small bumps/blisters on palms

[joel1839]

I'm sure many of you have seen something similar to this but it's definitely new to me... at least it's a new symptom that is. I was on MTX (5 at a time, every Friday) along with Enbrel injection (once a week). Everything was seemingly getting better. Well, as my job would have it, I got switched around on my schedule and forgot to reschedule my doctor's appointment to get my next script for MTX. One thing led to another and it was about three weeks before I made it to my derm. This was three weeks without MTX after stopping cold turkey. I did, however, keep up my Enbrel. Now, with my most recent flareup, I've been affected from head to toe... literally... it has even gotten to areas where NOTHING should be getting, if you know what I mean. One of the newest things though, and one of the most aggravating, are these little blister looking things on my palms.

If you can open the pictures, look around my fingers and the outskirts of my hands. It is also in the center of my palms. They look like little bumps, almost like a wart, but they've got these little "dark spots" in the middle of them. If one is popped, a clear liquid will ooze out but it does not seem to go away at that point. It only seems to fill back up and become more tender. They hurt too! They feel like a bunch of little thumbtacks just resting against the skin, annoying it, until you move or put pressure on the skin. Then it feels like they are pressing inward. The itching is dang near unbearable too!!

My current regime now (been back on MTX for three days) is 7 MTX at a time, every Friday, and one Enbrel (50mg) autoinjector every week (Wednesday). I also take one Folic Acid every day except the day I take my MTX. I've been given Betamethasone Dipropionate (0.05%) which seems to only make me greasy without doing much of anything. I also have some leftover Atarax (Hydroxizine) for itching. I'm taking this sparingly. The derm did not give me any more at this time so I'm trying to stretch it. Benadryl seems to do about as much good as a Tic-Tac.

Anybody seen or dealt with things like this? One other thing I forgot to mention. The outbreaks everywhere else looks a lot like the pics for guttate psoriasis but the derm keeps saying plaque psoriasis. The only place that looks like plaque is on my feet, which are horrible to say the least. They fill my shoes up with puss and blood daily.

Help? Suggestions? Advice?

http://i138.photobucket.com/albums/q280/joel1839/Hands003.jpg

Here's a few more:

http://i138.photobucket.com/albums/q280/joel1839/Hands006.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands005.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands004.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands003.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands002.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands001.jpg

[docmks]

Hi Joel,

I don't think I've had the chance to welcome you to the boards yet, but I read your post and wanted to respond and that led me back to your previous posts to see what I could learn about you and your psoriasis. First, welcome! We are glad you are here!. These boards are a great place to find support, come and vent, and learn new information about Psoriasis and Psoriatic Arthritis (PA). It doesn't sound like you're troubled by PA and hopefully you will never be, but Psoriasis can do plenty of harm on its own.

We need somebody with a history of full blown palmopustular/plantar pustular to come along and look at the pictures, but I am wondering if this is what is developing in you. When I was a child (I am now 51), I used to get these small blisters on my fingers and plams; I seldom get them as an adult. I also develop peeling on my fingers and palms and my fingers would get raw and swell forming what we call sausage digits (and in me the joints get involved, too). So, I think these blisters might be the beginnings of what we call palmo-plantar pustulosis (PPP) or pustular psoriasis (PP). See the description on the web page http://www.psoriasis.org/about/psoriasis/pustular.php.
I am not sure about this and I am not an MD doc...but another kind of doc...but your pictures are excellent and I've had this myself. SOmebody with a more recent history of PP or PPP will be along, I am sure, to render an opinion soon, I'm sure. Above all, though, since this is a new development, you will want to consult a derm.

That brings me to point 2 to consider. You might want to think about seeing another derm. From your previous posts, it sounds like your derm is not as supportive as he/she might be when it comes to certain things, including insurance matters. And in truth some derms know a lot more about Psoriasis than others. It is a complicated, unpredictable and highly variable autoimmune disease and you are dealing with one hell of a flare right now, pardon my language. You need the very best help you can find; and, you deserve it.

Yes, you are working in a high stress environment and you need support for this too. I can imagine that it doesn't get much more stressful than law enforcement. My nephew is a police officer in St. Louis, current homicide capital in the US, and I've worked with law enforcement in a consultive capacity. I've gotten a little taste of what you go through every single day for hours. Stress management is something that you need to give some thought to. I so sympathize; I know how hard this is to even think how you can de-stress in healthy ways, but please spend some time thinking of what actions you might take when you go off duty (or before you go on duty) that can serve you in dealing with this extreme stress.

I want to suggest also that you see an internist, or your primary health provider (PHP) and get tested for strep and checked out for other bacterial infections. Many of us with P and PA have a history of strep and you need to get tested. Insist that they send it out for a culture and don't do the quickie test; or don't just do the quickie test. They need to cook the swab and see if anything will grow. Please watch your skin for any type of infection as well. Follicules can get infected as can raw patches of skin. When I was on Enbrel and MTX at one time, I had bad ankles (one of my most persistent areas, like you) and one got infected during a flare. Within four hours I had a band of red spreading up my leg and down my foot. That's a case where you got to get antibiotics immediately...it's a soft tissue infection called cellulitis and you have to be very, very careful.

The other thing I'll say about seeing a PHP and possibly another derm is that antibiotics are sometimes used to treat certain types of Psoriasis, including palmo pustulosis (I think) and guttate (when there is underlying infection). I know it is a giant, royal pain to get new medical docs. Many of us have gone through several derms and rheumies (for PA). My personal count is 2 derms and 3 rheumies, but I think I've got winners now. In any event, do check out antibiotics and other kinds of topicals.

Ok, this is a dissertation. Sorry about that. Others with more extensive knowledge of P will be along shortly to provide additional advice and opinions and support. That's what we are all here for, and I am glad you have joined us. Don't ever feel badly about coming here to vent. We all do it from time to time and we help each other out that way.

Take good care

MK

[joel1839]

docmks, thank you very much for your response!! It's nice to feel welcome and know that there are people out there that know and understand where one is coming from with this stuff.

Here is a close up of the "blisters" on my hands. Can't really see them that close in my other pictures.

http://i138.photobucket.com/albums/q280/joel1839/Hands010.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands010a.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands009.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands008.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hands007.jpg

Here are a few pictures showing my ankles and a few places on my legs. My ankles are by far the most affected and seem to stay this way year round. The rest of my body looks like the pics of my arms.

http://i138.photobucket.com/albums/q280/joel1839/Hand011.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hand012.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hand013.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hand014.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hand017.jpg
http://i138.photobucket.com/albums/q280/joel1839/Hand018.jpg
http://i138.photobucket.com/albums/q280/joel1839/Leftlegbelowknee.jpg
http://i138.photobucket.com/albums/q280/joel1839/Rightlegaboveknee.jpg

Anyone have experience with similar?

[joel1839]

Oh yeah, forgot to say... the shiny stuff you see in those pictures is the medicine. These were taken when I got up this morning.

[docmks]

Hey Joel,

You are very welcome! That's what these boards are for and I've made some wonderful friends here. I don't think I would've made it over the past few years without them.

A couple of thoughts...I am wondering if you could ask for a job accomodation under the ADA (Americans for Disabilities Act) for a vest that you can wear over your shirt. I know that police departments can be complicated places to work, with internal politics and such, but this might be a solution for you. SOmebody who works with advocacy at the NPF or perhaps another member will be able to advise you here. I started a process of asking for accomodation and by the time my employers would talk to me I was ready for disability. It can be a complicated and delicate process. There is something called the Job Accomodation Network (JAN) that might be of some help. In my case, I did not get particularly helpful advice and part of the problem was them not understanding beans about psoriasis or PA.

Looking at the photos, I really would wish you would consult your primary care physician about the possiblity of an infection. It could be that you need to be on antibiotics.

You are very wise to keep these photos, I am realizing now as I prepare my case for disability. It's a great source of documentation, in my opinion, and I don't have so many of my flares.

Do you have any joint problems at this point? Hopefully, if you don't you never will!

I'm glad you've joined us and hope you'll keep posting!

Hang in there, we'll help ya through it

MK

[PJ Leary]

Hi Joel,

I know what this is, and I feel really badly for you. It is exceptionally painful, you are accurate in your description that it feels like a bunch of tacks or needles when there is any contact.

You need a new derm, or at the very least a second opinion. The last time that I looked loike you do now, I had both a strep induced guttate flare and palm/plantar pustular psoriasis. Getting back on the mtx will help to calm things down, but you need antibiotics asap.

I find it worrisome that a derm who is prescribing these meds for you cannot accurately diagnose your current condition. For that reason, I do think you need another opinion.

Further, you need to be really careful about getting any secondary skin infections while your spots look like they do now. That would be really bad. I also suggest you might want to ask for some topicals to help things along, you need to get those open sores under control quickly.

Please feel free to post back here with more questions. I'll try to check in a couple of times a day. You can always send me an email or a pm as well.

[cakp12]

Hi Joel,
First let me welcome you to a wonderful supportaive place- I also have pustular P- just on my hands now- your blisters look very familiar- except mine tend to "cluster"- this disease is different with everyone- You should definately get to another derm for eval/ second opinion. Feel free to PM me with any questions.

[RichJ]

hi joel,
i was dx with pp or ppp but can't remember witch one. but now he says it ezma. i don't think he knows half the time. when i had it like you do. i had 1,000's of the blisters (some yelloish brown) on my feet and hands. they looked just like yours are. i had a very hard time walking and using my hands. they did itch alot and i wound wake up at night bitting them. i get the red skin to. mostly on the top of my feet and my wrist. perdasone was the only thing that helped me to get clear. i get some blisters still but nothing like that and i pray that it don't come back. i don't know what i will do if it dose. i hope you can find some thing that will clear you. i wish you the best and welcome to the p family. you have met some of the wonderful people on here and will find alot of great info. welcome and nice to meet you

try and have a good day

richard

[mamaooch]

Hi Joel,
Your fingers and hands look like what I have on the palms of my hands and on the bottom of my feet. I have been diagnosed with palmar-plantar pustular psoriasis along with Psoriatic Arthritis. It is very painful especially where the blisters are located now.

You should see a derm right away. I know the longer I waited to see the derm, the worse it got. I wish you the best and I hope you find relief soon.


Keep us posted!
Cindy

[MikeK]

Hi Joel,

I'm sorry to hear that you're going through such a rough time. :(

There's a couple things that I think are going on here. (I'm not a doctor.)

First, you mentioned:Now, with my most recent flareup, I've been affected from head to toe... literally... it has even gotten to areas where NOTHING should be getting, if you know what I mean.
You also mentioned:One other thing I forgot to mention. The outbreaks everywhere else looks a lot like the pics for guttate psoriasis but the derm keeps saying plaque psoriasis.From your description and pics, I tend to agree with you -- you're having a guttate flare. (Guttate sometimes morphs into plaque psoriasis and some of your pics do like like plaque psoriasis.)

MK mentioned:I want to suggest also that you see an internist, or your primary health provider (PHP) and get tested for strep and checked out for other bacterial infections. Many of us with P and PA have a history of strep and you need to get tested. Insist that they send it out for a culture and don't do the quickie test; or don't just do the quickie test. They need to cook the swab and see if anything will grow.As MK mentioned, guttate psoriasis is often triggered by some sort of infection. Strep is the usual culprit, but just about any infection can trigger a guttate flare. More then a few people have posted here that either their psoriasis or their child's psoriasis was either triggered by or gets worse when they have have infection. To add insult to injury, many of these same people have also posted that they (or their child) were asymptomatic for the infection. (I.E., They didn't have a sore throat or fever in the case of strep throat.) To further complicate things, the psoriasis won't respond to treatment until the underlying infection is taken care of. So, I echo MK's suggestion that you get a strep test. (As MK suggested, insist on a culture, because the so-called "quick test" is often unreliable.) Some people have to get a blood test (called an ASO test) to confirm that they have strep. Here's the links to some previous discussions:

http://www.psoriasis.org/forum/showthread.php?t=7538&highlight=importance+strep+test;

http://www.psoriasis.org/forum/showthread.php?t=3074&highlight=presentation+strep;

http://www.psoriasis.org/forum/showthread.php?t=4988&highlight=uti; and

http://www.psoriasis.org/forum/showthread.php?t=18602&highlight=aso. (The ASO blood test is discussed in this thread.)

You also need to be aware that certain medications (i.e., beta blockers that some people take for high blood pressure, etc.) are known triggers for psoriasis. Here's a link to the NPF's discussion of psoriasis triggers: http://www.psoriasis.org/about/living/triggers/.

You mentioned:The only place that looks like plaque is on my feet, which are horrible to say the least. They fill my shoes up with puss and blood daily.Based on your pics and your description is thiat post, I tend agree with both MK and PJ, it sounds like you have palmer planter pustulosis, which is often referred to here as pustular psoriasis or ppppp. A lot of medical terms are in Latin. Palmer is Latin for palm; planter means foot; and pustulosis means pustules or blisters.

The fact that you are experiencing blisters on the tops of your hands is very troubling to me. (As it's name implies, palmer planter pustulosis, usually occurs on the palms.) Also, in your "Law Enforcement and Psoriasis-Help?" post you mentioned:It seems as if I have tried nearly every form of betamethasone dipropionate 0.05%(sp?) and triamcinilone acetonide 0.1%(sp?) cream on the market. It may work a little bit but I usually end up getting several places that are like boils. They're hot, swollen and look like a zit and they're painful!! (Sorry, I know that's gross) I've told the derm about this but I kind of feel as if it is of no concern.Source: http://www.psoriasis.org/forum/showthread.php?t=21187.

I'm also very concerned about those boils. When pustular psoriasis occurs on places other the palms and hand, it's called Von Zumbusch or generalized pustular psoriasis. It's actually a very serious form of psoriasis. (You know that something's bad when they name it after someone.) It can also be triggered by an infection. MK already gave you the link to pustular psoriasis but here it is again: http://www.psoriasis.org/about/psoriasis/pustular.php. (A friend of mine who has endured several bouts of Von Zumbusch tells me that "it looks like zits".)

As you can probably tell, I'm very worried about you. I STRONGLY echo the recommendations that you get a second opinion. ASAP (To say that I'm underwhelmed with your derm would be an understatement.) I also stongly recommend that you see a derm who is affiliated with a teaching hospital, if possible. You can find another derm via the NPF's Physician's Directory. The directory is basically a list of doctors who've contacted the NPF and expressed interest in treating either psoriasis or PA. It's not an endorsement by the NPF, but it's a great place to start. It's searchable by zip code. Here'sa link to it: http://www.psoriasis.org/treatment/directory/. You can also find a derm via the American Academy of Dermatology's website. It's also searchable by zip code. Here's a link to it: http://www.aad.org/public/searchderm.html. Also, what city do you live near? Perhaps someone who also posts here lives near you and can recommend someone.

PJ Leary mentioned:The last time that I looked loike you do now, I had both a strep induced guttate flare and palm/plantar pustular psoriasis. Getting back on the mtx will help to calm things down, but you need antibiotics asap.I agree. You need to go on antibiotics ASAP.

GrannyFranny has had pppp for over 40 years. She tried and failed (often with some horrible side effects) just about ever treatment that's out there. She cleared when she had to go on antibiotics after she developed a staph infection in one of her fingers. She's still taking antibiotics. Here's a link to some of the threads where we discuss her experience:

http://www.psoriasis.org/forum/showthread.php?t=21227;

http://www.psoriasis.org/forum/showthread.php?t=20993.

The MTX and Enbrel (along with an antibiotic) should help to calm down the flare that you are experiencing. That being said, and I hate to sound like a broken record, but you need to a second opinion. ASAP.

In addition to the Atarax and the Benadryl, here's some other suggestions that you can try for that awful, awful itch that you described: Corn Starch;
Ice packs;
Taking a bath with a product like Aveeno Oatmeal Soak (http://www.aveeno.com/detailAction.do?id=3689);
Anti-itch powders creams and lotions such as Gold Bond. (I usually buy store brands.) My current favorite is Eucerin Itch-Relief Moisturizing Spray. I like it a lot. It's easy to apply because it's a spray and it really does help to relieve the itch. Here's a link for some additional information about it: http://www.eucerinus.com/medicalsite/products/handandbodycare/anti-itch/anti-itch.html. You can also Neutrogena Anti-Itch Moisturizer (http://www.neutrogena.com/ProductsDetails_36.asp).I also find that it helps to avoid antibacterial and deoderant soaps, because they tend to irritate my psoirasis and make it drier and itchier then it already is. I've had similar problems with the dyes and fragrances in detergent and dryer sheets, etc. I haven't had any laundry related problems since I switched to "free and clear" laundry products. And, here's a link to some previous diccussions about psoriasis and soap: http://www.psoriasis.org/forum/search.php?searchid=692178.

I'm sorry that this turned into a novel. You're probably suffering from information overload. :rolleyes: I hope that it helps in some small way. Again, I'm very worried about you. Please keep us posted and let us know if you have any other questions.

Mike

[mystery]

Hi Joel,

When I had my last outbreak of guttate psoriasis, I too, got bumps on my palms/fingers/soles of my feet, and it freaked me out. I saw my derm again and she confirmed that it was just psoriasis, but she didn't say what kind. From your pictures of your other areas (red dots), it does look like guttate to me, not plaque.

MTX will probably help, but it takes a bit of time for the body to react to it positively. You may also wish to talk (to another derm) about other therapies to try in combination. I also did UVB (or lie in sunlight), Dovonex, and Cyclocort.

Another thing is, be sure not to apply too much of your ointment, and apply in the direction of the hairs so you don't get folliculitis (bacterial infection of the hair follicles). This just complicates things, and if this happens, just apply some polysporin or benzoyl peroxide. If it gets really bad, have your doctor prescribe some oral antibiotics (which would also help if you have a strep infection which caused the gp outbreak in the first place). Bear in mind that gp can also be triggered by viral infections which are not helped by antibiotics and you must 'ride it out'.

Good luck, and let us know how it works out for you!

If you're in Toronto, I can recommend my excellent derm to you. Let me know.

[wildflowerAnn]

Hi Joel,
Wow, that is RED skin. The erythma is the worst part. :( It is hard to know just what those white pustules are by looking; but a punch biopsy should let you know just what it is. My internist also extracted cells from one of my pustules to determine whether it was infected (and it wasn't). This was before the punch biopsy report had come back. I had my punch biopsy taken right where those pustules were to find out what was wrong with my skin. It was Von Zumbush, but my pustules get full of T cells and not fluid.
Will be interesting to know what those little white pustules are. They do look like Von Zumbush pustules, but you can't tell without a lab test. If more and more of those white pustules start appearing fast, then you need to cut in line at the derm's and find out what is happening. It can spread like a wildfire
in a few days; and then you can have erythrodermic psoriasis coupled with the pp. If your skin starts to shed in sheets; and you are sweating, yet freezing cold, then you are in trouble. Let your derm know everything ASAP.


Do you get the wild itch right before it gets red? I keep wet wash cloths and hand towels in the refrigerator to wrap and soak out the heat. I found that adding ice chips to the cold towels kept them colder longer.
From what I've read here on these boards, everyone's treatment just takes time to finally work, and sometimes the treatments don't work and something else has to be tried. When I'm RED, if it burns and itches, then Vicodin helps take away the burn, along with sucking the heat out with cold wash cloths.

Sorry you got P. Welcome to the boards.
Ann

[jdeldrid]

Joel,

I'm going to second or third the opinion that you need a new derm. Can you go to a teaching hospital?

Your pictures look just like my hands and feet, and I was diagnosed with palmar plantar pustular psoriasis about two years ago. It really sucks, and, yes, it's very painful. I had to go on disability for a couple of months in 2005 because I literally could not walk.

I've tried Enbrel (did nothing), and am currently on Humira (too soon to tell) and NBUVB. The only thing that worked, and it worked really, really well, was Soriatane. Unfortunately, it made my blood lipids go way too high, and I had to come off of it.

I'm going to disagree with Mike here, in that unless you are getting blisters in places other than the your hands (even on the backs) and your feet (even on top), it's probably not an emergency situation. I get blisters around my finger and toenails, and on my knuckles, backs of my hands and tops of my feet from time to time, and my derm said it just sometimes does that. The only cause for alarm is blisters elsewhere on your body.

One "advantage" to having psoriasis on your palms and soles is that you really don't (again, according to my derm) have to worry about thinning that skin with topical steroids. When mine gets really bad, as it was a few weeks ago, he has me occlude clobetasol ointment with vinyl gloves and saran wrap overnight.

Good luck. Definitely time to look for another derm.

-- Jaye.

[joel1839]

Thank you all for the support! I've got to sit and sort through it. It's a lot of information and my mind simply isn't with me like it should be right now. It's off scratching skin somewhere but I do thank you all just the same.

I've been to my family doctor and have asked for a referral for a second opinion. He was very leary of granting it but said that he would. He did strongly urge for me to give it some more time though, which I did, before he would do it. My derm is "highly recommended" here in the upstate of SC for psoriasis treatment and supposedly has been treating patients for nearly 27 years with 500 psoriasis patients per month. It's a father-son practice and they come highly recommended claiming many, many treatment resources. My dad has been to the older derm for treatment (eczema) on his hands and loves the derm to death. I was seeing the older derm, based on dad's recommendation, and thought a lot of him. He had suggested that I start PUVA treatments and gave me a treatment schedule. As some of you know, or have figured out, I am a police officer. That being said, my schedule sucks! I police in a neighboring county so just dropping by during the week is out of the question with my supervisor and Sheriff, both of which have actually suggested disability or the old "suck it up and drive on" method.

While I'm on that point, I approached my Sheriff about an external vest to wear and was told that wasn't going to happen, that we "weren't going to ride around looking like the gestapo out there". In short, he was VERY close minded to anything and everything and I tried every diplomatic approach that I could. They actually agreed to let me wear plain clothes to work the desk, after I took my shirt off and showed them the sores, only for the Sheriff to come back two days later and fuss at me for being in plain clothes. See my dilema there? That's why working PUVA into my schedule just isn't happening.

Back to what I was saying though, the older derm seemed as if he got offended when I couldn't do the PUVA. A nurse (off the record) said to do a tanning bed if I couldn't do anything else. It worked for a while. One day, I came back to my derm and magically was seeing his younger son who is now a derm at the office. I feel as if I am herded in and herded out as soon as possible there. Don't get me wrong, it's nothing personal against them it's just that it seems as if I am paying them $40/visit to see how quickly they can get me through there. A very long story short, I'm on the Enbrel/MTX regimen weekly. I ran out of MTX about three weeks ago and stopped cold. Yes, my schedule interfered with my getting to the derm. His openings weren't on my days off and I couldn't get the time to go since we're so "understaffed" at work. (Hopefully the work thing will get a little bit better, I've got a new supervisor who seems great to work with). My visit to the derm this week got me a butt chewing for stopping the MTX and was told that this is the reason for the flare up.

Maybe it is, I don't know. Even on the Enbrel and MTX it never really goes away. It's always lingering and rares it's head from time to time. My derm isn't open to the strep test thing either. Just pretty much shakes his head and says "Ahhh, we're working on it. We'll get you healed up before long." Gee, what words of encouragement. (Sorry for the sarcasm) Keep in mind, this is the same office that when I first went to them, whem my hands were like this before, the older, more experienced derm, came in, picked up my hands, looked at them, turned them over, looked at them again and said... ready for this... he said, "Looks like you've got you a case of the scabies."

Scabies?!?!?!?! You've got to be freakin' kidding me!!! I am known, and laughed at, at work for always washing my hands, cleaning everything relentlessly and etc... I asked, can I get this from arresting someone that had it? He replied, "No. You would have to have a good bit of contact (intimately) to catch it like that." Well, now... seeing as I was married at the time, and had been with the same woman for ten years (at time of diagnosis) I knew the intimate thing was out the window! Heck, I knew that to begin with!! You can only imagine the discussion I had with my wife that evening and how thrilled she was for us to have to wash/boil all the bed clothes, clothing, and not to mention rubbing that awful smelling lotion on both of us each day!!

Well, I did some research and found out about the scrape test for these little critters to look for the eggs and the trenches... I asked the derm... He pointed out a "trench" on my right hand, near my little finger (knuckle area). You should have seen the look and felt the air in the room when I reminded him that it was a scar that I got from a fight with someone I was arresting, that didnt' want to go to jail, several years prior to that visit. I still have the scar. Well, the diagnosis quickly changed to contact dermatitis, eczema, atopic dermatitis, you name it... I heard it...

Now, I have "plaque psoriasis"... no deviations, no variants... no explanations for anything... nothing... just "plaque psoriasis". I guess I'm just dumbfounded at how nonchalant the whole derm visit is. If I suggest anything, such as the strep test, new med, cream... anything, I feel as if I'm quite frankly making him mad, or stepping on his ego, or something. I had to basically argue with him this last time due to his wanting to put me on Triamcinilone ointment (the white paste in the jar). I told him that the past three times I've tried it, it irritated my skin and left me with big "boil" type sores where ever I put it. I don't like feeling like that from my derm. This stuff is bad enough to deal with by itself.

Now, to give every dog his due, I know from experience that you tend to get calloused from seeing "the same thing" over and over. I face that in my job. People think cops are a**holes, and unfortunately some are. We're all human. But I understand that one tends to get calloused having to deal with the same thing over and over but you don't really expect that from your doctor... Heck, I don't know... Am I being overly sensitive to this whole thing? Have any of you dealt with the same type thing?

[joel1839]

I am in Greenville SC area. Anyone know of any good derms around here??

[joel1839]

Joel,

... Can you go to a teaching hospital?... -- Jaye.

I've been thinking about that very thing. I've heard several people mention Duke University here in the Carolinas. Heard anything about their derm division?

[jdeldrid]

Joel,

I don't have any direct experience with Duke, and I don't really know much about their dermatology practice, but my mother, who lives in NC, was taken there when she developed serious heart problems about 20 years ago. She was given about a 10% chance of even making it, and she's still going strong today, at 80. She currently sees doctors at UNC, which is closer to her home, and is quite pleased with them. Any large teaching hospital is likely to have some excellent doctors, although it may take some sleuthing to figure out which ones they are. My current derm is affiliated with the University of Washington.

Someone on this board (PJ Leary?) actually is the founder of the NC psoriasis support organization, so she may have more info.

-- Jaye

[mamaooch]

Hi Joel,
As far as derms go, I see a derm in High Point, NC but my Rhemy is at Duke and he is wonderful. You might want to check it out, I heard that the Derm department is great.

Wish you luck,
Cindy

[MikeK]

Hi Joel,

I don't know how far Greenville, SC is from Durham, NC, but I can tell you that PJ Leary speaks very highly of her derm at Duke. His name is John Murray. (He saved her life when she went through an erythrodermic psoriasis (click here (http://www.psoriasis.org/about/psoriasis/erythrodermic.php)) flare a couple of years ago.) Here's a link to his contact information:
http://www.dukehealth.org/physicians/74D9BD4F0F59156E85256DFD006A943F.

I hope this helps.

Mike

[FlakeyMatt]

You been given plenty of advise already VERY HAPPY to hear that are trying to get a second opinion

It certainly makes sense that a break in your treatment regimen could have a caused your flare but ( and I may have missed this but) did your doc check for an infection?!??!?!?

ONE THING ALSO TO KEEP IN MIND ABOUT PUVA Besides your schedule YOU ARE OUT OUT IN THE SUNLIGHT ALOT given your profession When on PUVA your skin and eyes NEED to be protected from the suns ultraviolet rays So I think overall it was a good thing you didn't pursue it

As for being over sensistive No I don't think you are being over sensitive This is a tough disease to deal with and sometimes docs have to realize that so a little compassioin Listen MOST people hate my derm. He can be egotistical and is a COMPLETE TYPE A personality However, during one of my flares, he showed a more caring side and gave me words of encouragement

Good luck and keep us ummmmmmmmm "posted" *giggle*

FM

[grannyfranny]

Joel,
I sent you a message.
Charlotte would be much closer to you. Look for roseyposey,,,she lives there and probably has an excellant derm.
Don't wait!,,,,looks like you have an infection with your psoriasis.

[PJ Leary]

Hi Joel,

Mike already gave you the contact information for Dr. Murray at Duke Dermatology. Here in this area we have an active Support Group, and many of our members are patients of either Dr. Murray or another of the fabulous derms at Duke. Even if you have to drive a ways to get there, it is well worth the trip.

While I understand that your current derm is well respected, it sounds as if you and he do not have a good fit. That is of critical importance to each one of us. I can tell you that I have never felt rushed when in my derm's office. He has often been known to take hours, when necessary, to tend to one patient.

Years ago when I lived in New England, I was fortunate to have another fabulous derm, Dr. Joel Sabean. He had a needlepoint hanging in his office that said " If you are waiting it means I am listening ". We all deserve to be accorded that level of care. You, and all of us here, have a serious disease. If your cardiologist or oncologist were to treat you that way, you can bet you'd feel more than justified in getting a second opinion.

Good luck, and by all means don't let these docs push you around or make you feel that you disease is not important enough to warrant appropriate attention.

Regards,

[twinieten]

Your hands, well all of your p, looks terribly painful!

I don't think you're being overly sensetive. My son's derm has a tendency to remind me of his expertese whenever I bring something up. When I tell him what I've learned, he tells me to be careful about what I read on the internet. OK, whatever. We visited one derm who pretty much made me wonder if my son's presence was even necessary since he and his intern or whoever just talked to each other. It's a terribly frustrating process finding someone you can "click" with.

You've already gotten great advice. I have nothing to add. Good luck with everything and keep us posted!

[JesseLou]

I have a suggestion for getting a strep test around your Primary care's objections: go to a walk-in clinic and lie. Just tell them you have been exposed to strep, are not feeling well, and would like to get a throat culture. If you go at an odd time, a lot of insurance will treat it as an emergency.

Hop things start looking up for you really soon.

[MikeK]

Hi Joel,

I sent an e-mail, about your problems, to a friend of mine, Dave King, (his screen name here is davidk46219). He was away this weekend, but was able to check his e-mail. Here's a copy of his response:

"Anytime you suddenly stop a med you can get a saver reaction be it
intentional or not it does sound like pusular on his
hands and feet this can be very debilitating and needs
to be addressed soon Now I am not trying to take over
your job but here is a link
http://psoriasis.org/about/psoriasis/sites/hands_feet.php
I have had this several times myself so know how much
it hurts I even stopped my MTX at one time and paid
the price like JOE This is an emergency situation and
needs to get to a doc as soon as possible
Dave"

Thanks, Dave.

Mike

[joel1839]

I feel guilty if I don't start out by thanking you all. Just the fact that I've been getting all of these responses means so very much to me.

I telephoned my primary care physician today and he had me come in to the office where he worked me in. We discussed some issues involving my derm. Granted, I don't want to "not get along" with my derm, but it's just not working. My primary agreed to give me a referral to another derm for a second opinion. He admitted to me that P was not his specialty but he does have some patients come into his office with flareups. He prescribed me a regimen of prednisone to help knock out some of the swelling after I told him what I was currently on. He somewhat, sort of reluctantly, gave me a test for strep. I believe it's an "ASO" test (blood draw). I think this was more or less, from his point of view, to appease me in helping to answer a question. That in itself helps a lot that he would go the extra effort. Every time I mention something to my derm, it's as if it offends him. Just like I told my primary... I'm not trying to offend. I'm really not, but I just want to get better as quick as possible.

Anyway, that's that for today. I haven't heard from the strep test. Am I correct in that it takes about a day or so? I don't want strep but I'm almost catching myself hoping that it's there in the hopes that it can be knocked out with antibiotics and I can start seeing the light of day!

Just thought I would keep you all updated. Thanks again, very much, for all of your support, insight and advice!!

[mamaooch]

Thanks for the update Joel! I am glad you went to see your PCP today and he performed a strep test. Keep us posted on how things turn out. Sometimes it feels as if we have to fight to get anyone to listen, so I know how you feel.

I hope you find relief soon!
Cindy

[joel1839]

Got a question. The pharmacist, when I picked up my meds, gave me a bar of "Conti Olive Oil Soap" from NUMARK Laboratories and told me that it was one of the most gentle soaps made and that it was available OTC (They order it for you). Granted, my hands smell like I'm back overseas (guess it's the smell of olive oil) but they feel smoother... minus the few hundred bumps. Having a hard time describing this but I think y'all know what I mean. The ingredients, from what I can find (not printed on package) are "Olive Oil, Sodium Palmate, Sodium Cocoate, Water, Glycerin". My specialty is criminal/traffic law. Can anyone help me with this on whether or not it should/shouldn't be good for you? Has anyone ever heard of it? Anyone ever used it?

[docmks]

Hi Joel,

Thanks for the update!

I wish that I could tell you about the soap. Your description of the smell reminds me of the six weeks I did fieldwork out of a fishing village on Crete. Oh for the good old days.

I am not sure how long the strep test will take; it's been so long since I was tested....

Looks like I am not too helpful this evening!

But I did want to assure you that you did the right thing by going in and it's your doc's job to rule out all possibilities that might be responsible for this flare. Strep is high on the list for something that could be responsible. Many of us who are severely affected with either P or PA or both have gotten a lot of experience in learning to be advocates, both for ourselves and others. Many of us have been to and through several derms, rheumies, primary care people, and sometimes pain clinics, therapists, etc. You will keep learning more and more about P and PA and that will be "off putting" to some docs/health care providers. Just don't get discouraged, and believe in yourself...and your absolute right to get the best care possible for yourself. It will be a big relief for you once find a good fit with your health care providers.

Hope you can get in to see a derm ASAP. Is coming up to NC a possibility?

I am glad to help, and so are all the other wonderful people who posted. For me, it helps me feel better when I can help other people with this awful disease.

You take care. Feel free to PM anytime.

Best,
mk

[twinieten]

When we get a strep test, lab culture, we'll have results in about 3 or 4 days. When we get the ASO test, we'll have results in about a day or two.

That soap sounds wonderful! It was nice of your pharmacist to recommend it. You know it's bad when you and your pharmacist develop a relationship! :D I mean, it's good, but it's always better to see the guy (or gal) once every couple of years for that sinus infection instead of them recongizing you when you walk in the door becuase you're picking up yet another tube, jar or bottle of something.

I'm glad you had a good gp visit, and he "humored" you with the tests. I know the feeling of hoping for something like an infection so you can actually get something that might possibly make a difference.

I don't know if you read about Grannyfranny, who had sever pppp. I say "had" because she's cleared up with Keflex. She still has pppp, and still takes antibiotics, but she's currently clear. Sometimes people who test positive for strep require more than your typical 10 days of antibiotics. Sometimes it takes a month, 2 months or more. See if your gp will agree to a longer run if it's helping. THe most I have gotten out of my son's pediatrician is 24 days and we are nearing the end of this scrip. I can only hope that his hand does not get worse again.

In your line of work, you probably have pleanty of opportinity to pick up strep or some other bug, so pay attention to your skin and consider strep testing whenever you flare. I can't say antibiotics will work for everyone, but it's been known to help some people. Most information you'll find is anecdotal, however. I have searched for studies and papers. Not much out there.