Newly diagnosed and about to start Acitretin

[Caroline]

The main thing is to stay positive, there is a treatment that will work for you, hopefully it will be the next one...

Yes fumaderm turned my life around and really gave me my confidence back after suffering for most of my adult life. That's why I promote it at every opportunity  

Sounds good to me. 

If it works for you, DMF is really good stuff.
I would go for Skilarence, if I were you. That is a pure version of DMF, Fumaderm has additions that are not useful. Anyway, mention them both.

[JohnB]

I'll chuck my two pennyworth in. Even though Methotrexate gets a bad press on here, dont dismiss it too quickly. It has helped some like Dave.
What I would do is take somebody close with you  - partner, best friend etc with you when you visit your Dermy, it does make a difference if you have somebody in with you. Also really play on how it is affecting your life.

[Turnedlight]

Agreed.
My first flare up with P everywhere including my face put me on mtx, and it did work well for me, for about a year. I stopped because it stopped working.
In lower doses I didn’t really notice any side effects.

My dermatologist didn’t mention fumaderm at all but when I raised it, said I could try it. They seem to steer you away though, maybe it’s because you have to tweak doses and therefore see the patient more often? Not sure really.

[jiml]

Hi turnrdlight I agree they try to steer you away from Fumaderm, my dermatologist said it's because it's unlicensed in this country and they have forms to fill in to get approval, it's far easier to prescribe things approved but NICE. So Skilarence should be easier to get prescribed.

[Kentpatient]

The main thing is to stay positive, there is a treatment that will work for you, hopefully it will be the next one...

Yes fumaderm turned my life around and really gave me my confidence back after suffering for most of my adult life. That's why I promote it at every opportunity  

Sounds good to me. 

If it works for you, DMF is really good stuff.
I would go for Skilarence, if I were you. That is a pure version of DMF, Fumaderm has additions that are not useful. Anyway, mention them both.

Will do thank you

[Kentpatient]

Agreed.
My first flare up with P everywhere including my face put me on mtx, and it did work well for me, for about a year. I stopped because it stopped working.
In lower doses I didn’t really notice any side effects.

My dermatologist didn’t mention fumaderm at all but when I raised it, said I could try it. They seem to steer you away though, maybe it’s because you have to tweak doses and therefore see the patient more often? Not sure really.

I will ask about all the alternatives to make an informed decision (if they are prepared to offer anything else other mtx. Thank you

[Kentpatient]

I'll chuck my two pennyworth in. Even though Methotrexate gets a bad press on here, dont dismiss it too quickly. It has helped some like Dave.
What I would do is take somebody close with you  - partner, best friend etc with you when you visit your Dermy, it does make a difference if you have somebody in with you. Also really play on how it is affecting your life.

Yes good thinking. Last time the dermatologist saw my face he seemed pretty convinced my quality of life was impacted. My arms and legs are in a bad way now. I will definitely emphasise how badly it is affecting me.

[Kentpatient]

Hello everyone and thanks for your advice. 
I saw the dermatologist yesterday. Of course my skin was looking calmer again by the time of the appointment although it has noticeably spread in coverage. The dermatologist said that I have 'acute unstable psoriasis' but didn't give me a type of psoriasis like plaque and said it was atypical. He also told me that the reason I have felt so ill and shivery is my skin temperature trying to regulate itself which is what Turnedlight mentioned. He thinks my psoriasis is on an increasing trajectory currently so the Acitretin is more working to contain it rather than dramatically improve it. He also said I may well not get clearance but just a level I can manage which was disheartening. 
Because of some improvement on my face and hands he said stick with Acitretin for another two weeks at least when we could consider a higher dose. Then he said methotrexate would be the next step. I asked about fumarates and he said he didn't have much experience with them. I said I wasn't tkeen on methotrexate and he said in low doses it could be OK. He mentioned another new drug I didn't write down or 'biolologics' as things to consider in the future . 
He also said go on holiday and relax. Just like all of you ?

[Caroline]

Morning KP,

Main line is I think that this reaction was to be expected of a dermatologist who believes in his own treatment. He “thinks” that the Acetretin is trying to contain it, so he is not sure about that. Amazing on that point is that he would try to increase the dose.
Well I don’t think you currently have another option then to continue for another two weeks. Perhaps you could make a diary for yourself in which you write every day, by the end of the day, what you have thought about your condition of the day. This can give you a handle to speak with the doc.

I don’t want to say anything about MTX, I hate it myself, I have used it and I will never use it again.

On the fumarates, there he has a way to easy attitude. "I don’t have experience with that." So he won’t prescribe it. To my opinion that is a stupid attitude. He is a doctor, he should educate himself, there are piles and piles of information on DMF, the past 35 years have delivered a lot of reseach. Over here in the Netherlands the trend is that DMF is slowly getting to be the preferred starting treatment for Psoriasis. That does mean something. Every dermatologist knows about it (the rheumatologists still don’t ).
I wonder if he also has this attitude towards the ever expanding biologicals.
You have to consider for yourself if you are satisfied with a doctor like that.

I know that what I wrote above is not really positive to be reading, I'm sorry for that, but that is what I feel when I read your post.
To turn to a good direction anyway, is to tell you that there will be something available finally that will work for you, but it may take a bit of time to find it.  

In the mean time... yes, go on holidays and relax. Take some extra vitamine D with you and try to get in the sun regularly.

[Kentpatient]

Morning KP,

Main line is I think that this reaction was to be expected of a dermatologist who believes in his own treatment. He “thinks” that the Acetretin is trying to contain it, so he is not sure about that. Amazing on that point is that he would try to increase the dose.
Well I don’t think you currently have another option then to continue for another two weeks. Perhaps you could make a diary for yourself in which you write every day, by the end of the day, what you have thought about your condition of the day. This can give you a handle to speak with the doc.

I don’t want to say anything about MTX, I hate it myself, I have used it and I will never use it again.  

On the fumarates, there he has a way to easy attitude. "I don’t have experience with that." So he won’t prescribe it. To my opinion that is a stupid attitude. He is a doctor, he should educate himself, there are piles and piles of information on DMF, the past 35 years have delivered a lot of reseach. Over here in the Netherlands the trend is that DMF is slowly getting to be the preferred starting treatment for Psoriasis. That does mean something. Every dermatologist knows about it (the rheumatologists still don’t ).
I wonder if he also has this attitude towards the ever expanding biologicals.
You have to consider for yourself if you are satisfied with a doctor like that.

I know that what I wrote above is not really positive to be reading, I'm sorry for that, but that is what I feel when I read your post.
To turn to a good direction anyway, is to tell you that there will be something available finally that will work for you, but it may take a bit of time to find it.  

In the mean time... yes, go on holidays and relax. Take some extra vitamine D with you and try to get in the sun regularly.

Hello Caroline
Thanks for your response. I was disappointed that he was not more familiar with all the options because it seems to limit mine. I think he's quite old fashioned but he's not inexperienced or uncaring and he does have a good CV (I have checked out his different roles and he's worked at some good places).  I am going to give Acitretin a chance and get some (carefully controlled) sun and relax. Then I will think about what else I can do. The psoriasis just keeps erupting in new places as one place slightly improves. It's all new to me and I don't know what to expect. I have started a diary to note everything down. 
I realise there's no cure but I want to believe my psoriasis will clear at least from my face and forearms so I can feel less self conscious.