5 stages of Psoriasis?

Something I was reading on twitter the other day got me thinking about Psoriasis and how you cope with having it.  This goes back to the publication of a paper which showed that those who suffer from psoriasis are more prone to depression than others. I can't even remember the article that was tweeted or who it was tweeted by but it was something to do with mental health in psoriasis sufferers.  What it got me thinking about was something I mentioned in an earlier post....  Does the age at which you first develop psoriasis have any bearing on how you cope with having it?


Take me for example (I can only speak from my own experience), I've had psoriasis since the age of 4.  I'm now almost 36, so that's almost 32 years of having dry, flaky, red, inflamed, itchy skin but I never let it get to me these days.  Why?  I figure that there are stages of psoriasis, like the stages of grief...  You have denial, anger, bargaining (to an extent), depression and acceptance.  Like grieving, dealing with any physical "abnormality" comes with these emotions.  These take time to work through and not everyone manages to get past the depression stage to acceptance.

Looking back on my life I can't honestly say I was ever in denial about having psoriasis (I was too young to understand really) but I know a few with the condition who for years maintained they just had "dry skin" before they were eventually diagnosed. Then again, I hear daily from patients with psoriasis who still think they can be cured, that somehow their psoriasis will miraculously disappear overnight when they try the umpteenth treatment, only to be disappointed again.  I can say with 100% certainty that I have had phases in my life where I got VERY angry about having psoriasis...  The "Why me?" question has passed my lips many, many times over the years.  I've bargained...  Not to any deity in particular, just any one who happened to be listening, obviously that didn't cure my skin!!

Depression seems to be the point where people get stuck... they switch between hope that a treatment will work, and when that fails they become depressed and disheartened.  As I said before, I did the angry and sad thing not really the depression....  I never really hid myself away, although I did cover up most of the time.

It's acceptance that has me scratching my head (not literally or there would be white flakes everywhere) about how you get to this state of being.  It would seem that the younger you are when diagnosed the more likely you are to reach this stage.  I know a few psoriasis survivors who have been diagnosed as adults who have achieved acceptance of their condition but the majority of people I know at this stage are, like me, those diagnosed as young children. Those diagnosed as adults or teens seem less likely to accept their condition and are the ones who need the support of mental health professionals and support groups. It would be interesting to see if there are any papers out there on research into age of onset vs. acceptance of psoriasis.  If not maybe I should re-train and do a study on it.

I don't know how many people actually read this blog, or if anyone is actually on the same wavelength as me. Most other blogs I have read have been quite negative regarding psoriasis and psoriatic arthritis but I guess had I written this maybe a decade or two ago I would have been where they are now.

What a difference a year makes!

So,

This time last year I was running round like a blue arsed fly finalising my wedding preparations. I was also beginning to struggle with stiffness and pain in my hand and wrists. I put it down to stress and lack of sleep on the build up to our wedding day and carried on taking my Naproxen and the occassional paracetamol while working my butt off in the lab.

I figured the stiffness would ease off after the stress of the wedding was over but gradually the pain and stiffness got worse. By February this year (2012) I couldn't go on. I went into work one morning with the intention of getting an early start in the lab and setting up a very urgent experiment only to find that I couldn't grip a pen without being in excruciating pain. My neck, back, wrists and fingers were screaming in agony at the slightest movement. In tears I told my boss I had to go home and left.

My GP was great, I got an emergency appointment and he signed me off work for the week with instructions to rest my hands and wrists and he also sent a letter to the local rheumatology department to get me an appointment.

I followed the instructions of my GP and felt I was well enough to return to work after a week off. How wrong was I?? After 2/3 weeks I was in so much pain it wasn't funny. I struggled to hold a mug of tea or a pen, let alone cell culture flasks, pipettes and microbiological cultures. I went back to my GP and he decided it would be best to sign me off until I saw the Rheumatologist.... IN MAY!!

March onwards is still a blur to me... I was on such strong painkillers that I sat in my pj's most of the time and stared at the tv like a zombie. I tried my hardest to keep up with the housework, cook meals and keep myself busy but it was all too much. I was exhausted all the time, the Tramadol that I had to take every 4 hours made me flaky, gave me horrendous constipation, brought my skin out in spots, and generally wiped me out. As if all this wasn't bad enough I was also dealing with pending redundancy. Guess a lesser person would have been depressed and maybe even suicidal but not me. I took up jewellery making to keep my hands active in an effort to stop them from seizing, I went for long walks (in my lucid moments) with my dogs and I generally tried to keep everything as normal as possible.

I was made redundant just 2 weeks before seeing the rheumatologist.

Since June (took a while for letter from rheumy to get to my GP) I have been taking 10 mg of Methotrexate on a weekly basis. That's 4 months under my belt now. Initially I noticed a decrease in the stiffness in my joints after a couple of weeks. There was still some pain there but that began to ease off by the 1 month point. At this time I was still taking 500 mg of Naproxen twice a day and on my review appointment with my GP I told her I would rather take the NSAIDs than increase the dose of MTX unless I really had to. She agreed, MTX can have some particularly bad side effects and we would both rather minimise those risks.

In September I did something I haven't done in a long time... I forgot to take my NSAIDs for a day... Imagine my surprise when I realised that although I hadn't taken them I had no pain or inflammation in my hands and wrists. That was the day I decided to just let the MTX go it alone. One month on and I feel as if there has never been an issue with my joints. I have full motion in my hands with no pain, swelling or stiffness.

My blood tests are all coming back clear... No drop in RBC count, no elevated White cell count and no Liver enzyme issues. The only side effects I appear to be having with the MTX is that I now contantly run warm (was always cold before) and, because I take it on a Friday, generally feel quite tired on a Sunday.... When that's all said and done though I can live with those side effects!