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Doctors' Answers to "Frequently Asked Questions" - Psoriasis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 11/28/1999]
Question: My Doctor has just put me on Celexa for depression and Lotensin for my blood pressure. I take Celebrex for the arthritis and have tried EVERYTHING for the psoriasis. I see the side effects of this new medication are similar to the Seratone, since I already have Psoriasis, will this medication make me have "flare-ups"? It is super tough to keep this under control, and "flare-ups" can contribute to aggrivation (increasing the blood pressure) and deeper depression. Thanks for your time and concern and please advise.

Answer: I haven't seen any reports of Celexa or Celebrex exacerbating psoriasis. Are you aware of any?

[posted 11/17/1999]
Question: Is Psorasis contagious,can it spread by sharing the same telephone or the food handle by a person with this skin disease?

Answer: Not contagious what so ever.

[posted 11/9/1999]
Question: I am 18 years old and have suffered from psoriasis for approximately 9 years. At the age of 17 i was admitted into hospital and my psoriasis was diagnosed to have covered 70% of my skin. After some intensive treatments icluding those available on the NHS and 'alternative' treatments i was able to keep it under control. However my skin was and is still in a very bad state. I have it very badly on my lower legs and is spreading to my forearms rapidly. It has appeared on my back, stomach and upper legs recently but is very mild at the mitalt. Past experience, since i have had it chronically, has taught me to deal with the situation before it becomes dire. I have read a lot about methotrexate and a doctor on the NHS suggested it to me about 4 years ago. In your opinion what are my chances of getting this drug from a dermatologist and have you any statistics about the side effects and deaths people have suffered while on this medication

Answer: You should respond nicely to this drug and most physicians would allow you to use it, although some would worry about your age. Toxicity is minimal if monitored closely. It is mainly liver toxicity and this can be avoided with regular liver function tests.

[posted 11/6/1999]
Question: I have been taking Lipitor for over a year now. I have been taking a weekly dose of Methotrexate for psoriasis for just over a year. The doctor who prescribed the Methotrexate does a blood text every 3 months to check my liver function. She told me this week that a liver biopsy would not be needed until next spring. However, later that day, her nurse called and said that the liver function was extremely elevated and the biopsy had to be done now. I then saw a commercial on TV about lipitor and it too stated a blood test was needed to keep a check on the liver. My doctor who prescribed it has not ever mentioned this side affect to me nor did a blood test to check it. Is it possible that the two together have caused the liver function to raise and what are the possible outcomes of the biopsy considering the length of time I have gone unchecked?

Answer: Certainly possible, most physicians would stop both drugs and watch the liver functions and biopsy if they didn't return to normal. Since it has been less than three months, there is little likelyhood of permanent damage or fibrosis.

[posted 10/16/1999]
Question: Can you please give me any information on UV light treatment for phoriasis? Is there any in home light treatment available? Thank You. Justin

Answer: This is usually given in a doctor's office to limit dosing since it can cause serious burns if given in excess of your skin's ability to respond. Dermatologists traditionally are the major sites due to the demand. But, an occasional internist will have one. Call the dermatologists in your area. I'm sure one has a UV set up. However, traditional tanning salons will have some effect, will take more treatments, but works.

Psoriasis [posted 11/5/98]
Question: My 9 year old sister and I have psorasis very bad to our scalp. Her's is going so far as going down on to her face. Others have said cod liver oil really help is this true and is it safe for my little sister to take. Thanks for you help.

Answer: Not a great effect, but there are other drugs like methotrexate that may need to be considered in severe psoriasis.

Psoriasis / Melatonin
Question: I had a first outbreak of a severe skin rash on my leg and stomach about 9 months ago. The first doctor I saw diagnosed it as an allergic reaction. The next doctor did tests for fungal and bacterial causes, but determined that it was neither of those. A doctor at my HMO determined that it was probably Psoriasis, but said it looked like there were hives on top of it. It finally spread all over my body and I was given a variety of creams including Seldane, Cyclocort, and Hydroxyzine, at various times. Prior to the first outbreak, I had been taking Melatonin at night to help me sleep. I stopped taking Melatonin shortly after the skin rash outbreak. As of a few weeks ago, the skin rash was completely gone. I started taking 1500 mcg of Melatonin about a week ago to help me sleep. A few days later, the same skin rash that was diagnosed as probably being Psoriasis broke out on my stomach. I am wondering if the rash might be a reaction to the Melatonin? I stopped taking it and the rash is currently contained to my stomach. Is there a source of information on possible reactions to taking Melatonin?

Answer: Mellatonin is usually side effect free. However, the binders and dyes can cause reactions. I would expect this is the cause. I would avoid melatonin after your experience. Unfortunately, there is no data bank available other than the FDA. I would have your doctor file an adverse reaction report to the FDA. They may contact you for follow up in certain cases.

Question: I have recently developed several red spotted areas on my legs and arms. I also have developed a very itchy red rash on my back where I was sunburned mildly. The spots on my legs seemed to be like pimples, but they never went away. The "pustules" would go away, but the red spots would continue, and then some would progress to larger red, scaly areas. I also received minor cuts on my upper leg from a cat scratch. After what is now two or three months, the bruising has gone, but the red, scaly patches are continuing to spread. The spots itch slightly, and then appear to "peel", but they don't go away. I'm not sure that I have psoriasis, but information I have found on the internet seems to point in that direction. Is there anything I can do to slow down the spot development? I have also received information that "strep" throat infections can trigger aggressive T-call development which can lead to some form of psoriasis. I have had multiple strep infections in my life and two bouts in the last year? Is this the cause? The progression of this skin disorder is quite depressing, and unsightly to say the least. For your information, I am a 34 y/o, obese, white female.

Answer: Psoriasis appears to be an inherited disorder. Actually, we really don't know what causes it. It can be activated by any infection, stress, etc. It usually improves with sun light, coal tar applications and topical steroids. Severe cases will require methotrexate. Topical vitamin A has also been used. The patches are always symmetrical, although not identical. They usually appear on the elbows and knees but can appear anywhere. Until you see your dermatologist, you can try topical steroids(available as hydrocortisone cream over the counter). The other possibility is that these are a mild form of fungal infection. These would require antifungals(usually not available OTC).

Question: Is ultra-violet treatment really helpful and is it worth the additional risk of cancer?

Answer: There are several tried and true treatments for psoriasis. These include local coal tar(or equivalent), sunlight(or UV light) and topical steroids. Severe cases necessitate use of methotrexate-- usually once a week. For some reason, the risk of UV doesn't seem as high in psoriasis patients as patients without psoriasis. I'd use UV versus a drug like methotrexate.

Question: I have psoriasis on my scalp and patches on the back, buttocks, legs and, sometimes, the hands and arms. I am using "Capitrol" shampoo. However, it has not been very effective. Is there a better alternative? I am using Fluocinonide gel on the spots. Is this the best treatment? Some of the spots are very persistent.

Answer: Psoriasis has several treatment options. First is local coal tar. This is messy, but it generally helps. Second is sun or UV light. This long term treatment may increase the risk of skin cancer, but it helps. Third is local steroid. This is effective, but can produce systemic problems if used in large doses for long periods of time. Fourth is methotrexate and other systemic drugs. These are reserved for severe cases or with systemic organ involvement (arthritis, etc.).

Question: For a flare-up of psoriasis, I was prescribed Deltasone in a quantity of 8 tablets (5 mg each) the first day, decreased by one each day. Could there be any side effects for taking such a large dose?

Answer: For a short period of time the side effects are minimal. Taking large doses over long periods of time will produce side effects. About the only problem for short term use is that some patients experience difficulty sleeping and there is a possibility of high sugars if you are diabetic.

Vitamin D3 Therapy
Question: Are there any serious side effects when using Vitamin D3 therapy to treat psoriasis. I have tried every thing from coal tar to ultra violet light therapy but the psoriasis keeps returning.

Answer: Actually very few. Your calcium level will need to be checked occasionally and occasionally liver function tests; but, I haven't seen any problems.

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