Psoriasis Update-Looks Like I'll be Stopping Treatment Early

[nobhillhepc]

Hi, jmjm530 was on the money!

Well, went to liver doctor today, we only have spoke on the phone since starting treatment, after he saw my psoriasis he said if UV treatment does not help significantly I can go ahead and stop at 16 weeks (currently am on week 14), he then called a colleague, a doctor very involved in Hep C research, they both agreed that because of low viral load at beginning of treatment, cleared in first two weeks and genotype 3 that my odds of SVR are almost the same as going the full 24 weeks.  WHAT A RELIEF! So, the plan is if UV works, might as well go ahead and finish, I have done pretty well on TX with exception of skin condition continuing to deteriorate, but if I can't get some psoriasis relief, I can stop.  I know that there is a slight chance I won't remain clear of virus, and that could happen in either the 16 week or 24 week scenario, but it sure feels great knowing I might be done in a couple weeks!  

Marcus

[nobhillhepc]

Thanks Jim,

I actually have appt. at clinic my liver doctor recommended, its run by a doctor who is the leading psoriasis authority in San Francisco.  They bascially told me that it would take 4-8 weeks to get any real improvement, that there is no quick fix.  I am going full steam ahead with stopping inteferon/ribavarin in two weeks.  I have appointment with new dermatologist on Feb. 28th and I will take it from there, they said there is a good chance I'll need some help to get back to pre-treatment level, I'll keep you thoughts in mind.  Not sure how realistic this is, but if skin gradually improves and itching gradually subsides after stopping treatment I'll probably just let it do its thing and hopefully be cleared up in 2-3 months as you mentioned. I'll keep you posted.  Thanks for your input and experience, much appreciated!

Yes, guttate is what I was told I have from previous dermatologist.  Actually info. above was based on phone conversation with doctor in psoriasis clinic, they of course have to see me in person, determine if I am good candidate for therapy, its the type of UV therapy you mention.  Guess bottom line is they don't have any openings for new patients now and they did not say "come on in now and we can get you feeling better in a couple of days so you can continue interferon" and liver doctors said if they can't snuff the psoriasis right away then stop at week 16 and you still have a 90% chance of SVR.

[jmjm530]

The UVB started to suppress my guttate within two weeks, but apparently that is not the norm, as my doctor was surprised. I only mentioned not extending UVB treatment too far beyond HCV treatment because UVB has its own set of risks not often spelled out for you by the dermatologists. Sound familiar :) Again, my experience (and the opinion of one psoriasis expert) was that the psoriasis will go away within a few months after stopping the tx drugs, UVB or not. The main purpose then of treating psoriasis -- UVB or otherwise -- during treatment is simply to allow you to stay on treatment.

-- Jim

[jmjm530]

Hi Marcus,

Wish I was literally "on the money" -- maybe less time at the gym and more at my desk :)

Anyway, sounds like you have a plan but a few thoughts...

If I remember correctly, you had guttate psoriasis like myself. What seemed to suppress it was UVB Narrow band. Is that what your doc is recommending? UVB is probably fine if they don't offer narrow band in your area but PUVA (psorlen plus UVA) can be liver toxic. You also didn't mention anything about a dermatologist being involved. Last time you mentioned you were switching derms.

If you do go ahead with UVB, try and cover up areas that aren't affected by the guttate as best you can with either a good barrier type sunblock (zinc oxide/titantium dioxide) or a sun block material. This is especially true of your face which probably is not affected. I suggest mutliple layers of towels soaked in cool water to protect not only from the UVB rays but from the heat generated by the  light booth. You probably won't feel much heat in the beginning when exposure is in seconds, but once it gets above 2 minutes it can get quite hot. I attribute some of my rosacea problems to longer exposures in the light booth from the UVB and/or heat.

Lastly, keep in mind that once you stop treating, the guttate should go away on its own in 2-3 months -- therefore you might want to stop your light treatments at that point regardless of how well its working. Psychologically this might be difficult, but UVB does have its risks like any UV exposure, especially to skin sensitized by the tx drugs. I actually tanned quite nicely in the beginning of my treatment and now I have to be extremely careful of the sun. But keep in mind I probably had over six months of UVB treatment.

Hope it all works out,

-- Jim