Tx and Psoriasis

Hi,

I was diagnosed with Gen1Hep C about 4 years ago. Liver biopsy showed no damage. Hepatologist said since I have psoriasis that treatment was pretty much out of the question. My load is "moderate" according to the doctor. I am 61 and reasonably healthy but suffer the common symptoms from Hep. Is there any treatment alternatives in this situation. Thanks.

[jmjm530]

Yes, pre-existing psoriasis will inevitably flare -- sometimes dramatically so-- with interferon treatments. That was the case with me. Extremely mild psoriasis pre treatment, `whi`ch t`u`r`ne`d into` o`ver half my body being covered with either plaque, plantar pust`ular, o`r g`u`t`tate psoriasis on treatment. That does not mean you cannot treat, but ``with` n`o `l`iv`er ``damage,` def a consideration. ~I'`ll` try `and po`st `m`or`e `at a l`ater dat`e but having some obv`i`ous computer problems.

-- Jim

[jmjm530]

``````````spec`if`i`c `t`o y`o`ur `qu`e`st`ion` -`-` curr`en`t`ly no treatment alternatives that do not use interf`eron` --` b`ut `mayb`e i`n the f`utu`re `-- `5`-`10`` y`ear`s. ``````that said, `sho`r`t`er t`r`eatment `p`r`o`t`o`col`s ar`e in tr`i`al `n`ow. ```````My` psoriasis didnt hit hard until after week `1`2 `and maybe tx may get d`own to `1`2 weeks when they start combining tsome of the newer drugs. `b`ut not y`et.

[1percentfree]

Thanks. I figured that to be so. I have had psoriasis since late teens and has been bad at times. A flare up would be pretty tough.

[jmjm530]

~It `will flare. ~A ``sy``st`emi`c `or biologic may `conteract the flare. So, in the end,you will have to weigh one against the other. If youve had hep c for a long time -- and espif yourre female -- and you still have zero damage -- then, you may be one of those lucky ones who` will never progress to much damage even withouth treatment. But whatever you do, keep monitoring your liver. A new n`on-`evasive device called Fibroscan hopefully will be avail soon.

[alagirl]

Jim, did your doctor ever try etanercept (sp?) for your psoriasis?  Supposedly it's good both because if you aren't treating, its a med that doesn't (ostensibly) damage the liver, and if you are txing, it helps with the psoriasis.  Just wondering if you tried it because a lot of these meds that sound good in theory are just that - good in theory.  Supposedly it can also be used for RA, which makes me kind of interested in it, because I am having symptoms which I think are related to either the virus itself or to the tx.  Probably the virus though, or at least a combination since much of the joint pain was happening during the acute phase prior to tx, it's just gotten worse in my hands in the past week.  Never had to deal with psoriasis though.  I feel for both of you.  I've had good friends with it and it has been very difficult for them at times.  Life altering in many ways.

[jmjm530]

Interesting that you mentioned the biologic Etanercept (Enbrel).

My first treatment derm-from-hell (most of them are) actually suggested Enbrel after my first major outbreak of guttate, inverse and plantar pustular psoriasis -- which all seemed to start within a week of each other. For a number of reasons I declined, but primarily because I wanted to try UVB Narrow Band first and in any event you couldn't talk to this guy anyway and his distain for patients (or maybe it was just me) was quite apparent. I may have made a mistake in not taking the Enbrel injections, but that's history.

Later, I did research Enbrel out, and like you say, it appears to be liver friendly as systemics go. In fact, there was an old study that tried to prove that Enbrel actually facilitated SVR, but no follow-up on the study, so I guess it fizzled for one reason or another.

As stated, I went another route with my psoriasis, but around mid-way in treatment I had a consultation with a well-known hepatologist who was very familiar with Enbrel -- my hepatologist didn't have much of an opinion on it one way or another. What the second fellow said was in essence don't rock your RVR (rapid viral response) boat unless you really need to.

What he meant was the Enbrel, as interferon, is an immunosuppresive, and not enough studies have been done on how one immunosuppresive might react with another. So his advice -- since at the time I was doing very well in terms of viral response -- was to only use Enbrel if the psoriaisis started to threaten me continuing treatment. So I continued on with UVB Narrow, Ximer Laser, topicals and suffereing.

Sometimes I think I could have made my life a lot eaiser on treatment if I did the Enbrel, but of course that is just speculation.

-- Jim

[alagirl]

it just seems interesting to me.  Right now for me, I can live with any pain I have by using either otc medication or prescription pain meds.  So its not necessary for me to try a drug like that.  However, I think that if I did and at the same time I was in a situation with my liver where I either needed to treat, or was in my current situation where I only had one chance to hit this treatment window while acute, I would probably try it if there were no good alternatives.  I've read some pretty decent things about it both when used alone by hepc patients who need this type of med and don't want to damage their liver or use anything that might help the virus replicate, and when used by hepc patients with psoriasis who are doing the combo treatment.  I think its pretty new though that its been successfully used like this.  Don't know.

And Right? What is UP with the dermatologists?  Mine is pretty cocky too.  

[jmjm530]

Don't get me started about dermatologists, but I have a feeling that most of them -- the men at least -- were the ones in the back of the gym class in grade school who always got picked last to play on the team. Now is revenge time and they do that bit very well :)
You don't see anyone on Grey's Anatomy trying to get into a derm fellowship, do you ?

Anyway. my shrink's take (ex shrink that is for now) is that dermatology is a very subjecti ve branch of medicine and they don't agree among themselves on much, at their meetings for example. So, if they say, use this or that creme -- they don't really want the patient asking "why" because the "why" is that they say use that creme.

That said, if you go to enough of them -- the good ones (or at least the well schooled ones) -- you do pick up some good stuff here and there, and I finally did and now have a pretty good tx regimen for my post tx psoriasis, seb derm and rosacea issues. So like women. Gotta love 'em. Gotta hate em. But gotta go to them, especially when treating.

-- Jim

[alagirl]

because the "why" is that they say use that creme.
------------------------------

The old, "because I said so." LOL

Grey's Anatomy.  You are too funny.  Actually, yeah.  I may have to go if this ulcer on my leg doesn't clear up.  And here I'd successfully managed to steer clear of my dermatologist for three years...  No way I could go through tx without the shrink.  Oh wait.  Actually, there really IS no way I could go through tx without the shrink.  She got mad that my first appt (I was referred by one of my primary care physicians) was three or so weeks away so she picked up the phone and got me in with a different doctor sooner.  (And he turned out to be a great guy actually - she was right.)  And he does seem to know his stuff.  So far anyway.  But.  Since she referred me, he made her send a statement prior to my starting basically saying that I wasn't terribly depressed or prone to attempting to off myself or anything, and that she would follow me at least monthly during my tx.