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gt;plaque psoriasisgt; in her 30s and struggled to find flattering clothes to wear. gt;gt;"The first and most important step for any individual who has psoriasis is to seek gt;treatment from a dermatologistgt;," Gunn says. "It's the first step in managing the symptoms, achieving fashion fabulousness, and navigating the world with exceptional confidence and joy." Here are his top six tips for looking your best with psoriasis. gt;gt;gt;1. Realize the importance of undergarmentsgt;gt; "They should be cotton or silk and feel good against your body. Undergarments serve as a frequently necessary barrier between the surface of your skin and your apparel. Undergarments are especially useful when gt;lotions or ointmentsgt; are being applied to the skin, because they prevent your apparel from stains. Furthermore, they can wick moisture away from your skin." gt;gt;gt;2. Don't be afraid to show off your legsgt;gt; "Women with psoriasis are frequently inclined to wear pants rather than skirts. I suggest that you consider skirts with opaque tights as a feminine and fashionable option to pants." gt;gt;gt;3. Skin-tight is a fashion faux-pasgt;gt; "Women should consider loose-fitting items that don’t hug the body or constrain movement. Provided that the psoriasis in not in or around the waist, the items can be belted to give them—and you!—some shape. This is more difficult for men who must wear suits. For them I repeat the virtues of undergarments." gt;gt;gt;4. Lighten upgt;gt; "Consider wearing light colors and patterns to mitigate the skin’s flaking, one of the problematic side effects of psoriasis. Choose lighter-weight fabrics that breathe, such as cottons and silks, which are generally more comfortable. Any heavier-weight fabric, like wool, will be uncomfortable, by definition of the pressure it puts on your skin. Linen can be uncomfortable, too, because of its uneven, slightly stubbly surface." gt;gt;gt;5. Build an outfit layer by layergt;gt; "Layering is beneficial to all of us, because it allows us to respond to fluctuations in temperatures—our environments and our own. Overheating can be very uncomfortable for individuals with psoriasis. And remember the benefits of undergarments for wicking moisture away from your skin." gt;gt;gt;6. Leave the headbands at homegt;gt; "Psoriasis can appear anywhere on the body, including the head and scalp. Patients may think that these accessories will hide flare-ups, but if the psoriasis has not been effectively treated, then the hat or headband may exacerbate the pain." ]]>

gt;gt;I was diagnosed in 2005 after going to the doctor with soreness in my back and a spot of psoriasis on my foot. But it wasn’t until early 2007 that my condition got really bad. I was living in Illinois and didn’t have insurance so thought I couldn’t get any help. gt;gt;By the time I went to the hospital, I had to get six pints of blood because I was so anemic. I was there for five days in January with all kinds of doctors working on me, and I had to go back for five days in February. My feet were so bad that they had to soak them because the psoriasis was about an inch thick. When I left the hospital, I had to wear cast boots even in the winter in the snow. gt;gt;When I finally left the hospital, I spent the next two and a half years filing for disability. I knew there was help down the road, but I didn’t realize I could get care before the disability kicked in. I was living in Iowa by that time and they had IowaCare, a health insurance program that allowed me to see a doctor. When I got this, I was finally able to get back on my feet and get around a bit. gt;gt;I assumed there were other people out there who were laid up as well with all kinds of health problems and didn’t know they could get help. Some were probably too stubborn to get the help they needed or weren’t educated about what was available. So I decided to go on a trip to spread the word. gt;gt; gt;gt;A cross-country journeygt;gt;I ordered a Harley and got it just before my trip. My bike has three extra wheels on the back—two of them are like training wheels—because with my arthritis, I don’t have the strength to hold the bike up. Most of my pain is in my lower body: my ankles, my feet, and hips. The motorcycle is easier for me to drive than a car because I can use my arms and wrists to drive it. gt;gt;I decided to take off about two weeks after I got my bike. I knew the day I was leaving and the day I was coming home and the order of the states I would travel through. I was on the road for three months and traveled across 48 states. I never knew where I was going to stop, and I often stayed in small towns. gt;gt;I talked with people and spread the word about chronic pain and how people can get help. I am working with a production company that is helping me by filming people who are suffering from pain. I call the cause PURPAL, People United Relieving Painful American Lives.gt;gt;About halfway through my journey last year, I hit the gt;Medicare "doughnut hole"gt;. I quit taking Humira and my pain got really bad this winter when I got back to the snow and the cold. gt;gt;I began taking the medication again in January and could tell a difference immediately. I take a shot every week (my doctor recently upped my dosage) and they are about $900 each. I have taken six shots so far this year and hit the "doughnut hole" in early February already. But I got a present the other day. The HealthWell Foundation, a nonprofit that helps people pay their medical bills, told me they will cover $2,800 of my prescriptions. And with the new health-care reform, my Medicare Part D will cover 50%, too. gt;gt;So, this year I will do a lot more. I’m planning on going out again too. I’d like to bike to the NPF [National Psoriasis Foundation] meeting in D.C. in June. I’m hoping to find a sponsor this time around; I didn’t have one last time. It was all me, to prove to others—and, most importantly, to myself—that it could be done. ]]>

gt;gt;It has also been a great motivator, and when I’m helping people deal with psoriatic arthritis, I forget that I’m that person as well. gt;gt;And I’ve been that person since about the age of 12. I was in pain but doctors always dismissed my arthritis as growing pains. My dermatologist thought I had a fungal infection instead of psoriasis, and they never put two and two together. Eventually my doctor diagnosed me with arthritis, but just told me to take Motrin for the pain. gt;gt;I was officially diagnosed with psoriatic arthritis when I was 26. By that point, my neck had started to fuse, my jaw was fusing, my knees would swell really badly, and I was walking with a limp. When I could barely walk anymore, my dad came to me and said I needed to see a specialist.gt;gt;Before that, I didn’t even know what a rheumatologist was, and my doctor had never suggested that I see anyone else. I come from a family that always looked to natural ways to heal whenever possible. We kept trying things like changing my diet, and I spent about five years—and a lot of money—going to chiropractors and naturopaths. gt;gt;The gist of it is that I didn’t really know what to do. I honestly thought I could cure my psoriatic arthritis naturally. And maybe some people do. I believe in holistic medicine and chiropractors, but they just didn’t work for me. Looking back now, I think if I had gotten help earlier, I don’t think my body would have as much damage.gt;gt; gt;gt;I was hospitalized for 11 daysgt;gt;When I was finally diagnosed, I was put in the hospital for 11 days because I had so much inflammation. They started me on anti-inflammatories and systemic medications. I didn’t want to go on methotrexate because of its possible side effects, but we couldn’t get my condition under control no matter what we did. With methotrexate, it was about 30% under control; it worked only to a certain extent. gt;gt;Throughout the 1990s, I was on pain relievers, anti-inflammatories, and systemics. By 1997, I had to have wrist replacement surgery in my right hand because mine was destroyed. (I’ve had the surgery again since then, and will have another this year.) I was in intense pain, and I’d already been on disability because I couldn’t do anything. gt;gt;My doctor had been recommending a biologic for years, but I was dismissing his suggestion because I was scared to take it. He finally asked me what the risk really was since my quality of life was so bad. I started taking one in 2003 and it has really helped me. gt;gt;Once I started feeling better, I decided to try and go back to school so I could get a job eventually. I took one class and after things got easier and I could drive better, I started taking two and doing more things in general. gt;gt;One thing I learned in the hospital—in occupational and physical therapy—was everyday things. I learned how to run my sweeper and got a tool that could help me get out of the bathtub. I used these kinds of work-arounds when I went to school. I ruined a lot of textbooks because I would tear out a chapter at a time so I could carry them with me. gt;gt; gt;gt;I had no social supportgt; gt;In 2003, I also decided to start a support group in Pittsburgh, because I had never met anyone else who had psoriatic arthritis. I felt very isolated and I didn’t have any social support. I wanted to interact with others who had this disease. I saw that I could change people’s lives by having a meeting, just giving them a place where they could come together and talk. gt;gt;I was planning on getting my degree in anthropology, but I changed it to public service. I now plan to work in the nonprofit sector. The experience with other people with psoriatic arthritis really changed the course of my entire academic career. I am now on the Psoriasis Foundation’s board as well as the international board, where I am in charge of advocacy. gt;gt;I am still in a lot of pain. I have nerve damage that can make it difficult to even touch my skin, much less sleep at night. But I’ve learned to work around this. When I go to an international meeting, I just have to plan for a week of downtime after I get back. It’s extremely difficult and really wipes me out. gt;gt;But I’ve learned to plan everything before I go. I plan time to rest, how to get from the house to the airport, and how to get wheelchair assistance when I need it. When I get to a foreign country, I never know what I am going to run up against. Luckily I’m not alone, and when I meet up with my colleagues, things are always better. ]]>

gt;gt;Q:gt; Is it my imagination or does snowy weather make my skin really flare?gt; gt;gt;gt;gt;A:gt;gt; It’s not the snow that aggravates your skin. However, when it snows, and you spend time indoors to keep warm, the dryness of the interior air dries your skin out and that’s what causes your psoriasis to flare. You need to use more moisturizer than usual, and the ceramide-containing moisturizers, like CeraVe or Aveeno Eczema Care, help to maintain the water content of your skin. You may also consider using a humidifier to keep more moisture in the air. ]]>

gt;gt;Q:gt; Are there any natural products that I don’t see in my drugstore that you can recommend?gt; gt;gt;gt;gt;A:gt;gt; Natural products for psoriasis that may or may not be available in your drugstore include:gt;gt;Ceramide-containing moisturizers such as CeraVe and Aveeno Eczema Caregt;Aloe vera creamgt;Psoriaflora or Relieva creamgt;Omega-3 fish oil supplementsgt;Vitamin D3gt;]]>

gt;gt;Q:gt; What is a helpful supplement regimen for someone with persistent psoriasis?gt; gt;gt;gt;gt;A:gt;gt; I would suggest omega-3 fish oil, up to 2 grams 3 times daily. Nordic Naturals is a good brand. And Vitamin D3, up to 10,000 IU daily. You should have your doctor check your baseline level first, and follow his or her suggested dosage for 3 months, then have your level re-checked. Aim for a target of 65 ng/mL.]]>

gt;gt;Q:gt; Yeah, stress triggers my skin problems, but yoga and meditation are not my thing. What works to relieve stress for people who can’t relax?gt; gt;gt;gt;gt;A:gt;gt; Physical activity is probably the best answer for stress management for someone who finds it difficult to relax. It can take many forms, from dancing to rock climbing. Do the types of exercise that you enjoy the most, for at least 3 hours a week. If you are not in good physical condition to begin with, start slowly and build gradually. We all relax when we sleep. So another option is to take a 20-30 minute nap during the day. And lastly, you might consider counseling as a helpful way to manage stress.]]>

gt;gt;Q:gt; Will I pass along my skin condition to my partner? She is afraid to catch psoriasis.gt; gt;gt;gt;gt;A:gt;gt; Psoriasis is not contagious and cannot be transmitted from person to person. ]]>

gt;gt;Q:gt; What do I need to know about the risks of tar-based shampoos and other treatments?gt; gt;gt;gt;gt;A:gt;gt; Coal tar has been a dermatological treatment for over 150 years, both by itself and in combination with other treatments. It is generally lacking in serious side-effects. The biggest complaints with coal tar are typically the smell (just like the tar-covered pilings of a pier), and messiness (it’s typically delivered in an ointment base).gt;gt;A major concern of many people considering coal tar as a psoriasis therapy is cancer. While occupational exposure to coal tar (miners, asphalt workers, or chimneysweeps for example) may be responsible for some lung, skin, and scrotal cancers, no relationship between even high therapeutic dosages of coal tar for psoriasis and any form of cancer has been established. Some 25-year-long studies have found no increase in any form of cancer over what would be expected without coal tar.gt;gt;A problem that many people are not aware of, though, is that coal tar is a photosensitizer. After applying coal tar to the skin, it is important to be more careful than normal when exposing the same skin to sunlight or other UVB light sources. The photosensitivity can make tanning and burning much more easy, and skin damage can worsen psoriasis.gt;gt;Typical therapeutic concentrations of coal tar are around 10% coal tar solution, which is equivalent to 2% crude coal tar.]]>

gt;gt;Q:gt; My skin trouble really makes me depressed. Can depression make my skin even worse?gt; gt;gt;gt;gt;A:gt;gt; Few studies have attempted to evaluated depression in people with psoriasis. The degree of itching is strongly correlated with depressed mood. The shame or embarrassment some people feel about their psoriasis results in avoidance of common social activities, like sports and swimming, which can deprive them of the benefits of exercise and sun exposure. Depression makes psoriasis worse through direct and indirect suppression of the immune system. Some psoriasis therapies may contribute to depression. ]]>