Stopping Treatment Early and Horrible Psoriasis

[nobhillhepc]

Hi, I started combination therapy about 13 weeks ago, I am genotype 3 and have had Hep C for about 23 years.  I was an F2 with low viral load of 213,000, AST was twice as high as normal, ALT was approx. 3 times higher than normal.  I cleared the virus during the first two weeks of treatment and liver enzymes returned to normal shortly after, with the exception of low white blood cells, blood work all looks good.  I have read about studies of types 2 and 3 who cleared virus very rapidly and had low viral levels, which indicate that 12-16 weeks of treatment is sufficient and more or less has the same rate of SVR. Because of a horrible case of guttate psoriasis, which continues to get worse, despite all types of prescriptions from the dermatologist, oatmeal baths, etc., at times wonder if I can maintain sanity for another 3 months of treatment.  I continue to work full time, which I think will be changing soon, I have been able to deal with other sypmtoms, fatigue, depression, etc., but this psoriasis thing is a bit much!  Does anybody out there have any insight about dealing with psoriasis on treatment or have any knowlege of the studies about stopping treatment early for genotypes 2 & 3 that are rapid responders to interferon/ribavarin?  Thanks!

[copyman]

jmjm530 is the expert on this and he will give you some great advice. i hope things get better for you, it would be a shame to see you stop early. good luck

[jmjm530]

I suffered from plaque, guttate and plantar pustular psoriasis from around week 14 until the end of treatment at week 54 and then for another three months post treatment. The only thing that seemed to repress -- not cure -- the guttate was UVB Narrow light treatments, 3X a week. In addition to UVB narrow band, I also soaked nightly in OTC Balnetar Bath oil which was recommended by one dermatologist.
Link to Balnetar:  http://tinyurl.com/ylahy2

Have you had any recent viral/bacterial infections, especially in your throat, ears, sinuses? As you may know, guttate psoriasis is also associated with strep and similar infections. My derm was quite vehement that antibioitics would not help after the fact, but when I started taking antibioitics for my sinus and prostate infections, I noticed my guttate got somewhat better. Coincidence, I'm really not sure.

As to topicals, be careful you're under the direct care of a derm because you don't want to use too high a strength steroid for too long. You definitely don't want to use any steroid on your face for longer than a couple of weeks and even then only under a doctor's supervision. With UVB Narrow Band I was able to keep the guttate under control to a certain degree without using any topicals.

The one thing you should be cautioned about regarding UVB Narrow -- and I never was -- is the possiblity that the light treatment - or possibly the heat from the light chamber -- could trigger another skin condition called Rosacea. So, if you do go this route, make sure you cover over any area not affected with cold wet towels or similar so the heat and UVB rayw will not get through. Especially for your face and also chest and other sensitive areas not covered with the guttate. In my case, I had guttate covering my arms, back, buttocks and sides but not on face and little on legs and chest.

Depending on how agressive you want to fight the guttate, there are also systemics which can be used if it's between that or going off of treatment. The downside with the systemics can be liver toxicity. There's also a new class of drugs -- one being Enbrel -- that has shown promise with guttate -- however Enbrel is also an immonsuppresive (like the Peg) so I was told to hold this back as a last resort since it might interact with the Peg in some unknown way in terms of SVR.

You have my total sympathy, especially having to hold down a job with the guttate. Because of my skin and other problems, I was home most of the time and still barely got through some of the days.

Def discuss UVB narrow with a a good derm. If you're not seeing a derm, go see one.

Hope it all works out.

-- Jim

[copyman]

wow jim! never knew you suffered 30 weeks with the skin problems. more power to you brother.

[jmjm530]

Regarding stopping early. A couple of studies suggested similar SVR results for either 12 or 16 weeks versus 24 weeks for those who were non detectible by week 4. (12 weeks for Peg Intron, 16 weeks for Pegasys)

A later and larger study suggested that 24 weeks showed better results than the shorter courses, but I believe the shorter course group still had an SVR rate of around 80 per cent. The study therefore concluded that while the optium tx length for geno 2's and 3's was 24 weeks -- the shorter course is a very good option for those experiencing significant side effects -- which definitely would be someone like you.

If it were me -- especially knowing what I know about where this skin stuff can go (I still have skin problems such as rosacea 10 months post treatment) -- and I had little or no liver damge, I'd definitely do short course in your shoes and take my chances with SVR. 80 per cent ain't all that bad but maybe someone can pull up the study for an exact number. Once you stop the peg, within 2-3 months (maybe sooner) your skin hopefully will be back to normal. On the other hand if you have significant liver damage the decision wouldn't be so easy.

-- Jim

[jmjm530]

Actually that would be 40 weeks with the psoriasis stuff and then another four bad months post tx with the rosacea and things still ain't normal yet. Did I mention I had plantar pustular on my feet so bad (also 40 weeks) I couldn't wear shoes some days? There's a reason(s) I don't suggest treating unless you have significant liver damage. In part it's called my personal experience.

Be well,

-- Jim

[nobhillhepc]

Hi Jim, I have not had any other infections, I have had a very mild case of psoriasis for years, but after a few weeks of treatment it got worse, and worse... My dermatologist asked me the same question, but I almost never get sick, its been a couple years since I have had a cold, last sore throat was about 5 years ago.  I am seeing dermatologist, but currently looking for a new one, liked the one I was seeing, but turned out he was not in the network with PPO, so I'll hopefully find one with direct experience with treatment-related psoriasis, called one who thought interferon would make psoriasis get better!  Go figure.  Luckily my face has been for the most part spared from skin stuff so I rarely use anything on my face, but its the only place (palms of hands and bottom of feet have been spared too), I share your concerns about taking anything systemic and also with UVB treament, there really is not an area left besides face that does not have guttate, did yours hurt?  Mine either REALLY itches or feels like a burn, can be quite painful at times. Oh I forgot to say that I take Atarax, an antihistimine, that seems to help take the itch away.  From some internet research I think the very mild case of psoriasis I had prior to treatment could have been associated with the Hep C, my hope is that after ending treatment all of it will eventually go away, not sure if that is realistic or not, but its my hope. I'll deal with this and get through it, I think I might use up my sick days and vacation days at work to take the next 12 Fridays off, to give me 3 day weekends for the remainder of treatment, maybe try that first, but going on disability might be necessary, I will take that one day at a time.  Did you clear after treatment? How is your skin these days?  Boy, my heart really goes out to type 1's and all others who have to deal with this for one year or more.  I remind myself constantly I could be dealing with this for 9 more months instead of 3 more and also lots of people have the skin stuff on top of a whole other set of hard to deal with side effects.

I notice depression is setting in as treatment progresses, but wonder if antidepressants might not be worth the trouble, my understanding is that it can take a while for them to kick in, find out dose that works, and at times some people have to try more than one to find out which one works for them, with only 11 shots to go, I just figure it will be almost over with by then, so I just deal with that.

Marcus

[genedog]

i had the samething for have Dr give you kenalog cream only thing that helps

[jmjm530]

Forget about the derm who said interferon might make the psoriasis better. In fact, why don't you report him to the AMA LOL. Don't discount the UVB Narrow Band (different from UVB normal) just be careful as noted. It did help repress it some. Yes, mine itched and was painful at times. The UVB and Balnetar helped some. Also, try wearing all cotton next to your skin, white if possible. Another way to go is to wear long silk underwear under whatever else you are wearing. Synthetics and wools can be very irritating to inflamed skin. Use mild, non pefumed detergents or soaps, double rinse everything and change undergarments as much as possible -- I would go through 2-3 pair of white cotton socks a day. I also had very mild psoriasis pre-tx -- on face where I shave. That part has gotten better after tx but then I got some psoriasis in new areas on face so it's a wash. Also developed rosacea near the end of tx and still have problems with it. Not sure if it was from the UVB treatments, the peg or both. The rosacea I have now is much worse than the psoriasis I had prior to treating. Like I say, if I were you I'd think twice about going the full course unless you are prepared for the possiblity of more and longer lasting skin issues. It's not an easy decision.

-- Jim

[nobhillhepc]

I do go back and forth about stopping treatment early, I was stage 2 fibrosis, and I think stage 3 inflammation, and I would certainly NOT want to stop early if it meant I would have to start all over again at a later date, I have an appointment with my liver doctor on Jan. 22nd, I have decided I will bring these studies up to him and if he thinks, because of rapid response, genotype, low viral load at start of treatment, my chance of SVR is about the same, I might stop early, but only if he is on board, my guess is that he'll say do the 24 weeks, and I'll say "okay", I am going to go with his judgment unless the side effects go from the present state of "miserable" to "I just can't do it anymore", it is difficult for us with Hep C to weigh the pros and cons of treatment, my doctor says he feels extremely confident this will be a part of my past in the near future, that's what keeps me going day to day.  

Marcus

[nobhillhepc]

Thanks all for suggestions on skin, I'll print this out when I get to work tomorrow and go over all this and make to-do list and a shopping list,
Marcus

[aquarius64]

sorry to hear about your tx sx s**king. hope things improve for you!

[nobhillhepc]

Thanks Aquarius64!  I'll get through this, hopefully your treatment is going, went well,
Marcus

[LindyK]

I am also a Geno 3 doing 24 weeks.  A study that came out of the Boston Conference last October suggested that you have a better chance of SVR if you treat > 17 weeks.  Maybe you could make it to week 17 or 18 and then stop if you needed to.  Talk to your doc about that possibility.  I will send you the link to the study if you want - just let me know.

Linda

[Cindy10]

I really don't know about this, but just wanted to wish you well with this issue. Have had skin issues before and their not fun on a good day. Hang in there!

[nobhillhepc]

Cindy, thanks for encouragement, I'll get through this!

Linda, link would be appreciated, how are you doing on treatment?  Responding quickly I hope.  The last few hours I have been telling myself I'll hang in there until 20 weeks, we'll see what happens, have to admit my nerves are shot, not sure if anybody has seen one of those nature films that show the animals in Alaska running around going crazy in the summer when the mosquitos are biting and swarming, I have to admit I can totally relate!

[l-horn]

I too have developed some pretty bad skin problems but for some reason it has been on my arms and there is a 6 inch 'band' around my neck. I'm in week 20. This started pretty early, around week 8.
Fortunately I don't have anything on my face breaking out.

I've been washing the areas a couple of times a day then pouring hydrogen peroxide on it, which seems to help. This is not something the dr. ordered so I'm not recommending it per se. Whenever I talk to my liver doc about my skin he always says, 'lotion' and leaves it at that. I think I'm gonna have to go to a derm if it gets any worse. It kinda looks like it's turning into scar tissue.


Also, my injection site reactions no longer appear to be clearing up after a couple of weeks as the first few did which also kinda freaks me out. Like I said, time to see a good dermatologist.

[nobhillhepc]

Good Morning I-Horn, I agree 100% that you should see a dermatologist, hopefully your skin stuff is not too uncomfortable, but see a specialist as soon as possible, I am now also taking flax seed oil, have heard the Omega 3's are real good for psoriasis, made it to work, feeling okay so far this morning, slept through the entire night, did not wake up itching, first time in a while this has happened! Woo-Hoo!

[LindyK]

Here is the link I posted about earlier.  I am doing well with tx (8/24).  Guess I am one of the luckier people - minimal sx.
Hope things get better for you.  I'll keep you in my prayers


http://www.clinicaloptions.com/Hepatitis/Conference%
20Coverage/Boston%202006/Capsules/342.aspx?Track=HCV%20Treatment

Cumulative Exposure to Peginterferon Alfa-2a and Ribavirin Predictive of SVR in Patients With HCV Genotype 2 or 3
Posting Date: October 30, 2006
Shiffman M, Pappas S, Greenbloom S, et al.

[nobhillhepc]

Thanks so much for link, I'll check this out, wishing you continued success on treatment,
Marcus