Pustular (pronounced Pus-tew-ler) psoriasis is an uncommon, but potentially very serious type of psoriasis. There are two main types of Pustular Psoriasis: Generalized and Localized. If it widespread over the body it is referred to as Generalized Pustular Psoriasis; if it is limited to just one part of the body, it is referred to as Localized Pustular Psoriasis. There are two types of Localized Pustular Psoriasis: Acropustulosis, which occurs only on the tips of the fingers, and Palmo-plantar pustulosis, which only occurs on the palms of hands and/or the soles of feet.
Palmo-Plantar Pustular Psoriasis
In general, Palmo-Plantar Pustulosis is localized to the palms of hands and/or soles of feet. It normally occurs in people between 20 and 60 years old, may be triggered by infection and/or stress. It has also been found to affect females more than males. As with Generalized Pustular Psoriasis, Palmo-Plantar Pustulosis occurs in a cyclical pattern, with new pustules occurring after a period of low-to-no activity.
How is Palmo-Plantar Pustulosis treated?
Palmo-Plantar Pustulosis often proves stubborn to treat. Topical treatments, such as corticosteroids, are usually prescribed first. PUVA, acitretin (Soriatane), methotrexate or cyclosporine (Neoral) sometimes must be used to clear this form. Combination treatment with PUVA and Soriatane (called RePUVA) may also be effective.
Notice that doesn't say "Cured". It only says "treated" because there is not yet a cure. I believe one day there WILL be a cure but until then, thousands of sufferers can only treat their psoriasis. Some will get their psoriasis to go into remission. Others like myself, battle it on a day by day basis.
My psoriasis story.
About 5 years ago I noticed that I had half a dozen small red spots and peeling skin on the soles of both feet. I thought it had something to do with my diabetes to be honest and since it didn't really give me any trouble I just kept putting moisturizer on my feet and ignored it. Not really a smart thing to do not just because I'm a diabetic but because when anything is going on with your body you should have it checked out by your physician.
So after moving with my husband to northern Michigan from Louisiana I came down with the flu, then I had bronchitis followed by the flu again and finally I ended up in the ER room with a case of strep throat. I had been running a fever of about 101 for 3 days at the time. The doctor gave me a shot of penicillin and although they couldn't get my fever to come down they sent me on my way. I ran that fever for another 2 days before it finally broke. That's when my PPPP went wild. At the time I had no idea what it was.
Well maybe 3 days later I start having little blisters pop up on the palms of my feet and hands. I'm like well this is weird and kind of painful. So everyone in my family says oh yea that's hoof n mouth, I'm like the COW disease? lol ok yes they're country folk. Anyway I end up going to the ER Room again where they tell me they think its Coxsackie Virus, (also called hoof and mouth which made me laugh) gives me an anti itch pill because at this point its really starting to itch, I go home, take the pill, fall asleep, wake up, OMG its worse. Like these blisters overnight completely covered the palms of my hands. There were blisters on top of blisters, skin is getting thick, old blisters turning dark red and I am freaking out.... FREAKING OUT! To make things really bad the anti itch pill which was Atarax. The only thing that pill did was make me sleep constantly.
So I go to the dr, my insurance doesn't cover a dermatologist, and he says, "I don't think its Coxsackie or it would be getting better not worse, I think its such and such Eczema (sp?) I'm like ok dry skin you're kidding right? So he gives me some steroid pills to take, alike a 5 day treatment to get the swelling down because my fingers looked like they were going to pop and a medium duty anti itch cream for the itching. Well the swelling came down dramatically, I only occasionally itch, but then my skin was thick like leather, my hands looked like they were rotting, literally, and new blisters coming up on top of the leathery skin which already still had blisters.
Anyway, I start talking to my brother after someone says something stupid to me "Oh that looks like Leprosy" lol Talk about freaking me out... he gets to looking on the web and finds pictures that look exactly like whats on my hands and they are pictures of palmo-plantar pustular psoriasis. NOW I'm freaking out. I frantically search the web, all I can find out? It cannot be cured. You get it you get stuck with it and your life is slowly taken over and ruined by it.... niceeeee! Just wonderful!
For 4 days I couldn't even pick up a glass to take a drink using my hands and now I'm thinking I have to live this way? So I finally find a wonderful website, The National Psoriasis Foundation. What did I find there? I found that no one there is freaking out as much as I am, so it cant be the end of the world if this is what I have.
So I go to the doctor again. He looks at it and says "No thats not PPPP that's coxsackie I'm positive." He gives me a script for some steroid cream and sends me on my way. At this point this had been going on for almost a month. I'm no fool, I knew there was something else going on and not what this doctor was suggesting.
I end up a week later at Urgent Care. The doctor looks and says he thinks that this is eczema and gives me Presidone 60mg a day for 7 days and a medium duty steroid cream to slather on twice a day. I clear up. Completely. But about 6 days later the blisters start coming back. So I go back to Urgent Care because at least that doctor made me feel he wanted to help. Well he is there but not working so he talked to the doctor who was on duty and she turned out to be very nice, very caring. She tells me that it 'could be Coxsackie' but she thought it looked like possible psoriasis. She gives me a super potent steroid topical. This worked great, although I havent been clear since I took the Presidone. She also went beyond what she needed to do and found a dermatologist who accepted my insurance.
Well I went to the dermatologist. I don't like her. But she diagnosed me right away with PPPP. She gives me a script for Halobetasol ointment which is a super potent steroid and sends me home.
I can only use steroids for 2 weeks at a time due to problems that can occur from it getting into the bloodstream and into my liver and kidneys. Occasionally you'll find me ranting and raving about how I'm feeling. That's part of why I decided to blog here. Although the National Psoriasis Foundation is a wonderful site for information and socializing, its a bit heavy with censorship. You'll know when I post things on my blog that I can't post on NPF's site lol Other than censorship, they're a great place and I recommend you checking them out if you have psoriasis.
That's all for now, sleep well!
6 comments:
Kel... thank you for being brave enough to share your story! Letting people know they are not alone is a powerful contribution to the world!! Your struggles with diabetes, and PPPP are alot to deal with, but yet you find time to help others. :) You are an amazing lady, and I'm glad you are my friend! :)
Thank you again for doing this!! Big hugs, Chrissy
PPPP is the hardest type of psoriasis to treat. It's disabling for many.
Your story is very compelling, the blog well laid out I too thank you for sharing it.
Hang in there!
Karen
Thank you for all the support you've given me in my posts on the forum, it's really encouraging and I think we all need it sometimes. Your blog is really lovely, and you are much braver than me with posting your photos. Hopefully I will work up the nerve soon!
- Meg
Soriatane worked very well for me in clearing up the worst blisters. I was probably about 80% clear after 3 - 4 months. My fingernails totally cleared which was a blessing because they were severely pitted. 6 months later, I started having severe sensitivy to light. If sunlight reflected into my eyes, I was totally unable to recover my vision for dangerous seconds while driving! I developed night blindness. If it rained, the rain drops seemed to go straight through my eyes. When it snowed, driving was absolutely impossible due to extreme difficulty concentrating while trying to not look at the flakes blowing across the windshield. I started driving with not one but 2 pairs of dark sunglasses on in bright sun as well as evening. Headlights were the absolute worst. Oncoming cars would totally blind me. I couldn't even look near the tail lights. On the day that I quit Soriatane, I was driving in my neighborhood and saw a neighbor walking his little dog. In the next moment, a ray of light reflected from my side mirror into my eyes and I was totally blind. I just stopped right in the middle of the road, unable to see anything.
It took months before I could stop wearing the 2 pairs of sunglasses. Now, 2 years later, I still have night blindness. You cannot take this if you have any chance of becoming pregnant. You can't give blood for 5 years. This is serious stuff.
My nutritionist claims that enzymes in milk aggravate this. I am now only drinking almond milk.
You also cannot take any vitamins with large amounts of Vitamin A in them. I also became extremely allergic to any fish oils. I would get purple rashes all over my body and my mouth would go numb.
I had to carry liquid Benadryl in my car.
Exposure to sunlight on my arm while driving would result in extreme sunburns with relatively little exposure.
For now, my PPPP is confined to two toes and the ball of my foot. I guess I'm "lucky" but I had my toes shift and change position and get throbbing pains at time in the only foot affected.
I refused to take Humira because I'm diabetic and because I've always got some crack in the skin or blister and couldn't risk the hit on the immune system.
Believe it or not, taking zinc seems to have helped, and I rub zinc oxide (generic diaper rash cream) on my feet during out breaks, (cover with thick white socks at bedtime) and emu oil to keep the skin soft. Best wishes.
I was just diagnosed last Thursday by my dermatologist with PPPP. I've had it for five plus months. I'm taking a more natural approach because the steroid creams burn my hands. I hope you start feeling better soon.
I have PPP. I also have celiac disease. When I first went gluten free my PPP started clearing up. Then I made some gluten-free cornbread and it came back worse than ever. Potatoes seemed to make it flare too. And salicylates did too. Salicylates are found in asperin, and also in many friuts and vegetables, berries are particularly high in sals. It took 14 months being away from these foods before my gut healed enough to be able to start adding some of them back to my diet.
I am now totally free of the PPP! My hands are totally clear and my feet are still red but no new pustules. I have been clear for several months now and the only time it flares is when I get an accidental glutening.
I truly believe that at least for some of us, diet is the key. It wasn't easy and as I said, it took the better part of a year before I had COMPLETE healing, but it only took a few weeks before I saw improvement so I knew I was on the right track.
Psoriasis is now known to be one of the symptoms of celiac. There is info about this relationship on many reputable sites, such as the Mayo Clinic and NIH.
I thank God I was diagnosed with celiac because not only has the gluten free diet stopped my digestive symptoms and my psoriasis, but the insomnia I have suffered from for years is a thing of the past. My ankles no longer swell, I no longer have heart palpitations, nor do I get the frequent cold sores. And on top of that I am eating a much healthier diet.
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