Aloe Vera treats Plaque Psoriasis

This just in - a study in Thailand demonstrated that topical aloe vera was possibly a better treatment for plaque psoriasis than topical steroids. Here's the link, and here's a quote from the investigators:

"Although contrary results were reported from two previous placebo-controlled studies, our study showed that aloe very cream was more effective than 0.1% triamcinolone acetonide cream after eight weeks of treatment".

Now, keep in mind that these results did not reach statistical significance. However, the aloe did beat out the steroid in only 8 weeks.

I wonder if my psoriatic arthritis would go away if I started drinking the stuff. Here's a link to a post claiming it would. (this is not a study, though, just an opinion).

I have been feeling like a big chemical cess-pit lately, so this study certainly caught my attention. I like when research proves that natural remedies work - it makes my scientific preferences feel at peace with my hippie soul.

And it burns, burns, burns... the ring of fire

I had my first laser treatment on Tuesday, and I wanted to share the experience here in the blog, in case anyone is considering trying it.

Excimer laser treatment for psoriasis is used primarily for people with stubborn but smaller and contained plaque areas. The laser's highly concentrated UVB light treatments have been proven more effective than other treatments for many folks, and can put psoriasis into remission for several months. About.com has a nice description of the treatment here.

I have plaque psoriasis on my scalp and on my elbows, and the Humira and topical ointments have not reduced these patches, so my dermatologist and I decided to give the laser a go.

First - getting on the calendar. The scheduler went ahead and scheduled all 10 of my appointments up front. Geez... scheduling those appointments took longer than the first laser treatment. I'm still not sure what was so challenging, but it took that patient woman about 20 minutes, 3 phone calls and a supervisor coming in to help to get me on the books. I'm going to be seen at 11am every Tuesday and Friday through the first week of May.

On Tuesday, I showed up about 5 minutes early, and was seen right on time by the physician assistant, who will be my laser-lady for every visit. We had a brief conversation about what to expect from the treatment and where I wanted to be lasered, and then she had me sign a consent form. This took about 7 minutes.

Laser-lady then asked me about how easily I sunburn, and adjusted the laser accordingly. Apparently, treatment is started at the lowest level, and then is gradually increased over time until it becomes too intolerable. As I mentioned in an earlier post, the hope is to avoid blistering (even though it puts you in remission sooner).

The laser itself is at the end of a wand, about the same diameter as a half dollar. We both put on safety glasses, and the treatment began. Laser-lady placed the wand over each area we wanted to treat, and pressed a button. The wand glowed blue for about 1 second, and then beeped and changed color to red when the laser shut off. Because the patch on my right elbow is bigger than the wand, she moved it several times, each time pushing the button to activate it.

Then we moved on to my scalp, and behind my ears.

The sensation is warmth, at least with these first treatments. Towards the end of each second, just before the beep, you can feel a bit of heat. But not much. I expect that as we increase each treatment, the heat will increase and it will get more and more unpleasant. But this was not unpleasant at all.

The entire treatment took about 5 minutes. Really. Took me 4 times as long just to drive to the office.

For the first day after the treatment, my scalp felt a little warm, but not very. My elbow is bright red now, not covered in whitish plaques, and feels a little raw. But other than that, I feel nothing.

My next treatment is tomorrow. So far, so good.

Chicken or the egg?

Those of you who get Google alerts for the word psoriasis will have noticed this headline popping up all over this morning - "Psoriasis may reflect systemic inflammation, heart disease".

The article this headline links to is on the American Medical News website, and refers to a key theme from the American Academy of Dermatology meeting in San Francisco in March. At this annual meeting, several forums focused on whether psoriasis should be considered a systemic disease (a disease which affects multiple parts of the body, instead of just the skin), and especially considered cardiac risks in people with psoriasis. The article states:

This meeting is the latest to highlight a burgeoning body of scientific literature, data and expert opinion that psoriasis is related to more than a lower quality of life. Like other inflammatory conditions, it is linked to a shorter lifespan and a range of significant health problems. The theory is that inflammation on the skin may be a reflection or cause of additional inflammation throughout the body.

Look at that last sentence of the paragraph I quote above, and note the words "reflection or cause". Those are the key words, right there, and suggest some important questions: Does the skin inflammation cause other portions of the body (like the heart) to experience inflammation? Or is it the reverse - is skin psoriasis the result of other inflammation (like in the heart)? Or, is there a third factor at play that causes both skin and heart inflammation?

This article also did a great job explaining the complexities of of studying psoriasis in humans, especially when you're trying to include how psychology affects these studies. Sometimes we smoke, sometimes we get overweight, sometimes we're non-compliant. Do we act this way because of our disease, or do these behaviors cause the disease?

Watch out, though... here comes my soapbox again. I found NO mention of the ugly stepsister in this article - not one reference to psoriatic arthritis was included. Time for my megaphone: Hello!!! What about the inflammatory disease closely related to psoriasis? We have quality of life issues. We experience depression and obesity due to pain and immobility. Don't forget us!

You know they talked about psoriatic arthritis at the March meeting. But the press didn't pick it up. I find that a bit frustrating.

Ok, soap box is going back in the closet. Check out the article, though. I liked it anyway.

Burn, baby, burn

Just a quick note... I'm going to be starting laser treatment for my psoriasis soon, if my insurance allows. Here's an article on it from the WSJ. This is extremely exciting new technology. My dermatologist said during each of the 10 treatments, they will only use the laser 'til my skin turns red. They have to be careful that my skin doesn't blister (although she also said that blistering works faster... eeeewwww).

I can't imagine not feeling embarrassed about my elbows this summer.

Morbidity and comorbidity

The National Psoriasis Foundation recently headlined a news article about the long term risks of psoriasis because of its highly inflammatory nature. At the recent Annual Meeting of the American Academy of Dermatology, Dr. Joel M. Gelfand (a dermatologist) explained:

that for the last two decades, research has shown that excessive inflammation is a critical feature of psoriasis... Excess inflammation also is present in other common conditions, such as hardening of the arteries, heart attacks, stroke, obesity and diabetes - which may explain why some psoriasis patients may be at an increased risk for developing these other serious conditions.

He goes on to say that people with severe psoriasis are likely to die 5-7 years earlier than those without.

Upon reading this, I went racing off to PubMed to try to locate some of this comorbidity research that Gelfand is talking about (especially the stuff that says I'm gonna croak soon), and ran across this 2008 article. Here are some highlights from the abstract (italics mine):

The risk factors of cardiovascular disease and other disease comorbidities appear to be more common in patients with psoriasis compared with the general population. To support this concept, the association between psoriasis and cardiovascular disease and other comorbidities was analyzed... from 1127 patients with psoriasis and a matched cohort of nonpsoriasis patients. Psoriasis patients were significantly more likely to have cardiovascular comorbidities... compared with nonpsoriasis patients. Other comorbidities significantly associated with psoriasis were arthritis, depression, sleep disorder/insomnia, chronic obstructive pulmonary disease, and gastroesophageal reflux disease. Responses to this large survey confirm that patients with psoriasis have a higher rate of cardiovascular risk factors and other comorbidities compared with patients without psoriasis.

Wait, wait... now I'm confused. Because I have psoriasis, I'm more likely to have arthritis? So...am I a patient with psoriasis, and the psoriasis is manifesting itself through the comorbidity of arthritis?

Or, am I a patient with psoriatic arthritis, which is an inflammatory condition similar to rheumatoid arthritis, but I also have some skin stuff going on too??

It's all just so blurry, and leads me back to questioning the diagnostic process again. I think I'm going to go back to reading those autoimmune books. While there's still time.

What am I hiding?

Even after 38 years with psoriasis and 15 years with swollen arthritic knees, if someone asked me if try to hide the physical traces of my disease, I would deny it outright. In my idealized view of the world we should be judged on who we are, not on how we look. For the sake of my daughter, I'd like to think that I live this ideal.

But truthfully, I do hide.

I didn't recognize how much until I read this article from WebMD on how to camouflage your psoriasis or psoriatic arthritis. I was truly surprised to realize that I do use many of the tricks recommended in this article. My wardrobe is the offspring of embarrassment and years of trial and error. I don't wear dark colors often. I won't wear shorts - haven't in years, because my knees are so huge. I wore long gloves at my wedding to cover my scabby elbows. As for cosmetics - well, that secret will stay with me.

I'll resist the urge to write a pedantic paragraph about women's obsessions with our body images, the powers of marketing, modern feminism, and "Our Bodies Ourselves". You have all heard it before, and I'm sure you'll just agree with me.

Instead, I'll just end with a question - why do we feel better physically when we look better?

More power to Tim Gunn.