Back Into Hell

[Fred]

My new Derm has not discussed anything in depth with me at all. I will be back in clinic on the 19th and I want to compile a list of questions. Any input would be appreciated.

1. You have a rubbish Dermatologist, ask to see one who does their job correctly.
   
2. Are you still smoking? it's bad for PPP.
   
3. Reduce the stress and worry, it's bad for PPP.
   
4. I don't see why he thinks methotrexate will be any better if he wants to stop ciclosporin, but it sounds like a protocol thing to me (oh and a rubbish derm)
   
5. You could ask about Fumaderm, I'm not sure if it will work for PPP but you have nothing to loose and it's better for your body than methotrexate or ciclosporin.
   
6. I don't think they will try the Bio treatments as although they can be effective unfortunately they can induce palmoplantar pustulosis as a side effect, so I would imagine that rout would be the very last option.
   
7. Pile it on at your appointment and make it clear that you are not happy, it's ruining your life and you don't feel you are getting the right help. Ask to see another dermatologist for a second opinion, you need to be firm it's your body and it sounds like you are just being fobbed off.
   

Here is a little piece from British Association of Dermatologists about using Bio's

Quote:

---

There are two disabling and difficult-to-treat conditions affecting the hands and feet in which localized pustules are associated with psoriasis elsewhere on the body.

The more common of these, chronic palmoplantar pustulosis, has in the past been termed chronic palmoplantar pustular psoriasis. There is, however, evidence to suggest that, although it is associated with psoriasis in up to about 20% of cases, it is a distinct disease with a different clinical and genetic profile.

This evidence is strengthened by the almost complete lack of reports of benefit from TNF antagonists but, conversely, an increasing number of reports of newonset palmoplantar pustulosis in patients with conditions other than psoriasis treated with these agents.

A recent small pilot study found no benefit over placebo of etanercept 50 mg given twice weekly for 12 weeks. TNF antagonists
should therefore be avoided in these patients.

The second condition is acropustulosis (acrodermatitis continua) of Hallopeau. Although uncommon, acropustulosis can result in considerable morbidity from an intense pustular inflammation centred around the terminal phalanges and often sufficiently severe to destroy the nail plate. It is commonly associated with a destructive arthritis of adjacent joints. It is recognized that patients with acropustulosis are at risk of developing generalized pustular psoriasis.

There are no controlled trials of interventions for acropustulosis. It is frequently unresponsive to conventional systemic antipsoriatic agents. There are now at least 10 case reports of significant benefit from TNF antagonists (etanercept, infliximab and adalimumab) for this rare but disabling condition.

This contrasts with only two reports of failure to respond and, in one of those cases, the patient subsequently responded to a different TNF antagonist. If acropustulosis has a major impact on quality of life, it is therefore reasonable to recommend a trial of one of these agents.

Also cop a read of this: NICE issues new guidance for GPs treating psoriasis

Brighteyes I would say get ready for battle, go in there and give em hell and demand to get your life back.

I wish I was nearer I would come with you, Good luck.