3 yr old just diagnosed, have ?'s

[emmoore5124]

My 3 yo daughter Molly just had her diagnosis of eczema changed to P. I'm assuming she has plaque P because her derm kept mentioning her plaques. She also has been having a problem with her nails loosening(which is what led to the change in diagnosis). Since my husband and I don't suffer from P, we sometimes have trouble understanding what she's going through. I have a few questions I hope someone will be able to answer.

1. Since she first started flaring up at about 6 mos. old, she has steadily been on stronger medications. We are currently using fluocinolone drops for her scalp, lidex 1x per day and dovonex 1x per day. I understand that dovonex is used to loosen scale. Right now she doesn't seem to have any scale. She has red patches that are somewhat raised but that is about it. Should we continue to use dovonex or just the steroid?

2. I believe she may have PPPP on hands and feet. She constantly picks at her feet and has cracks at some joints and on the sides of both hands and feet. Her palms and soles are red and her feet in particular feel like sandpaper. Her instep looks as though she was rubbed raw by a pair of shoes. I know she is just making everything worse by scratching but at her age it's kind of hard to stop. She takes a ton of Atarax and it helps somewhat but doesn't make her drowsy. My question is still re: dovonex. Would it work on her feet and hands?

3. I've noticed people talking about weaning off the steroids to prevent a rebound flare. How would I do this? Would I go to every other day? Start working down through the steroids to lower strengths?

4. Molly seems to get itchier when she is sick or upset or having a tantrum. Do you find that there is anything else that causes flareups or is it just without any pattern?

TIA

[MikeK]

Hi Tia,

First, I'm sorry to hear about Molly. :( Second, welcome to the Board. :cool: You've come to the right place. A lot of very nice and helpful people post here. Your fellow "P moms" use this place as an online support network.

Before I answer your questions, I've got a question for you. Has Molly been tested for strep? Strep is one of the many triggers for p ... especially in children. Some people don't show any of the common symptoms for strep -- i.e., a sore throat. Their psoriasis is the only indication that they've got strep and they won't get the p under control until the strep is treated.

BTW, I'm 46 and was first diagnosed when I was 7.

Now here's the answers to your questions.

1. I think that you should continue to use the Dovonex. It's safer then the steriod. Also, everyone and their p is different and what works for one person may not work for another. To add insult to injury, something that works today will stop working tomorrow, but will work again the next time that you try it. If you don't see any improvement, you might want to ask your derm if you can try [b]Protopic[b]. According to my derm Protopic (a) has been approved for eczema, but she's studies that show promising results for p; (b) is safe to use for children as young as 2; and (c) is not known to cause skin thinning like certain other psoriasis treatments. Here's a link for some additional information: http://www.protopic.com/index1_1.html. (Sorry about the pop-up.)

2. I use Dovonex (in combination with a steroid) on my hands, and by itself on the top of my foot, and on my ankles. Have you asked your derm about your suspicions re: the pustular p? I don't have it, but I understand that it's sometimes treated differently than other types of p -- especially for children.

3. The sudden stopping of a steroid can lead to a rebound. To prevent that from happening, my derm limits the use of steroids to two weeks max or just to the weekends. I would think that you would just cut back on using it ... i.e., every other day. Ask your derm.

4. Stress or illness can cause p to flare.

Aveeno make a couple of over the counter products that you might want to try. The first is an oatmeal soak that you use in the bath. It helps control the itch. The second is an oatmeal moisturizing lotion for infants and children. It will also help her itching.

Good luck. Hope this helps. Let me know if you have any other questions and please don't be a stranger.

Mike

[chaimFL]

Welcome to the board. Sorry to hear about the diagnosis :(. Mike gave you all the good stuff. I didn't develope p until I was 15, now I'm 27. My gut feeling (I'm not doctor) would be to limit the use of steriods, they're not so good for the skin. Dovonex is much safer, albeit with slower results, but it's worth it not having the negetive results that the steriod can give you. Mike gave you golden advice to have your daughter tested for strep, it's a killer triger.....if that was to be the case, a very important thing to know is that one 7 or 10 day treatment of antibiotics does not always get rid of the infection and that's only relevent for p sufferers because for the rest of the world the infection is signifigantly weakened and thus your body can do the rest. For some reason p can thrive on a strep infection and so when the antibiotics run out you would want to get retested to make sure it's all gone.
Use a lot of moisturizers for your daughter because it can help with the itching and keep the scaling down.
Good luck!

[emmoore5124]

So then Dovonex isn't just for areas with plaque? I should continue to use it even when the skin is just raised and red or on the cracks for her feet and hands? We have tried protopic but didn't have much luck. We have had better luck with Elidel but not when the P is bad. I hadn't thought to have her tested for strep but I will discuss it with her pediatrician. As far as limiting steroid use, when we still thought she had eczema, her derm said that we would probably be using the steroid 2x a day for about 6 weeks.

[MikeK]

Hi Tia,

Yes. Please continue to use the Dovonex until the lesion is completely healed. Even if there aren't any scales. I've had p for almost 40 years. I didn't start treating it aggressively until a couple of years ago. Since then, I've noticed that things get out of control very quickly if I stop the treatment too soon.

Hope this helps. Please keep us posted.

Mike

[Shana Hansen]

Hi Tia,
Sounds like every one gave you some good advice but having a 3yr old with psor. myself I can totally relate to the itching when they throw a tantrum. Lillian gets so worked up and hot when she is upset that she turns red and then starts itching. Which of course I try to stop which then leads to more screaming. But really any time she gets hot, she starts itching. If possible I just give her a cool bath and this helps. Apart from that I try to dress her so she stays cool, especially at night. There has been times in the middle of the night where she has gotten too hot and the only way to get her cooled down and stop itching is to put her in the bathtub. Also keeping the skin well moisterized helps a lot. Hope this helps,
Take care,
Shana

[Marielle]

Shana
Just a little hello and that we have missed you! How is Lillian doing? It has been so long. I know us mothers get busy. That is why I do all my writing on breaks and lunch at work. Well talk about work....I will try and write more later.
Don't be a stranger.
Talk to you later.
M

[itzlisah]

Thank you so much for the emails as soon as i got them i called and left a message i started andrew tonite on the shampoo hope it works he says his head has been hurting him since its been cold here in southern maryland cant wait to get the pack thanks again i will be on again soon. lisa