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Archive for the ‘Treatments’ Category

It has long been recognised that psoriasis is a complex skin disease that has psychological associations as well as physical ones. It’s thought that stress can play a role in the flare-up of symptoms, and many sufferers can often trace their first outbreak back to a stressful event or period in their life.

With this in mind, the role of stress reduction has become an important part of psoriasis treatment. Stress releases a hormone called cortisol in the body, which can cause inflammation. In psoriasis, symptoms are triggered by an inflammatory response in the body, so it’s not hard to see how the two go hand in hand.

One approach that has been gaining traction in recent times, alongside conventional psoriasis treatment, is the use of cognitive behavioural therapy, or CBT.

CBT is one of many so-called ‘talking’ therapies, and its aim is to change negative thought patterns in patients. By altering the way that you think or behave, it can help you to better manage your problems or health condition (http://www.nhs.uk/conditions/cognitive-behavioural-therapy/Pages/Introduction.aspx).

CBT is most often used to treat anxiety or depression, but a number of studies have recently been carried out to see what effects it may have on treating skin diseases that have a psychological interaction, such as psoriasis. The results, so far, have proved quite enlightening.

Researchers have discovered that treatments such as CBT can prove beneficial in many ways, improving the quality of life of sufferers and reducing the severity of symptoms (http://psoriasisnewstoday.com/2016/06/14/efficacy-of-biofeedback-and-cognitive-behavioural-therapy-in-psoriatic-patientsa-single-blind-randomized-and-controlled-study-with-added-narrow-band-ultraviolet-b-therapy/).

Studies have found that CBT can help to ease the anxiety or depression that many sufferers of this skin disease experience. In fact, it’s thought that a third of people with psoriasis report feelings of anxiety or depression (https://www.ncbi.nlm.nih.gov/books/NBK327714/).

Research has also indicated that CBT can help to retrain the brain to think differently about this skin disease and can even improve physical symptoms. It can also help to reverse the bad habits associated with the disease, such as changing behaviour to reduce scratching and itching. Other relaxation techniques and meditation have also been shown to help ease symptoms, although not to the same extent as CBT (http://www.telegraph.co.uk/news/health/news/9499471/Skin-disease-hope-through-psychotherapy.html).

CBT and other talking or relaxation therapies are certainly beginning to gain recognition in their role managing symptoms of skin diseases such as psoriasis. With further research, it could be that sufferers rely more and more on these treatments as much as conventional methods.

 

This guest article has been written by Tania Godoy from HelloSkin.

 

 

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Going to any function when you have psoriasis can often bring on bouts of anxiety. It’s not just thinking about what to wear to cover your skin or whether you feel brave enough to bare your scars. For me it is more about what to put on my skin. Yes, men get these worries too and so many of us choose to ignore or not discuss it because it is not perceived as something men should do. Even if you discuss it with yourself in your head it’s good for you, don’t feel you have to “man up” and just grin and bare it.

As a guest at a wedding later today I have spent what feels likes a month deciding what to wear. Well I knew I was going to wear my best suit, it’s what it’s there for. I have been preparing though. My scalp has been a bit flaky so there’s been some intense treatment to calm that down. I have just purchased a navy blue trilbury too so I have to be flake free. I don’t want anything to show on my hat or the shoulders of my jacket.

Then I had to think about a shirt because I have to think about is my skin irritable, will it be hot. Luckily it seems the weather has gone cooler so I have gone with an Egyptian cotton shirt. It’s soft, not too tight fitting, even though it’s tailored, and it’s thick enough that if warms up a bit I will still be comfortable without a jacket.

What next, ah yes, my legs. These are the worst part of my body. Obviously no shorts today but going back to the suit I will explain why this causes concern. The suit is from Savile Row, the iconic British Street which is home to some of the best tailors in the world. So yes it wasn’t very cheap and as you would expect it is made out of a very good material, material that would not get on well with my greasy ointments. A few months ago this may have cause me a lot of anxiety as my legs were pretty scaly and I would have to seriously consider wearing a different suit.

I have had a bit of luck with how to prepare for the suit though. Firstly, I woke up at 3 am this morning and have struggled to get back to sleep. This is not actually due to my psoriasis, this is more that my head is flooded with thoughts of the new house my wife and I took the keys for yesterday. So exciting times are ahead and the most stressful bit is out of the way. Why is it lucky I woke up so early? Well as I couldn’t sleep I thought I may as well put my Dovobet gel on now as it will have a good number of hours to soak in and work its magic before I need to shower. I have been making sure I keep my treatment regular this week also.

Also recently I have been lucky enough to receive a few gifts in the post recently.  One being a tub of Hydromol ointment. It is the waxy oily kind of ointment and I find this great to slather on before a shower. I wouldn’t put it on before getting dressed as it wouldn’t be comfortable but as something to seal in moisture and protect your skin whilst showering it is perfect. Even washing doesn’t dry your skin out if you put this on.

The other gifts were from Galderma who sent me some of the products from the Cetaphil range. I have been using their Restoraderm Skin Restoring Body Wash and have to say it probably is the best body wash I have used to date. You don’t need a lot, you feel clean and you don’t get that dry tight feeling after you shower. Even without the routine above of coating my body with Hydromol, it still works well.

After this I use something I have been wanting a long time. It is a new product they have called Moisturising Body Mousse. What can I say? It’s brilliant. Again you don’t need a lot to go a long way and it is great if you have a few patches of psoriasis rather than total coverage as you can use this all over. It’s not just your psoriasis patches that need moisturising, you do need this all over and the mousse is excellent. It is really light and soaks in quicker than anything else I have come across. This means you don’t feel like you need to let it soak in for half an hour or so before getting dressed. You can put it on and in seconds feel dry enough to dress.

Also, the mousse isn’t greasy so when you’ve got a fine suit or that special item of clothing you want to wear there is no worry. If you have severe psoriasis thought his really won’t be the product for you. So that’s the suit sorted then. No staining, no stickiness, I can wear my suit and not only look good but feel good.

So that’s how a man chooses both what to put on his skin and what to wear to a wedding. A wedding where the invite is to my wife and I. Psoriasis has not been invited. I might post a pic once we’ve been to he wedding.

For more info on Hydromol please visit http://www.hydromol.co.uk/hydromol/home/ You should be able to find a 500g tub of the ointment is around £8.00 in most chemists.

For information on Galderma ranges including Cetaphil please visit http://www.galderma.co.uk/ Please note that the mousse is a brand new product, it should now be available in most Boots stores. RRP £13.99.

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Following UVB light treatment last summer, which unfortunately only gave me about a month’s clearance, the last 10 months have been all about control of my condition with varying degrees of success. The first few months were fine but then a slight flare up around February this year led to more patches appearing and the fight against flaking starting again.

I went through numerous creams and ointments, trying new things, bathing and so on. Then came the idea to move house (which annoyingly still hasn’t happened yet) so there has been added stress since April. Add in a health scare, which has turned out to an infection of which I am now clear, May and June were particularly stressful.

Some who read the blog will know I tried a new product, Philips BlueControl LED. I had high hopes for this and have to admit defeat. That is not to say that it does not work, it just didn’t work for me, As the name suggests it controls psoriasis and if you add stress and bad health into the equation it could prove not to be as effective as it should be. I did go through a couple of weeks not using my topical steroids whilst using it and my skin got no worse. Effectively it kept my condition stable so this does show that is has some kind of effect.

I do feel I may have been a little unfair to BlueControl as I have quite a few patches, 7 on one side and six on the other side of my body (plus other spots here and there. With each treatment session taking 30 minutes this could mean trying to find up to three and a half hours each day to take the treatment. So this just didn’t fit into my work and home life. It should not discourage others from looking into it and giving it a go though.

So how have I managed to start clearing my skin. Well the stress levels have certainly not dropped. We have not yet moved and are becoming increasingly frustrated with how long everything is taking and I was only given the all clear by the hospital yesterday that there was no serious underlying issue with my health.

My routine has been this:

Shower every day, bath 3-4 times a week. I know, water dries your skin out and people with psoriasis often shy away from showering or bathing too often. When showering I have been washing my hair with Alphosyl 2in1 shampoo and also using it as a body wash on alternate days with Dove deep nourishing body wash. Yes, Dove that you buy off the  shelf and isn’t medicated.

When I bathe I put a drop or two of Alphosyl in the running water along with a good squirt of Aveeno body wash, also using Aveeno to wash with.  Once or twice a week I will also slather on an emollient before getting in the bath. Generally this will be Diprobase or Boots Derma Care moisturising cream, something thick and rich. In the bath I regularly add in a mix of dead sea and Epsom salts.

Once out of the bath I put a light lotion on so I don’t feel too sticky and currently have been using Aveeno moisturising creamy oil as this soaks in really well. After that goes on either Dovobet Gel (Ask for the gel, it’s so much better than the ointment) or Dovonex although usually Dovobet at the moment. Also applying the same in the evening a couple of hours before bed At the weekends I do something that I am not sure is right but it is working. I will put on the cream, then Dovonex and follow this an hour later with Dovobet. It was using the two products in conjunction lie this which really started to make a difference.

Now I am not sure if using a shampoo as a body wash and using two prescribed treatments together is correct or would be approved by my derm. The thing is when nothing else works, we become desperate and from desperation comes invention. This is nothing really harmful in Dovonex and it is not a steroid so I thought, what the hell. I am sure I am not the first psoriasis patient to use treatments in places they are not meant for. Please note though that as I ma not a doctor, I cannot recommend you do the same, I am writing this to make a point. The lack of effective treatments leads to us making or own.

I may as well add for my scalp I am using Betnovate and dab a bit on my fingers to do the inside of my ears. So there you have my current routine. Sounds like a a lot but in the morning I am showered and creamed up in half an hour. I always have a moisturiser and dovonex with me in case I need a top up during the day. The difference it has made is this:

9th May

9th May

The picture about is from the 9th May, you can see flaking and scaling which has been constant up until three weeks ago when I changed to the routine above. Below you can see the same leg is still red but has no flaking or scaling.

26th June

This may not look like a massive change but to a psoriasis patient it means a lot. No flaking means a lot less itching and no itching means restful nights, reduced stress and much less discomfort. I still won’t wear shorts but at least I’m not spending all day scratching, feeling tired or worrying about the pile of flakes I am leaving under my desk at work.

Money saver notes:

You can get this in double packs and my GP found he can then give me two of these on your NHS prescription so you get four bottles instead of the normal two.

Look out for offers in Boots if you want to try the creams I mentioned, they are often on 3 for 2 or other deals. Bulk buy when on offer.

The most cost effective bath salts I’ve found are Westlab, £4.99 for a kilo bag. They also do Himalayan as well as Dead Sea and Epsom. .

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A few of weeks ago I was sent my appointment to see the consultant for my follow up after UVB light treatment last year. After the disappointing consultation previously I decided to cancel this. After years of seeing doctors and follow up appointments after light treatment I knew what the response would be. “Well you’re not severe enough for us to consider anything else so it’s back on topical treatments.

I called to cancel the appointment and followed it up in writing. I explained my reasons, which were the poor treatment, lack of eye contact during consultations, lack of actually examining my skin and total lack of confidence in the consultants at my local hospital. The reply “We confirm cancellation of your appointment”. That was it. Possibly it would be a little cynical of me to think that the same attitude runs through the hospital.

I am glad to say it doesn’t. I have mentioned before that while I was undergoing light therapy the nurses were outstanding. The compassion and empathy they show makes you feel comfortable and at ease. They are remarkably good and getting you to talk about your feelings without you even realising too.

Having had to visit the hospital for a completely unrelated health matter reinforces my view that the poor attitude in Dermatology is not hospital wide. I spent two hours in one outpatients clinic and things ran fairly on time. I had to see a nurse and a consultant separately which was organised extremely well with only a few minutes back in the waiting room between both. There was no rush, lots of explanation and, importantly, eye contact. It may sound silly, eye contact is so important. Would you trust someone who doesn’t even look you in the eye? It restored my faith a little in the hospital and reinforced my decision to cancel the dermatology appointment.

So, what did I do after cancelling? I went back to my GP and we had a chat and after discussing topical treatments we agreed on one batch of a steroid gel to kick my psoriasis in the butt before going back on a mild topical treatment. The side affects of steroid cream cannot be ignored so this will be a one prescription treatment. There is another reason for doing this to calm my skin down, I will be trying a brand new treatment soon which does not use steroids, in fact it doesn’t involve and form of prescribed topical treatment. I am meeting with the company responsible at the end of this week so look out for an update soon.

I should add that I did not have a knee jerk reaction to cancel my appointment. I weighed up the pros and cons and considered if I would be better off going or not. The fact I was due to see the same consultant as before and that even if I asked to see someone else they couldn’t guarantee it on the day it just didn’t seem worth it to me. I do have a GP with a dermatology background which is useful. I don’t want to encourage people to cancel their appointments, please do think about it and consider your options. If nothing else, make sure you cancel in plenty of time so you do not get a bad record.

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Swiss Dermatology company, Galderma, recently launched Calmurid® Pro, a skin care range for people with dry to extremely dry and uncomfortable skin conditions. I was asked if I would like to try the new range and over the last two weeks I have been trying three of the products. Here are my thoughts on this new range.

Calmurid Pro Body Hydrolotion (200ml; RRP £12.99) is developed for normal to dry skin and the easily-absorbed lotion contains 2% Urea to help increase water content in the skin.

The Hydrolotion is what I would consider a light body lotion. I found that the lotion spreads very easily and soaks in really quickly so when they say it is “easily absorbed” they are spot on. As it is a lotion, it is something I’ve found useful for putting on in the morning when I am getting ready for work. It soaks in and your skin feels dry fairly quickly, this means not having to add time to your morning routine. My skin is fairly clear at the moment so this is pretty much perfect for my current needs. It is for normal to dry skin so if your psoriasis is severe this would not be the product for you. At the end of the working day I found my skin was still feeling fairly good and had very little itching during the day.

Calmurid Pro Very Rich Ointment (100ml; RRP £13.99) is suited for targeted treatment of extremely dry skin, including infants. It contains 75% natural almond oil to moisturise and soothe dry and dehydrated skin and can be used daily.

The ointment was the product I was concerned about, The word ointment always makes me think of something sticky and greasy. Of course it is more oily than the lotion, it is for drier and more difficult areas of your skin. However, I would say it is more of a cream than an ointment (I am sure there is some scientific difference between a cream and an ointment). It contains almond oil which is often included in many treatments. I have used this mainly on my knees, ankles and elbows and it has definitely softened those areas. I put it on before using my current topical treatment, Dovonex. It is always a good idea to soften your skin before using a topical treatment. With a high oil content is does leave you feeling a little greasy although not in an irritating way. I do tend to only use this at night though.

Calmurid Pro Moisturising Hand Cream (50ml; RRP £7.99) is ideal for dry and damaged hands and contains a nourishing blend of emollients and vitamin B3 in a light formulation for rapid absorption.

This works very much like the Hydrolotion, it is a thicker cream and soaks in very easily. You certainly do not need a lot as I found out when I first used it. A small spot on each hand is all you should need. I found it was best to apply in the morning and then mid or late afternoon as a top up. I am having a little trouble with my hands lately so drier than normal and this has definitely helped. It doesn’t leave your hands feeling too greasy, very handy for applying just before driving to work so my hands don’t slip on the steering wheel.

All in all this range is definitely worth trying out. It is there to help with dry skin and does not claim to be a cure for psoriasis. As with all your psoriasis treatments you still need to keep your skin moisturised. The range is available at Lloyd’s Pharmacy and you can buy it online, click here to go to the website. At the moment they have reduced the price from the RRPs quoted above.

Click here if you would like to know more about Galderma.

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Winter is Coming

It may be quite clear from the title of this post that I am a Game of Thrones fan. This isn’t going to be a post where I relate psoriasis to The Game of thrones, although it has crossed my mind that I could be Simon of the House Stark fighting the might of the House Psoriasis. Or maybe I am one of the Whitewalkers and the healthcare professionals are the Night’s Watch. The fun I could have making up my own little parody world. I simply used the title to say what it means, winter is coming, and for psoriasis sufferers and others with dry skin conditions this can be the worst time of year. In the past I have been pretty poor at preparing myself for the cold mornings and chilly winter nights. This is the first winter for some time where my skin has been relatively clear to start with so usually I am already in the midst of a routine. This year I have to think about it and for my psoriasis addled brain that is a task I find most tedious. So here are my tips for preparing for winter.

Moisturise. Sounds simple really and it is. Get a good moisturiser to start that protection and do it every day whether you’re going out in the cold or not. For me currently I use a lotion during the day as they’re lighter and soak in better than creams or ointment. At night a good cream moisturiser is a must, build up the protection of your skin before the next day. Aveeno, Boots Derma Care and Epaderm are my usual stock items. Always worth trying something new though so keep and eye out on offers. Avoid anything with added perfume. For added protection, baby oil at night is good, I found Mia Moo do a good baby oil.

Make sure you have a stock of your topical treatment (if using one). It seems there are many supply issues with a lot of the medications lately so make sure you don’t run out. Always important and more so in winter as it is a time when flare ups can attack quickly. I won’t suggest anything here as you need to consult your doctor on the best medication.

Hand cream. Oh I sound so masculine. Make sure you use a good hand cream, your hands are more exposed than most of your body so they need some extra protection. The main one I use is Aveeno hand cream, for me it is the least greasy. I am trying something new at the moment though and will let you know how that goes.

Don’t forget your face. This is an area that I have found difficult to manage in the past, I find a lot of creams leave my face feeling  greasy. For men I would suggest a good after shave balm or moisturiser. I tend to go for L’Oreal or Nivea’s skincare range. Sometimes pricey but the best I have found. Sorry I can’t really suggest anything for the ladies out there.

Have a bath. Firstly your friends and family will thank you for it. Don’t have it too hot as it will just dry your skin and out and you can risk damaging your skin. There are plenty of additives you can put in the bath, sea salts, balneum, oilatum. Not only do they help protect your skin, you can light a few candles, put on some music and relax so it’s quite therapeutic. If you prefer showers, you can wash with most moisturisers, Epaderm is good or you could get yourself a big tub of Diprobase or Boots Derma Care.

As it is coming up to Christmas there are a lot of offers out there so take advantage and stock up. Put some on your Christmas list and get the family to buy you a few bits. They will be presents you will definitely use and save you a lot of money. I would like to say that the ranges I mention above are ones I always have in my cupboard, I am not sponsored by them or asked to promote them, hence no links to their sites. They are simply what I find works and may not be suitable for everyone. Our skin is unique, you are unique so find what works best for you.

If, like me, you have psoriatic arthritis as well then the cold is definitely not our friend. The only advise I can really give for this is wrap up in layers. I find then if I get too warm I can just shed a layer and cool down gently which may even prevent the effect of sudden cooling and heating on your skin. I know this is not so easy if you’re going out to a party, if you look after yourself most of the time then you can have those days where you maybe don’t layer up as much or use as much moisturiser. If you are looking for tips on what to wear, my friend The Flaky Fashionista always has great ideas. So now we’re set for the winter and the party season will soon start so get out there and enjoy yourselves and try not to think about psoriasis too much.

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Anyone that has been following my progress on light therapy may have seen the improvements during the course. Well it has now come to an end, actually it finished just over a week ago. and so here are the results. I have just put the start and finish comparisons on this post. This is after seven weeks of UVA light therapy. How long it will last, I don’t know. All I know is that I am sleeping, not itching and not sore. It is a liberating feeling.


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SONY DSC
SONY DSC

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The marks you can still see are more like shadows of what was there, little reminders as the skin heals. I do still have some patches of dry skin which I keep an eye on and even with skin this clear, I cannot let my guard down. It has been nice to not have to use quite as much sticky ointments and cream as usual though.

Thank you to the nurses at Broomfield Hospital for their care and advice. It has been a difficult seven weeks and I could never have done it without the support of my family, friends, my work colleagues and the nurses. Thank you all.

 

 

 

 

 

 

 

 

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