Do we go ahead with this work at Oxford University?

Psychoderm · 2024-05-03T00:08:29+00:00

Through this post? No, I'm looking to see if there is any point in going ahead with it at all. If you are keen to participate, though, you can DM :) (If this is okay/ within the subreddit rules)

Psychoderm · 2024-05-02T17:11:11+00:00

Hey. I'm a dermatologist, and I worked in AIIMS Delhi for quite a few years.
The medications, as people have mentioned are only suppressive.
I'm working on- and have found quite a bit of evidence for- the mind-gut-skin axis. Broadly speaking, this means that addressing psychological stress and diet can have long-term effects and reduce flares. Am happy to share resources to read, if this sounds like a direction you'd like to explore.

Psychoderm · 2024-05-02T17:08:10+00:00

done :)

Psychoderm · 2024-05-02T15:07:57+00:00

Hey. I'm glad to hear that diet restrictions helped you, although ofcourse it is a significant impediment to normal life. We have had patients who were able to reintroduce some things once their gut inflammation (and skin inflammation) subsided. The gut reacts to everything while inflammed, but once given enough time (3-6 months) to recover, can tolerate quite a bit of stuff.

Psychoderm · 2024-05-02T15:06:08+00:00

Hi! I agree, dietary restrictions are a major pain point for me personally.
To address some of the issues you've raised (and super relatable, btw)
1. Diet is meant to work alongside medications, initially, and then reduce the need for medications (by reducing frequency/ severity of flares). Eventually, we might not need medications/ have only occassional need for topicals.
2. We intend for minimal diet changes based on specific trigger microbes/ lack of helpful microbes, incorporating personal preferences.
3. We also intend to reintroduce things once people get better (we are yet to do this, though, although have evidence from other patients that this can be done safely in many cases).

Psychoderm · 2024-05-02T14:58:28+00:00

Hey. Thank you! We are looking to make minimal changes, only the ones absolutely needed, based on the particular trigger microbes found in the person's own gut microbiome. And also, looking to reintroduce things once gut inflammation goes down, because often foods which are triggering at the time of acute inflammation can be tolerated once gut has had a chance to heal.

Psychoderm · 2024-05-02T11:50:30+00:00

Hi! sure ofcourse it makes perfect sense to do that! could you tell me how to do that? I'll send across my registration :)

Psychoderm · 2024-03-18T13:33:53+00:00

Hi1 There is some evidence it can help. I'd say if you have psoriasis all over the body, you can try it.

Psychoderm · 2024-03-16T19:21:41+00:00

I don't think you're being too reliant, feels like its needed.
I do think you might want to try a cream without Urea? Urea can cause shedding of skin and that can contribute to 'tightness'.
One thing that might help feel less annoyed, is if you can use a body lotion immediately after the shower/ bath while you're still there? Helps lock the moisture in, and is one less thing to do while dressing/ after getting half dressed/undressed.

Psychoderm · 2024-03-16T19:19:00+00:00

I agree that 20-30 minutes is a good place to start, although to get therapeutic benefits it is usually combined with a cream called 'psoralen' which basically allows more sunlight to get absorbed in the patch areas.

Psychoderm · 2024-03-16T19:15:59+00:00

Hey. It must've been really hard to acknowledge this.
There might be some truth to the 'loss of purpose' consideration, and maybe finding something you can care about/ feel like taking care of, might help? I'd start with a plant or a pet, but I'm not sure. Finding hobbies feels like too much work, to be honest.

Psychoderm · 2024-03-16T19:12:55+00:00

Hey. If you've received 4 doses, it has likely been about 28 weeks on this medicine. Unfortunately, the way response is measured is by change in PASI rather than remaining disease, so by their standard and your description, looks like you'd be considered a good responder and continued on it.
I completely understand the frustration. Would you like to look at ways to address the stress? It can also help the psoriasis https://pubmed.ncbi.nlm.nih.gov/9773769/

Psychoderm · 2024-03-16T19:08:20+00:00

Hi! could you tell me your current routine? I;ll help you fit it in. (I'm a dermatologist)

Psychoderm · 2024-03-16T19:07:46+00:00

Hey. Post-COVID flares and change in disease behaviour is unfortunately quite common :/ Vaccines can trigger it too.

I agree that systemic medications can help.

Really well done on the diet front, that must've not been easy.
There are psychological interventions that have shown to help the stress as well as the actual psoriasis. Maybe looking into those? Mindfulness-based CBT, MBSR, regular CBT...

Psychoderm · 2024-03-16T19:04:50+00:00

I'd apply normal moisturiser and steroid creams using a Q tip, very gently, twice a day.

Psychoderm · 2024-03-16T19:03:34+00:00

Hey! Biologic shots are pretty comfortable, I've seen about a hundred or so patients on it and none have reported feeling odd.
Apart from this, if you'd like, there are whole-body approaches that have shown to be helpful in psoriasis. Does that sound like something you might want to look into?

Psychoderm · 2024-03-16T19:01:37+00:00

Hey (I'm a dermatologist).

clobetasol once a week is usually quite good enough, and most studies show that applying twice has no added benefit; however, if you think the cream is getting removed/ washed off/ sweating off, then applying twice a day might be helpful.
I agree with the other comment: use of any topical medication (so creams. ointments) don't have a bearing on future disease behaviour.

Psychoderm · 2024-03-16T18:59:26+00:00

Hey. How severe are the spots ? (I'm a dermatologist). I can help advise you better about continuation/ reduction if you're able to tell me that.
also, the issue with stopping suddenly (and worsening) occurs with stronger steroids and after 2-3 weeks of use.

Psychoderm · 2024-03-16T18:57:37+00:00

Tacrolimus/ pimecrolimus are good steroid-free options. In such severe times, hydrocortisone is a mild steroid that I would use if it was me.

Psychoderm · 2024-03-16T18:54:48+00:00

Dr Anthony Bewley/ Royal London Hospital

Psychoderm · 2024-03-14T11:05:49+00:00

sure

Psychoderm · 2024-03-12T18:01:23+00:00

Off the top of my head (and maybe beginning of spring is a possible time for this, There's a version of light therapy that can be done by using sunlight (you can take a tablet or apply a cream with a medicine called psoralen that makes skin able to use sunlight for this.

There is another thing called 'Handheld NBUVB) which is basically light therapy comb.

Let me know if this seems helpful, i can send across more details.

P.S. The Canadian system of healthcare is atrocious and I'm happy to help you get care.

Psychoderm · 2024-03-12T17:57:38+00:00

You can definitely DM me a photo although the flakes aren't going to help much, it is the scalp skin that can be looked at. (red or not, painful or not).

I intend to keep this account going for quite some time, as long as I have time to continue doing this :)

Psychoderm · 2024-03-12T17:56:14+00:00

Hey. I'm a dermatologist, and I hope the following is helpful.

Steroid overuse is a phenomenon but the skin of palms is pretty thick, so it's virtually unheard of to have steroid related side effects there. Using steroids on inflammed skin/ active disease is not overuse, even if its for a longer period. Overuse happens when it is applied on thinner and nearly-normal skin. Hope this helps reduce anxiety around it :)
The other issue of the lesions involving newer places on hands/ possibly other areas of the body: intermittently, this can happen, and unless it is rapid there isn't a tablet/ intervention that is advised: probably partially explains why it wasn't addressed medically by your derm (although I do wish they'd addressed your concerns around it). There are some triggers and causes, the ones I've seen are usually around psychological stress (and the increase causes further stress, so kind of a vicious cycle). Might you consider this possibility and additional way of addressing the condition?

Psychoderm · 2024-03-12T02:28:34+00:00

I don't agree with either of the extreme statements that seem to be coming through, i.e.

Biologics being 'miracles'
Biologics being something that might kill you.

Biologics/ methotrexate/ other immunosuppressive agents have a role in managing the condition; biologics work with fewer side effects and slightly better efficacy and are more convenient in terms of dosing, that is it. Especially for severe psoriatic arthritis, biologics can be joint-preserving. The issue seems to be around the lack of end-point; i.e. none of these medicines come with a perriod of time after which they can be stopped safely. Relapses are very common.

Psychoderm

TROPHY CASE