A new chapter dictated by my skin – Psoriasis

I normally love winter, but this winter in Brisbane has been particular bone chilling. Over the last weekend, the mercury has dropped down to 3-4ºC and I’ve resorted to hacking my handmade quilt, cheap $25 Ikea coffee table and trusty heater into a makeshift kontatsu. A kontatsu is a low-set Japanese table with a blanket and table top over the top – its genius is in the heat source underneath. You slip your legs under the futon and keep yourself toasty warm in winter without warming the rest of the room.

But winter comes with its downside for me. Every winter, the skin on my right index finger becomes extremely dry and cracks painfully on the side. My elbows too have dry skin. I always attributed it to just the dry air and simply moisturised it as best I can through the season, and wear rubber gloves if I’m doing the dishes. I have now learnt I was wrong – I have psoriasis.

I recently had to take prednisone, which is an oral immunosuppressant drug and wasn’t very good about the weaning off schedule. What happened afterwards shocked me.

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These are psoriasis lesions. The ones on my face began as pimples. Injury to the skin can cause lesions for many psoriasis sufferers. I also always had ‘dandruff’ in certain areas (generally the left back of my head) and it’s now turned into lesions, that are spreading into other areas of my scalp.

Now I must add that I have had prednisone before and weaned off the drug without any issues in the past. But perhaps my body has finally caved from the additional stress of increased work responsibilities of two jobs, joining the EDB 2014 committee and trying to conceive.

 

How do I know I have psoriasis?

Because my younger sister has had it since she was 16 years old and I recognise its characteristics. Psoriasis has a genetic component, so having one sibling with psoriasis puts my risk factor at 24%. Of course my sister and I would’ve gotten it from one of our parents, but neither manifested psoriasis like either of us.

The dermatologist also took a biopsy from my scalp (ie. cut a 3mm chunk of my skin and stitched me up) and the results indicate I have psoriasis AND dermatitis.

 

What’s so bad about psoriasis?

Psoriasis is an autoimmune disease and like most autoimmune diseases, there is no cure.

Other than the fact it’s on my face and is putting a HUGE damper on my self-confidence, it itches like a mofo. Imagine an insect bite anywhere on your body. Now increase the affected area of itching to the entirety of your elbows, your scalp and face. In the daytime, I can control myself from scratching too much, but I have woken up in the morning to find blood under all my nails and my scalp feeling raw. This increases risks of infection and aggravating the psoriasis further.

 

So what am I trying to do about it?

UVB treatments

I visited Westside Dermatology in Taringa, which is also home to the Psoriasis Institute here in Brisbane. After speaking to the nurse specialising in psoriasis, we agreed I should start UVB treatment immediately as topical steroid creams are not advisable as long as we’re trying to get pregnant.

Thus far I have had 6 UVB treatments at increasing doses (duration less than 1 minute), but there were no visible difference. This is expected as most psoriasis sufferers reported changes after an average of 20 treatments. Thankfully the psoriasis treatments at Westside Dermatology are bulk billed.

However I have stopped this treatment, as the majority of the lesions are on my face and scalp. The treatments were subjecting my entire body to UVB, which is not very effective.

Cost: AUD$25 for initial consult and first UVB treatment (with referral)

 

Advantan Fatty Ointment

This is a prescription corticoid topical cream. It is generally used for a short period of time on body areas to bring the skin inflammation under control. I started with rubbing the tiniest amount into the lesions twice a day everyday and it has helped to reduce the inflammation and I can now reduce it to once every other day.

Cost: AUD$9.99 

 

Diprosone Lotion

This is also a prescription corticoid topical lotion that I’m supposed to apply to my scalp psoriasis, but the watery formulation stings like a mofo when the lesions are particularly raw and inflamed. The dermatologist has me using the Advantan Fatty Ointment on my scalp lesions until they’re better enough for me to use the lotion.
Cost: AUD$19.99 for 30ml

 

Clipping my nails short

To stop myself from causing my skin too much damage while I’m asleep. I thankfully don’t have fingernail pitting, another psoriasis characteristic and don’t mind having short nails.

Cost: 5 minutes every 2 weeks

 

Moo Goo Eczema & Psoriasis Cream

This is one of the first products I bought from the chemist and it has provided quite a bit of relief from the itching. This white cream is what I apply on all my lesions to reduce the itching twice a day – right after a shower and in the evening. I also keep a tube of it on my desk at work to apply if I feel an itch coming on. The SO helps me apply it to the scalp with a q-tip.

Cost: AUD$18.95 for 120g tube

 

Organic coconut oil

I picked a small sample of this up at my local organic store on the recommendation from one of the staff. After applying this once to my scalp, I didn’t like it. I found the consistency of the oil thicker and harder to wash out. It also didn’t relieve the itching as much as the hemp oil has (see below).

Cost: AUD$2 for 20ml

 

Organic hemp oil

After watching this video by a girl suffering from sebopsoriasis, I thought I might give her treatment a go for my own scalp. I ordered a 500ml bottle of organic hemp oil from Hemp Foods Australia via their webstore. They are south of the border in Bangalow and it only took them a day to ship it out to me. It’s a pain they don’t ship to a PO box, but otherwise service was great and the shipment packed really well.

I apply half a tablespoon’s worth of warmed hemp oil to my scalp and left it in there overnight, sleeping on a doubled-over towel over my pillow and then washing it out in the morning (see below).

The first time I did this, there was instant relief from the itching and I was able to watch an hour of telly before bed without scratching. I still scratched in my sleep. Two days later, I did the treatment again. There was the same instant relief and I was able to sleep well, waking up in the morning with no blood under my fingernails – proof I didn’t scratch myself raw in my sleep.

Has it reduced or removed the scaling? No/not yet, but the scales have been easier to remove with a comb and I find myself scratching less , which is in itself an improvement.

Cost: AUD$$29.95 + delivery ($9.90)

 

Dr Bronner’s Organic Liquid Castile Soap (Baby Mild Unscented)

This is another product the video mentioned: Dr Bronner Organic Liquid Castile Soap (Baby Mild Unscented). I mix half a teaspoon of liquid soap to half a cup of water in a plastic cup, and apply it to my wet hair. If I am trying to wash out the hemp oil treatment from the night before, I usually do at least 2 washes to get the stuff out and prevent my hair from looking like a grease bomb. The soap can also be used for other things and there’s an awesome dilution cheat sheet available.

I’m really enjoying this product. It does the job of removing the oil treatments out of my hair without stripping it completely. While it doesn’t lather as much as commercially available shampoos, it doesn’t sting my scalp’s sore raw spots upon application. My hair feels soft and doesn’t have that uncontrollable frizz I usually get after washing. I definitely want to keep going with this product to see if it helps in the long run.

Cost: AUD$9 for 237ml bottle

 

Bragg Organic Apple Cider Vinegar

I have used apple cider vinegar in the past to rinse product buildup in my hair, with good results, so I was quite happy to incorporate this into my scalp and hair routine. Bragg’s Organic Apple Cider Vinegar is unfiltered, unheated, unpasteurized and 5% acidity – it’s about as unprocessed as you’d probably get a vinegar. It also contains the mother, such is the orangey-brown stuff that collects at the bottom of the bottle. Those are naturally occurring enzymes. I’m not particularly crazy about the American Christian propaganda on the labelling, but it’s one of the best ones on the market.

Cost: Forgot how much I paid for this one.

 

Glycerine

According to the psoriasis forums, this one has had mixed results. However it’s extremely inexpensive and since I already had a bottle of it in our bathroom cabinet, I figured I might use it on one of my elbows to see how it takes.
I dip the tip of my index finger to pick up the glycerine and rub it into my elbow. It soaks in immediately and while it makes my skin slightly tacky, it’s not sticky and there isn’t any residue left to wipe off. I do this immediately after my shower and then apply the Moo Goo Eczema & Psoriasis Cream on both elbows as normal.

Thus far there has been noticeable improvement in the skin on the glycerine elbow. The lesions are less red and not as raised. The scaling is improving (but not gone) and I find I do not need to apply more Moo Goo Eczema & Psoriasis Cream during the day as I do with the other elbow.

Cost: A couple of bucks? It’s been too long ago.

 

Fish oil

The nurse at the Psoriasis Institute recommended I take daily supplements of fish oil. It’s known to reduce inflammation in the body and given I’m not consuming as much fish in my diet as I used to in Singapore, I figured it wouldn’t hurt to put more omega 3 into my body. Fish oil is widely available to chemists at varying dosages, so I am taking 1 capsule per day.

Blackmores Omega Daily

Cost: AUD$39.99 for 200 capsules

 

Vitamin D3

Vitamin D is a potent immune modulator, making it very important for the prevention of autoimmune diseases, like MS and inflammatory bowel disease. Although I live in sunny Australia, I have been tested with a Vitamin D deficiency, especially in winter. This is apparently quite common. Appropriate sun exposure is the best way to optimize your vitamin D levels, but when you’re more susceptible to skin cancer (as we are in Australia) and . The recommended dosage for adults is 1,500 to 2,000 IUs per day. I’m taking 1 capsule per day.
Healthy Care Vitamin D3
Cost: AUD$14.00 for 250 capsules

 

Vitamin E

Vitamin E is found in many foods including vegetable oils, cereals, meat, poultry, eggs, fruits, vegetables, and wheat germ oil. It is more popularly used to treat and prevent diseases of the heart and blood vessels including hardening of the arteries, heart attack, chest pain, leg pain due to blocked arteries, and high blood pressure.

Some people have reported improvements with their psoriasis after taking Vitamin E supplements, so I’m taking 1 capsule per day.
Healthy Care Vitamin E

Cost: AUD$21.99 for 200 capsules

 

Dermablend

I’m not particularly vain, but people have asked me what’s up with my face since the lesions appeared (someone asked if I had burned my face). Thankfully the lesions on my face are mostly flat and don’t scale too badly, so I can minimise their appearance by camouflaging their redness with concealer. Dermablend is available in some pharmacies and I picked up the Dermablend Cover Crème in warm beige.

I follow the instructions by scraping a small amount of the Dermablend onto the back of my hand, rubbing it with my index finger to warm the product before patting it onto the lesions and blending it with the rest of my skin. A neutral setting powder is dusted over the areas and I can get through most of the work day without worrying about too many people staring at my face. I’m still learning how to apply it well. Practice makes perfect.

Cost: AUD$56.95 for 28g tub

 

Reducing stress

Unfortunately the additional commitments to manage the psoriasis now takes precedence and I’m the only one who can decide how best to move forward. After the diagnosis, I had to have a very long hard think about how to do that and I repeatedly came back to needing to reduce the stress I put myself in.

My word is always my bond, so when I decided to leave the EDB 2014 committee, I was heartbroken. The committee are a great bunch of people and have been great friends, who have been extremely understanding about my situation and condition.

I also took a week off work to recuperate from 3 days of no-sleep. Sleep has never been an issue for me, but the itching drove me insane and I thought I was going to die. My team at work were so kind and supportive, making sure I got back on my feet when I felt physically ready to tackle my usual workload.

Cost: My pride

Read about my psoriasis one year later.