end up in a lung (or cause cerebral anoxia). Equally alarming is the disregard by many physicians to appreciate the impact of stimulants on the immune system. Effective therapy for psoriasis requires the patient to be an active member of the treatment team. The following information--if followed diligently--can be helpful in dramatically reducing the severity of the condition.
Pruritis (Itching). Never scratch a lesion, no matter how severe the itching. Instead, apply a cold pack that will resolve the itch within a few seconds. If a cold pack is not available, apply a wet paper towel to the area and fan it with any available implement, such as a booklet or magazine. Scratching temporarily relieves the itching but also stimulates the lesion to spread and then intensify the itching.
Scalp. Using a liquid steroidal medication (cream if bald) and avoiding irritants (see my "Friends & Foes" table under Autoimmune page) can clear up psoriasis of the scalp, after which a tar shampoo may be used daily as a prophylaxis against rebound. While the shampoo is effective in keeping the scalp clear, it is toxic. There is no hard evidence causes hair loss, but it does damage hair, visibly reducing hair thickness. If the psoriasis is not severe, a zinc pyrthione shampoo will serve as a good substitute, which is not damaging to hair.
Figure 1. The geographical form of psoriasis affecting the lower extremities, which
is one of the most difficult areas of the body to treat. This form can develop just
superior to the ankle and spread as a result of sitting with legs crossed for extended
periods of time. Ischemic compression-- especially against hard, cold surfaces--is
a foe of individuals with a diathesis for psoriasis. The larger the area affected,
the more severe the pruritis.
The two-year flare-up of severely erythematous psoriasis in the case illustrated here was found to be caused by an autoimmune reaction, following an insect bite. The body calcified the barb of the insect, but not until the calcification was removed did the psoriasis clear up 95%. Only by accident was the etiology of the flare-up discovered, following a biopsy of a spot on the leg.
The wound still had not healed after eight weeks. The subject thought a piece of bone was protruding as he pulled out the 1 cm long piece of calcification with tweezers. When informing his dermatologist that the severe pruritis had resolved within four hours and that the psoriasis was clearing up, the physician responded with no interest and dismissed the matter as unimportant.
Intractable outbreaks can be caused by such health issues as low grade infection of the prostate gland. A 65 year-old male enjoyed relief from raging priuritis following a biopsy of the prostate and a course of Ciprofloxacin (antibiotic medication), 50% of the psoriasis cleared up without any change in dermatological treatment, and the remainder responded very well to topical steroid cream and moisturization with petroleum gelly.
An autoimmune disorder, psoriasis can sometimes be managed with minimal or no need for toxic medication. Much of what exacerbates this inflammatory condition can be found in the "Friends & Foes" list, in the Autoimmune section at this site.
Individuals familiar with this chronic disorder will recognize that traditional medicine continues to focus almost exclusively on the symptom, not the cause. Even widely respected publications in dermatology seem to be confused about the most self-evident etiological factors, recently stating that "There is little scientific evidence that diet alone can improve psoriasis." Good grief! Were all in the study groups anxiety-disordered smokers? Don't expect anything to really help if you smoke that toxic stimulant or have untreated anxiety disorder.
Many physicians scoff at the idea that emotional stress is an exacerbating condition, even though the connection between stress and psoriatic flare-ups was observed as far back as A.D. 800, in ancient Persia. Sadly, people with psoriasis often need to educate their doctors. Logic dictates that use of anti-inflammatory medication should be an integral part of the treatment for psoriasis, since these type of drugs inhibit vascularization (which is reported by reputable sources to also starve cancer!). Celebrex is an effective Cox II inhibitor and tolerated well by most people. Taken five days a week, the non-steroidal anti-inflammatory drug (NSAID) might even allow you to drink a cup of coffee or eat some red meat without aggravating the prosiasis. Drug holidays keep the medication maximally effective.
Medication: I caution people against taking immunosuppressive drugs, unless the benefits far, far outweigh the potential for harm. Clearing up psoriasis at the price of cancer is not therapeutic. A good dermatologist will prescribe drugs like Enbrel only as a last resort, and only in the most severe case, monitoring the body's system carefully.
Most physicians are receptive to patient input if the language is couched (not a
threat to his or her expertise). For example, if you would like your doctor to initiate
a trial of a NSAID (antiflammatory) medication, you might ask, "Doctor, I understand
psoriasis is an inflammatory disorder. Do you think it might help if took an anti-inflammatory
medication?" If your doctor ridicules the idea, you need to find a better doctor.
TNF: Currently, researchers are seeking ways to tame the immune system in people with psoriasis, focusing on control of a proinflammatory cytokine called tumor necrosis factor (TNF), which is widely believed to be the chief cause of psoriasis. I will post information about TNF research when something we can use is made available. TNF is both a friend and foe to the psoriatic: it's antineoplastic effect impedes development of tumors and destroys certain cancer cells, but then it also contributes to inflammatory diseases like psoriasis. Since enough reliable data has been collected concerning TNF and psoriasis, we can safely say that most--if not all--of those (expensive) naturopathioc preparations are nothing more than products marketed by snake-oil salesmen. I must add that not all naturopathic, or natural, medicine is without value.
Scalp: Creams are not practical for scalp lesions, unless you are glabrous. A topical steroid solution in a dispenser that does not aggravate the sensitive skin of the scalp is effective. Keeping thick hair short helps vitamin D-forming UV-B light access the skin. Wearing a hat or cap in winter, even to bed at night if cold, helps prevent the scalp from drying out. Sunshine is the psoriatic's friend, but frequent exposure of the scalp to the sun can invite skin cancer down the road. Washing the hair daily with a good tar shampoo, like Classic Formula Medi-Dan, by A.I.I. Clubman (), is not an option for anyone with psoriasis of the scalp. Because daily use of a tar shampoo can cause the hair to become dry and brittle, mixing tar shampoo with a gentler anti-dandruff solution, like Queen Helene (by Para Laboratories, Inc.) or adding some hair conditioner to Medi-Dan is recommended. No evidence exists that washing the scalp daily causes hair loss. On the contrary, keeping the scalp clean with the stimulation of regular shampoo massage tends to promote hair growth.
Face: Caution should be exercised when applying a steroidal cream about the eyes, especially if the lesion is on the eyelid. Unconsciously rubbing the eyes in such case predisposes you to a number of very nasty ophthalmological diseases. Remember that steroids are immunosuppressive. The primary means of transmission for viral infection, such as the common cold or flu, is through the eyes (tell that to a politically correct AIDS "educator"!). Cautery treatment for refractory facial lesions is effective but should take into consideration future exposure to the sun: cauterized areas will not tan and appear as patches. Cauterization therapy should one of last resort, also because scar tissue can hide what might be developing under the lesion! Stubborn facial lesions virtually always respond to occlusive dressings that can be applied overnight. Continue to apply the dressings until the lesion is healed, even if the treatment takes weeks. After the lesion is cleared, wait a few days and treat the area again for a week to minimize the chance of rebound.
Ears: Wearing wax ear plugs at night helps to keep the affected ear canal from drying out and thereby reduces the severity of the condition.
Back: When treating lesions on the back, always monitor for keratosis and other suspicious-looking growths. Applying a steroidal cream to a pre-maligmant growth is dangerous as is scratching a lesion repeatedly then medicating it with an immuno-suppressive agent. Have a family member or trusted friend check your back periodically. Any suspicious-looking sore should be examined by a dermatologist.
Elbows: Compression of the skin at the elbows is practically impossible, since many activities of daily living involve leaning on the elbows; so naturally the genetically inherited immune disorder of psoriasis at this site, with accompanying pruritis, is especially difficult to treat.
One can develop a habit of avoiding to lean on the elbows (especially on cold surfaces like a glass top desk). Another option is to make some elbow pads. The present writer uses a piece of foam rubber to rest his arm when at the computer, which distributes elbow compression over a greater area and therefore reduces irritation.
Just as we develop callouses by excessive gripping (like digging with a shovel daily), whereby the body
automatically defends itself against the insult with thickening of skin, so the cells at the elbows hyperproliferate when squeezed (stimulated), in the psoriatic every four days instead of the usual 28.
Figure 2. Typical presentation of untreated psoriatic lesions on the elbow. The erythematous macules and papules coalesce to form lamellated silvery, yellow-white plaques. Vascularization at the site accounts for the bleeding when scales are scratched off. With age, osteoarthritis can develop in the joint, depending on the wear. Tennis players with psoriasis are at greater risk for development of the arthropathy. Transpore surgical tape, which allows the skin to breath, coupled with a corticosteroid cream, is this writer's treatment of choice for the elbows and other difficult-to-treat areas. A 30 gram tube of Clovate (Clobetasol 17-Propionate), 0.05 g/100 g sells for about 2.5 euros in Spain. The waxy Clovate in an occlusive dressing is highly efficacious. It is also sold under the brand names of Cormax®, Embeline™ E and Temovate®.
Figure 3. Other brands of surgical tape are available, but 3M's adhesive quality is far superior, sparing you of littering the floor with pieces of unsightly tape that became detached. In addition to providing an occlusive dressing, the the "Transpore" tape also keeps the lesion therapeutically moist, which means the dressing should not be kept on for longer than 34-36 hours, depending on the climate. But always consult your dermatologist before trying a new medication. The reader should be aware that bacteria, especially fungal infection, can develop in the moist environment between skin and tape, despite the porous tape. Antimicrobial therapy is not pleasant. But use of an occlusive dressing is a very effective and economical treatment modality for resistant lesions.
Of course, if you smoke with an intake of junk food, do not expect appreciable results. By modifying diet and lifestyle, you can enjoy drug holidays and avoid the serious health risks associated with chronic use of steroidal medication.
Figure 4. Make a few cuts, so that the tape will form to Figure 5. Press down the flaps created.
Figure 6. The folds will help the dressing to stay on Figure 7. The occlusive dressing on the
The rounded surface. elbows can be protected at night by wearing
socks with the toes cut away. In this manner,
the adhesive tape will not soil the linen.
Figure 8. September 13, after second day of treatment Figure 9. September 14, the fourth day of
with the clear Transpore tape and corticosteroid treatment. The lesion is ameliorated by about
cream. Mechanical removal of the scales is an option,
so that the medication can work faster. But this option
should firstly be discussed with your physician.
Figure 10. September 15. While still erythematous, the Figure 11. September 16. Lesion-free and the
Skin is regaining thickness. Cellular proliferation is reddening of the skin (scarring) is rapidlty
Arrested. fading. By avoiding my identified "foes" and
embracing my "friends" (see Autoimmune
page at this site), I need to treat the elbows
only once every month, for no longer than a
day or two.
WARNING!!! Never try to rub off the adhesive with your fingers, should some of it get left behind on the skin. Remnants of the adhesive will remain on the skin after the tape is peeled off only when the occlusive dressing is left on for longer than two days. By attempting to rub off the adhesive, you can rub bacteria into a partially healed lesion and cause a nasty infection. Fungal infections especially can result in such instances, since the dressing traps moisture and provides a breeding ground for bacteria. If you forget to remove a dressing for several days and some adhesive is difficult to pick off, use a little of the lemon cleanser that is used to remove gum from clothing (such as Goo Gone). Rub in one direction, away from the lesion. Lifting the adhesive, rather than rubbing it off with a towel, seems to be more efficacious. Often the accumulation of natural oils in the skin will cause the tape to fall off if the dressing is left on too long, but some adhesive may remain on the skin. Occlusive dressings are safe if these precautionary steps are taken, but you should always consult your physician before starting any new therapy that he or she did not prescribe.
Fingernails: Cutting the nail oval or straight across can modify its shape. Concave shaped nails (serious impediment for classical and flamenco guitarists) can press on the nail bed and aggravate psoriasis of the nail, which condition can be compounded by fungal infection. Prolonged squeezing of a pen is tantamount to ongoing trauma that often leads to the formation of a Heberden's node and psoriatic arthritis in the distal joint. Below are some illustrations of how the contour of fingernails are modified over time by cutting them in a particular way. See my Fingernails page for an illustrative guide.
The nail contour (concave or "spoon") of the little finger on the left hand is natural, identical in shape with those of the other digits on the same hand. In contrast, the nail contour of the little finger on the contralateral hand is slightly convex. Shaping the nail--and, eventually, the nail bed--of the one on the right hand was accomplished by use of a false fingernail, adhered to the surface with super glue. After three months of wearing a plastic fingernail, the modified shape has been sustained for many years by merely filing the nail tip oval (see my "Fingernails" page).
Buttocks: When sitting for long periods of time, use a Tempur-pedic comfort cushion to reduce psoriasis-aggravating compression. Always avoid sitting on cold, hard surfaces, even for short periods. You may purchase the visco-elastic material from vendors, like Sam's Club. Cutting a high grade "memory foam" topper into cushion size squares then fitting two or three layers into a cover is an affordable alternative to the expensive Tempur-pedic product. Use the remainder of the material to make pillows.
Genitals: Males should wash immediately after coitus to prevent an outbreak on the glans penis, caused by vaginal acidity. A mature, understanding mate will not be offended that you excuse yourself briefly to wash: she will rather regard you as intelligent for doing so. Remember that repeated bouts of psoriasis in this area results in loosening of the delicate skin. And applying steroidal medication on this part of the body is almost the same as injecting it into the blood.
Knees: Same care as for the elbows. I respect any genuine exercise of faith in God, but I doubt He wants the psoriatic sufferer to kneel in prayer and exacerbate any development of lesions in this area.
Auditory canal: Using wax earplugs at night after applying the medication to the ear hole serves as an occlusive dressing.
Feet: Foot baths (undiluted Medi-Dan tar solution), while watching TV, and use of an emollient cream at night can aid greatly in the painful cracking of the affected soles. Avoid prolonged exposure to the smell of any tar-based solution. The feet should be washed thoroughly in an antiseptic solution before any application of paraffin, emulsifying wax, or plaque-retarding petroleum jelly (Bag Balm is excellent). Using perforated Seran wrap or wearing socks to bed at night to prolong the hydrating effect of an applied moisturizer should only be done only under the directions of a physician, since the risk of contracting a severe fungal infection is present in such cases.
Joints: Psoriatic arthritis is chiefly controlled through diet (see list of "friends" and "foes" in the Arthritis section). Passive articulation is highly therapeutic but non-weight bearing exercise needs to become part of your daily routine, particularly in the morning. Only madness can account for the behavior of indulging in pro-inflammatory foodstuffs then seeking medical relief. But you can ask your doctor to prescribe an anti-inflammatory medication for you, such as Celebrex, for prophylactic use and enjoy a steak or some chocolate once in a while...once every two months is once in a while! If your physician scoffs at the idea of taking an anti-inflammatory medication two hours before eating beef, find a more knowledgeable doctor. If you hunt for an open-minded physician, you will find one; and the hunt will save you much needless suffering.
Many bone joints in the body are naturally stressed, and resilience is lost with age; so after the age of 50, don't expect to get away with doing things you did when 20 or 30. Remember, inflammation is an immune response, which for the psoriatic means degeneration of the joint and the development of deforming Heberden's and Bouchard's nodes (fingers and toes). Vascularization in the form of collaterals and also blood vessel dilatation accelerate the cycle, most aggressively in an already injured joint, like the spine at L4-L5: inflammation may cause internal pressure (and possibly nerve compression) and formation of scar tissue, scar tissue painfully aggravates local nerves (neuritis), irritating a nerve causes inflammation, inflammation in turn causes scar tissue, and scar tissue irritates the nerves, etc. The cyclic process can take on a life of its own.
Geographic psoriasis: Large areas of psoriasis tend to cause painful cracks in the skin, especially when affecting the soles of the feet. Treating lesions that have spread over large areas with medication, waiting 10-15 minutes, and then massaging the areas with Bag Balm will help prevent the skin from drying out and reduce the need for absorbing an immunosuppresive dose of steroids. Occlusive dressings also increase efficacy of the treatment, creating a time-release of the medication. The adhesive keeps the skin moist.
WARNING: Beware of physicians that scoff at the idea that high doses of steroidal cream delivered through the skin can place you at risk for serious health problems, due to immunosuppression. If you experience mild, flu-like symptoms after applying corticosteroidal medication to large areas of your body, your body is informing you that your resistance to all kinds of diseases, including cancer, is dangerously lowered. Your body is the best authority on what is good for you. When you notice that topical application of steroidal medication is no longer effective, you have developed a tolerance to the medication (tachyphylaxis). This means you are at risk for serious health problem, including such dangerous infections as sepsis, which can easily be fatal.
Skin stretching: Many people with psoriasis fear permanent stretching of the skin after a site has been healed. This writers experience has been that with proper skin care, little or no stretch marks remain if the affected areas are treated beyond the clearing-up stage. Keeping the skin hydrated is essential for cosmetic recovery.
Pruritis: Itching invites scratching and infection. Vascularization in psoriasis predisposes the psoriatic to bleeding from breaking the integrity of the skin through scratching. The larger the area affected, especially in the lower extremities, the more intense the itching. The safest method of alleviating this condition is the application of an ice pack, which is also a cheap but very effective anti-inflammatory treatment. The gel-form of a cooling pack offers the advantage of wrapping itself around an affected area. Applying a cold pack once a day for five minutes may contribute to therapy.
DR. TAYLOR'S EFFECTIVE HOME-MADE FORMULA FOR PSORIASIS
As always, consult your doctor before trying any new treatment for this "nuisance" disease. The following preparation consists of products already approved by the FDA. Still, you may be the one in a million that has an allergy to one of the ingredients. At least start out by treating a small area of the skin firstly.
1. Take a clean glass jar of approximately 8 fluid ounce capacity and fill about 70% of it with petroleum jelly and 20% with Bag balm, which is available from stores like WalMart in 10 ounce tins. I used one of my wife's old candle jars, shown above, which has a glass lid.
2. Squeeze out the entire contents of a 30 gram tube of the steroidal cream your doctor prescribes for psoriasis into the jar and mix thoroughly. The waxy Clovate (Clobetasol Propionate, 0.05%) is my preference. The combination of the agents will form a luxuriously rich cream that will promote exfoliation of scaly skin, so that the application of any medication will be more effective. I estimate wound-healing Bag Balm contributes to managing the rate of skin cell hyperproliferation.
3. Crush 1300 milligrams of aspirin and add distilled of filtered water to make a paste. Keep adding a few drops of water until a thick paste is formed then add the aspirin to the contents of your jar. A mortar and pestle is ideal for crushing aspirin into powder, but a spoon and small hardwood bowl will suffice. Be patient: aspirin will dissolve. If you add too much water, let the solution dry out a little--you want to keep the preparation at least the consistency of toothpaste for manageable application.
4. Finally, add two ounces of vitamin A (Retinol) cream then thoroughly mix the ingredients together. Swanson Health Products on the Internet offer high quality skin nutrients for prices lower than those at local health stores; and this reputable company does not gouge its customers with shamelessly high shipping and so-called "handling" fees.
5. Keep the therapeutic mixture in the jar away from heat and sunlight. While you will use up the mixture long before it dries out, keep a lid on the jar to avoid contamination.
You now have a long-acting medicinal-moisturizing cream that can be gently massaged into psoriatic lesions twice daily to keep the skin from scaling. With the skin-softening Bag Balm serving as a base, the preparation acts like a time-released delivery of the steroidal medication. The aspirin will aid the Bag Balm in exfoliation. Vitamin A will nourish the skin and minimize thinning. Apply just enough of the mixture to lightly moisten affected areas, and no soiling of your clothes will occur. Avoid rubbing hard into lesions that are heavily scaled. Applying plain petroleum jelly for a few days is a good alternative to scratching off thick plaques with germ-harboring fingernails. Thick psoriatic plaques must be removed firstly, so that any medication you apply can do its work.
I have tried adding Ibuprofen and a tar-based medication to the mixture but noticed no increase in treatment efficacy. Adding reddish-colored Ibuprofen and expensive (brown) tar cream only soils clothing.
Cellophane: Massaging Dr. Taylor's home-made formula into an affected area then wrapping it overnight with Saran Wrap, a thin sheet of plastic that sticks to itself, can effectively alleviate psorisais without need for dangerous amounts of steroidal cream. In fact, you may obtain better results with less medication in a shorter time by taking advantage of the time-release effect of the medication mixed with petroleum jelly in an occluded environment. Wearing pyjamas or track suit pants (the bottom tucked inside of socks) will protect the delicate plastic wrap from unraveling. Caution: Do NOT wear plastic wrap longer than overnight.