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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Dermatology
Satisfied Customers: 18527
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have what has been diagnosed by multiple dermatologists as

Customer Question

I have what has been diagnosed by multiple dermatologists as psoriasis, but the obvious treatments that I would expect to help (topical steroids such as calcipotriene, triamcinolone, & others) don't seem to do any good. I've Any ideas?
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: (Sorry, I accidentally hit return before I meant to.) I've also tried methotrexate, topical urea, . (And of course, the very first thing I tried was various moisturising lotions and creams.) BTW, it's predominantly palmar/plantar. I also had atopic dermatitis when I was around 10-11 years old on my inner elbows; it responded to some prescription glucocorticoid or other (not hydrocortisone, that's the most I can remember). Current medications: tranylcypromine 20 mg qid; zolpidem 20 mg qhs; buprenorphine, transdermal patch, 10 mcg/hr (previously 0.3 mg IM q.i.d.; cyanocobalamin supplements (I'm not a vegetarian but I eat meat infrequently), 1000mg qd; calcium citrate 1260 mg/day and 1000 IU
JA: What seems to make the symptoms worse or better? In general, how would you describe your health lately?
Customer: (I did it again. The other active ingredient in the calcium supplement I take is vitamin D3, 1000IU/day). My general health is okay, except for chronic insomnia. (My roommate got a cold with coughing and laryngitis and I managed to avoid catching it from her.) As noted, nothing seems to make any difference. How "lately" are we talking?
Submitted: 11 months ago.
Category: Dermatology
Expert:  Dr. D. Love replied 11 months ago.

Hello from JustAnswer.

Have you been tried on any topical tacrolimus or pimecrolimus?

Have you been tried on any immune modulating drugs beyond the methotrexate?

Expert:  Dr. D. Love replied 11 months ago.

I had asked for some further information and have not heard back.

I realize that someone that has been struggling with persistent psoriasis for years has been tried on many different drugs and it may be difficult to list each medicine when posting such a question, but without knowing what has already been tried, I may suggest medicines that you have been prescribed.

When using topical medicines for treatment of the inflammation, the primary medicines are the steroid medicines that you have already tried. If these are not effective, there are medicines that relieve inflammation by suppressing the immune system by a different mechanism, which are the tacrolimus and pimecrolimus that I asked about. If you have not yet been tried on either of these mediicnes, it would be appropriate to do so.

There are also a number of systemic medicines that work to modify the immune reaction. Of the systemic medicines, the methotrexate is the medicine that is most often tried first. When methotrexate is not effective, then the next medicines that are recommended are cyclosporine and acitretin. There are also a number of other biologic medicines that can be tried if each of these have been tried and were not effective.

If I can provide any additional information, please let me know.

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