My Psoriasis: routine update 2-3-2016

This is a follow up to my post of  “I. Hate. Psoriasis!” and My Psoriasis act two: successful treatment.

Whenever I searched for information on Psoriasis, I was always disappointed that there never seemed to be any updates after the fact showing how things turned out.  For this reason I am going to give my current status.  As of this date, I am still in remission.  My skin remains clear, with only two or three small red bumps here and there.

I include a photo of my back to demonstrate where I am at in regard to my condition.

back 2 3 16 cropped(Click on photo to enlarge.)

So to summarize, my first flare was from Sept 1, 2011 until mid April 2012.  The photo at the top of this post is from that period, taken near the point it was at its worst.  I had a second flare starting for all intents and purposes July 1, 2015 lasting until September 2015, or roughly 10 weeks this last time vs 30 weeks before.  Since mid September I have had no problems at all.

 

b4 and after 200 res dates copy(Click on photo to enlarge.)

The above photo is from my first flare up, during and after.

backs upper quad 8 31 2015 resz(Click on photo to enlarge.)

The above photo is from my second flare up, during and after.

One thing I wish to make clear.  I am not a doctor.  I am not going to prescribe anything to anyone for any reason. My intent with this and previous posts and with any later posts remains the same.  I wish to say this is what happened to me, this is what I decided to do about it and these are the results.  I am not attempting to foist off any “special cure” or miracle cure or anything of the sort.  I cringe when any one uses the word cure in relationship with any immune disorder or condition.  I urge anyone with the condition to run, not walk, to the nearest exit anytime anyone tries to sell any cure, SURE CURE or Guaranteed Cure in conjunction with psoriasis.  There ain’t no such creature.

I use the word remission to describe my current psoriasis free condition with deliberation because I do not feel I have in any way “cured” it.  There is no curing it, given the current state of the Medical Arts.  All I have been able to do is put the Genie back into the bottle and for now, at least, put the stopper back in as well.

My treatment regimen to end the flares was as follows: Omega 3,6,9 (Fish, Flax, Borage oil) @1 gram gel cap, Milk thistle @250 mg standardized extract gel cap, Evening Primrose Oil, @1 gram gel cap vitamin d3 @5000 IU + @2000 IU (total of 7000 IU) taken twice a day, once after getting up in the morning and then again just before going to bed. To this I added Resveratrol @ 250 mg capsule, Luteolin Complex @ 1oo mg capsules and Quercetin & Bromelain @ 656 mg capsule.  In addition I took for a time Resveratrol @250 mg capsule, but I hesitate to recommend this final item unless it is the version which is not  sourced from Japanese Knotweed.  (Simply put, Resveratrol from Knotweed may contain emodin unless specifically removed, and emodin may cause diarrhea.   The removal process increases cost, so choosing the cheapest form of Resveratrol is not necessarily the best choice in this case.)

In addition I took 1 Allegra 180 (or the generic equivalent) and a variety of NSAIDS (Ibuprofen,  Acetaminophen, Naproxen sodium) taking 1 of the three per day in rotation.  Simply put, my purpose in this choice of treatment was to take as many anti-inflammatory products as I could with the goal of these different anti-inflammatory compounds tackling a different inflammatory response mechanism in the body.  On the first flare, I did not use the luteolin or quercetin.  Also the vitamin D3 was at a lower consumption level of 2000 IU taken twice per day.

As I noted, the second flare was stopped much more quickly than the first.  I attribute this to the Luteolin and Quercetin plus the large increase in vitamin d3.  When I started taking the Luteolin and Quercetin, the guttate quit immediately, thus stopping the expansion of the flare.  In both cases, the flare started by way of guttate bumps showing up and then expanding in size to form large areas of plaque as well as near continuous erythrodermic psoriasis filling in almost all the remaining skin.  Stopping the guttate was the start in causing the remission of the psoriasis.  When I doubled the amount of vitamin d3 from 7000 IU per day to 14000 IU per day (after reading this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897595/ ) my involved skin was like a video running in reverse as it quickly began to clear.

The longest and slowest part was my lower legs from the knees down.  Clicking the links (above) on my earlier posts gives more detailed information about that.

The overall  methodology behind the madness of what I took was to moderate the various inflammatory pathways in hopes of reducing the severity of the psoriasis flares and thereby, ultimately, to send it into remission. The idea was to moderate the reactions of my immune system: moderate as many of the various elements rather than to attempt shutdown of the entire immune system.  Most the drugs intended to deal with psoriasis uses the approach of dialing back or shutting down the immune system and its responses.  The draw back to this approach is that once initiated, the system has to be kept in that shut down mode or else the psoriasis returns, often with a vengeance.  Also, with the immune system responses curtailed, the body is subject to being afflicted in many other ways.  With the immune system shut down, people are vulnerable to a number of different problems which may range from colds, flues and the like, all the way to various fungal, yeast and other infections all the way to various cancers.

So, my intent was not to shut down the immune system, even partly, but rather to introduce substances which moderated the various inflammatory pathways in order to cut back the immune system over reaction. The idea was to slow all the reactions down rather than trying to curtail them.  The most simple description of Psoriasis is the over reaction by the immune system to something within the body.  The plaques, the over production of the skin and all the other symptoms are the consequences of that over reaction.   When this overreaction is moderated sufficiently, the body then has a chance to heal and once healed, there is nothing for the immune system to react to and the psoriasis goes into remission.  That, at least, is my theory.

For those who are interested, here are charts which show some of the more important inflammation pathways:

F2.large

(Click on photo to enlarge.)

From here: http://ard.bmj.com/content/64/suppl_2/ii30/F2.large.jpg

h_inflamPathway(Click on photo to enlarge.)

From here: http://www.genecopoeia.com/product/search/pathway/h_inflamPathway.php

nihms271399f1(Click on photo to enlarge.)

From here:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081099/figure/F1/

Simply put, most nsaids (non-steroid anti-inflammatory drugs) such as Aspirin, Ibuprofen, Acetaminophen, Naproxen Sodium, etc. tend to work due to their actions upon the Cox-1 and Cox-2 inflammation pathways.

(More info here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743815/ )

NSAIDs are a class of drugs with distinct chemical structures. However, they can invoke the common therapeutic effect: an anti-inflammatory and anti-neoplastic effect [1]. The key molecular mechanism for this type of anti-tumor drug is the inhibition of cyclooxygenase (COX) pathway, whose center components include cyclooxygenase-2 (COX-2), cytosolic glutathione transferases (GSTM2, 3), and prostaglandin E2 (PGE2). In this pathway, key steps are the enzymatic conversion from arachidonic acid to prostaglandin G2 (PGG2) catalyzed by COXs (COX-1 and -2) and subsequent conversion from PGG2 to prostaglandin H2 (PGH2) catalyzed by the same enzymes. Each downstream component (including PGE2, PGI2, PGD2, PGF2 and TXA2) derived from PGH2 has its unique biological functions to mediate inflammatory responses and to involve pathophysiological processes [2,3].

Each one also tends to work on other pathways as well, ones unique to the particular formula.  However, there are other inflammatory pathways and cascade cycles involved with psoriasis, particularly in the il-# sequences.  I am not going to go into all of them here and now, but in general it seems that the Omega oils are particularly involved in these and do seem to help in moderating any over reaction of the T helper cells and the TNF pathways.

To put it most simply, there seem to be a large number of inflammatory pathways, each uniquely different  each of which which require different compounds to either moderate or to end production the compounds which produce the actual inflammatory condition.  Most of these pathways when they are initiated, also have have substances produced which would normally act as an “off” switch to the procedure.  It is my thought that often in the overreaction of the immune system, these “off” substances are either not produced in sufficient quantity, or they are swamped or eliminated by other agents produced in a similar but unrelated inflammatory pathway.  It seems to me that no one of these inflammatory pathways is responsible for the condition, but rather that many of them wind up being triggered and the way each one operates may actually interfere with the way another operates.  The end result is a runaway problem which continually spirals into a worsening and more worsening condition.  It is a feedback upon feedback upon feedback situation.  What needs to be done to end it is to moderate each of those  feed backs, to slow down each one so that they can be brought back under ordinary control.

At this point I will go into some of the rationale behind each of what I took.  Omega 3 tends to be a general moderator of inflammation.  There are numerous studies which support this idea.

http://umm.edu/health/medical/altmed/supplement/omega3-fatty-acids/

Research shows that omega-3 fatty acids reduce inflammation and may help lower risk of chronic diseases such as heart disease, cancer, and arthritis. Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognitive (brain memory and performance) and behavioral function. In fact, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision and nerve problems. Symptoms of omega-3 fatty acid deficiency include fatigue, poor memory, dry skin, heart problems, mood swings or depression, and poor circulation.

Now there is no particular reason why I chose to use the Omega 3,6,9 version other than it was a handy selection from Walmart when I went searching for the substances upon my first flare up.  This product sees to me to have some synergistic value in that the formula does more than just what fish oil would.  I have no evidence to support this but as they say, “If it works, don’t screw with it.”

I chose to take Evening Primrose Oil because at one point in time it was prescribed for eczema in the U.K.  Now it is asserted that there is no evidence that EPO has any benefit or has any value in reducing any of the symptoms of psoriasis or any skin disease for that matter.  As in anything, I tend to question how much of these assertions are related to  the methodology of the FDA in approving new drugs and the entire research process related to the approved drug market.  There would be no profit to anyone if any of the more common supplements could be induced to treat the problem, so there is little incentive to study them in this venue.  I did find some referneces that suggested EPO might be beneficial in “tightening” soem small capillaries.  Since my Psoriasis was accompanied by considerable Eryhtrodermic or “red skin” psoriasis, I felt that anything which might reduce bllod pooling could be beneficial.

I began taking Milk thistle because the literature I read all seemed to point at Milk thistle being of benefit to Liver health.  One of the problems that Psoriasis presents is that there is a lot of bio-chemical compound released at the various stages of the psoriatic cascade and once these compounds are in the blood, they can do harm to other tissue and cells with in the body.  The primary method of removal of these compounds is the liver, so anything which might even marginally improve liver function should (in theory at least) be beneficial.

Vitamin D3 (or a vitamin D analogue) is one method of Psoriasis treatment.  It is primarily a topical treatment accompanied by UV light treatment.  The link I posted above suggests there may very well be a place for oral vitamin D3.  I do not feel that low vitamin D levels is cause for a Psoriasis flare, but there seems to be a significant number of papers that suggest a correlation of some kind between low vitamin D levels and psoriasis.  My feeling is that vitamin D3 acts in a manner that increases the “leverage” or the efficacy of the other treatment elements.  (On a strictly personal note, it is my impression from all the research papers I have encountered in relation to vitamin D3, that the RDA for vitamin D is absurdly low.)

I took the Allegra 180 as a very good anti-histamine.  If there is any element of allergic reaction in the psoriasis flare up, I felt the Allegra would be beneficial.  Also, it seemed to help in reducing the amount of itching and discomfort I experienced.

Resveratrol, Luteolin and Querctin with Bromelain.  These three are all reputed to have very strong anti-inflammatory properties and in line with the objective of my treatment philosophy, each seem to operate on a different pathway.  I chose to take these for that specific reason.  As I said, I now realize I needed to find a different source for the Resveratrol. If I need to  use this procedure again, I will endeavor to find a source of Resveratrol which uses only grapes and grape-skins rather than going with the Knotweed sourced product.  The diarrhea is not fun.

Now for the 64 dollar question.  (Or perhaps the 20 thousand dollar question, considering the cost of the biologics currently in use to treat psoriasis.)  Will this work for anyone else?  The only answer I can give is simple.  I do not know.  I have no way to know.

All I can do is say this is what happened to me, this is what it looked like, and this is what the result was.  This process worked well for me.  That is all I can say.  I had two bad flares.  I am now free and clear of the condition.  I offer what photo evidence I can.  Beyond that, all I can truly say is good luck to anyone with the condition.

 

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