A deeper look

Kristin Donahue wanted to know what lay beneath her psoriasis. She headed to the National Institutes of Health to find out.

"How were you burned?" the woman asked.

Burned? Lost in the distraction of a tabloid magazine at the grocery checkout, I turned to look behind me to see who the woman was talking to. She was talking to me. Her eyes met mine and drifted to my forehead, ears, cheeks and neck — I watched her take it all in. It was summer, it was hot, and I had braved wearing a tank dress. A hot flush spread over my neck and cheeks, jawline and forehead — the plaques already raw and red from a new flare. It hadn't occurred to me that I might look like I'd been burned.

I've lived with psoriasis since I was a child, so this wasn't the first time a stranger had inquired about my skin. Throughout my life, I've been asked if I'm contagious, told that my hair could not be colored because of scalp psoriasis and that I could not swim in a pool. Over a lifetime, psoriasis creates — literally and metaphorically — a thick skin. But this new flare consumed most of my face, neck and arms — the skin most visible — and was eliciting a new type of attention.

Like many people diagnosed with psoriasis or psoriatic arthritis at a young age, I've tried various treatments. I've slathered on topicals and undergone narrow-band UVB therapy. I've considered going on a systemic drug and once held the prescription for methotrexate in my hand. But when the dermatologist suggested that I get my tubes tied or undergo some other form of permanent birth control, and that, on the drug, I would need periodic liver biopsies, I knew I couldn't fill the prescription. I was only 28 years old.

I left that appointment concluding that the disease posed fewer risks than the medication. Then the UVB treatments stopped working and actually appeared to be worsening the psoriasis on my eyelids and neck.

About the same time, new medical studies showed that people with psoriasis often are at increased risks for cancer, stroke and heart disease. When I read an article in the Spring 2012 issue of Psoriasis Advance about Dr. Nehal N. Mehta, a preventive and nuclear cardiologist, and his research on internal inflammation and psoriasis, I wondered: What would the consequences be of not treating my psoriasis more aggressively?

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