Erythrodermic Psoriasis Help!

Posted Sat 23 Apr 2022 14.48 by s1640823 (edited Sat 23 Apr 2022 16.32 by s1640823)

I'm 24 years old and writing to you from my hospital bed. Before January I had never really had psoriasis before other than the odd patch of dry skin. However, since Jan 2022 that has sadly changed. On the 20th December 2021, like many others, I went and got my booster vaccination like many others. For the first couple of weeks, things were fine. I had no issues or side effects.  On the 17th Jan I sent pictures to my GP of some small but quickly spreading scales. I was given some hydrocortisone cream and paraffin and told to keep the skin well lathered to reduce the spread. At this point I was still working in retail, but the psoriasis continued to grow out of control into large thick scales that covered my lower legs, forearms, face and scalp. After having numerous conversations with the gp practice over the AskMyGP app and calls to NHS 111 to try get my appointment rushed through, a receptionist felt so sorry for me after seeing my pictures that she bumped me up the waiting list for a couple days time. Again, I went to the GP and was prescribed more steroid creams and tubs of emollient. Showing what I think is quite a lot of mental fortitude, I followed the instructions to the letter on my own at home for the next couple of months. Yet my symptoms continued to get worse and worse. The psoriasis changed from large scales into fiery red planes of flaky skin. This became unbearably sore and itchy. No cream nor tablet I was given from the GP - and believe me, there were so so many types - did it's job and I had to start claiming sick pay, staying home to apply greasy, uncomfortable and itchy creams all day.  Once again, I went back to the gp and finally it felt like I was being taken seriously as a patient. My GP was able to refer me to the dermatology clinic and I was given an appointment the following day (which I appreciate during a pandemic is a miracle in itself). I struggled to walk to the clinic but got myself in the door. Sadly, the first couple appointments I was given yet more steroid creams and emollients which did absolutely nothing. I continued to decay until over 90% of my body was covered in the red, angry psoriasis. I began to have terrifying episodes of the shivers combined with burning hot skin, I would lose circulation in my fingers and toes and they would turn blue. After many long discussions over the phone, the following appointment I was admitted to the Western General hospital in Edinburgh on the 23 March. Almost everyday for 2 weeks roughly, a dermatology consultant came to see me, sadly, they kept prescribing the same unhelpful treatment, only reducing the strength of the steroid cream. At this point, I became aware that I would have to leave my flat to be with my partner who could better take care of me. However, she lives roughly an hour's drive away, meaning we'd need to find a new flat together, putting more pressure on myself and her. After the worst episode of the shivers (in which the nurses had to act quickly to reduce my skin temperature and increase circulation), a consultant finally decided I could take immunosuppressants, in this case ciclosporin. While the medication can be risky, I finally felt like I was getting somewhere. The psoriasis began to shed very quickly in massive amounts. A nasty side effect was that my skin became so tight, particularly around my face. I was assured that this was good progress, and I did start to feel better. One of the only drawbacks was the need to continue the steroid creams and emollients but I nevertheless persevered. On April 1 I was discharged from hospital, and I went to stay with my partner in her flat. For the next few days, my skin seemed to plateau at a point of dry, red and sore itchiness. I tried countless times over the next couple of weeks to get in touch with dermatology but nothing happened. Since the beginning, dermatology had assured me I needed no sleeping medication despite 3 months of no sleep. I still struggle now, every night I am awake itching and sore. This was perhaps the most frustrating part of my treatment because I understand that they can be addictive in the long term, but I need sleep to get better, and without them, I get nowhere. On 15 April, I had yet another shivering episode with blue digits, and I was sent to the hospital in my partner's hometown. After an approximately 12 hour stay, seeing no dermatologists, I was sent home with more creams and told nothing new. In fact, the dermatology department in Edinburgh were not even informed that I was in hospital to my own dismay. I was so frightened because I was told by a consultant in my previous stay that if this continued, I would lose weight rapidly and fluids to my body. I like to compete at a high level of sports, so learning how my body was damaging itself was unbelieveably distressing. Yet again, I struggled on home, and diligently applied creams and took my medication. While again not getting to the source of the problem, the doctors fail to understand the impact this was having on my partner as well as me. She spends a lot of her time applying my creams, sorting my meds, washing my emollient covered clothes, running errands to the pharmacy in Edinburgh for me, and staying awake with me at night while I suffered in pain. She deserves a medal for all this, something which nobody accounted for and for which she was given no support. After my symptoms decayed further, I contacted dermatology in Edinburgh, leaving 4 voicemails and receiving nothing until the evening of 20th April, in which I was told that I could come into the clinic for a review of my medications in a couple days time. Yet they continued not to promise any change in meds as they wanted to wait even longer to see if the ciclosporin would work better. I understand they have protocols, but I think that enough time had passed for me in severe pain and discomfort to know that it was not helping enough. Sadly, I never made it to the appointment. On the night of 21 April, my skin was so painful that I was yet again admitted to hospital via A and E. A 40 long minute wait in the queue and counting for NHS 111 was not acting fast enough for me to get treatment. After a short wait, I was triaged. I have been in hospital for 2 days now and still have not been seen by a dermatologist. I am at the stage where I flatly refuse to use steroid creams until I am 100% sure what is happening to my skin, and what the best course of treatment is. When I express frustration, all I get is empty "ohhh I understand where you're coming from" or "that looks so sore, I wish we could do more to help". The doctor here finally got in touch with the dermatologist in Edinburgh who has just blindly recommended that I just carry on with creams without even examining my skin. This is the point where I feel my mental fortitude can't go any further and why I write to you. These last few months have been the most trying of my entire life. The sheer exhaustion, both mental and physical, i worry have caused me long term trauma. 4 months of my life have been wasted by NHS bureaucracy and problems with staffing. I do not criticize individual staff by any means as they work so hard and do their best by me. But the system through which they work is so broken that it leaves people like me as sitting ducks, waiting for an infection or something worse to take hold before they are allowed to act properly.  My family and friends are worried sick, with no idea what to do to help or what to recommend. I'm at the stage where, even though I can't control it, I feel guilty about having to get people to chip in so much and help me. I hate being a burden, and this is how I feel now, as irrational as it is.  On top of all this, I suffer with OCD and Generalised Anxiety Disorder which means I can find it hard to process these kinds of changes to my lifestyle. Understandably I'm not in a great mental space at the moment, but I'm hoping posting on here will get it off my chest somewhat. Many thanks.

Posted Sat 23 Apr 2022 15.01 by SharonG

@s1640823 I really don't have any advice for you medically I just want you to know that us out here care. If I was you I would stay put in hospital and just refuse to leave until somebody somewhere helps you - I think that it's disgusting that you are having to suffer in this way - just say NO! You are staying! Sorry that I cannot be more helpful - thinking of you xx

Posted Sat 23 Apr 2022 15.24 by lizziep

@s1640823 Like Sharon, I don't have anything very useful to add, but I was very moved by your post. I hesitate to suggest going privately because of the cost, but one appointment privately and then asking to be moved to that dermatologists NHS lists, would at least mean you had a name to be contacting. You'd have to make sure you chose one who practised in your local dermatology department, of course. All the best.

Posted Sat 23 Apr 2022 15.31 by SharonG

Hi There is a Facebook Group - there is a lot of helpful advice from other folk that suffer - If you have Facebook then check it out. https://www.facebook.com/groups/486402214847452/ Psoriasis support group Uk I am sending for this ointment as a lot of folk have tried it with good results but it is only 40g Really feeling your pain :( Cold Tar and Salicylic Acid https://www.amazon.co.uk/dp/B082D1Y58X/ref=pe_27063361_485629781_TE_item Just trying to help.

Posted Sat 23 Apr 2022 15.40 by s1640823

Thank you for your kind words! Even just knowing that there are others out there who understand helps me to cope with the mental struggle! I will certainly check out that ointment Sharon!

Posted Sat 23 Apr 2022 15.44 by Steview
A P sufferer for over 30 years, through good and bad times.

Hi, sorry to hear of your current situation. In light of what you describe you are in the right place. Have the docs diagnosed you with Erythrodermic P? I have read both yours and your parents post and you are going through the ringer at present and rightly your parents are concerned for you. In the help post it says you have been prescribed a low level immuno drug, is this Cyclosporine? T.b.h. this is hardly low level, it can be a very effective treatment for some but can take weeks to notice a change. I am not sure why they have apparently stopped it so soon. It can be used in combination treatment with other treatments. The doctors must have their reasons for stopping. Many of us have spent time in hospital so fully understand and sympathise what you are going through physically and mentally. As another poster commented it may be best to stay in hospital until youvare stable and have a successful treatment regime. I wish you well and hope that something starts to work for you.

Posted Sat 23 Apr 2022 16.11 by s1640823

Hi Steview, Thanks so much for your response. I think with the ciclosporin my parent's wires and I got crossed. They live far away so I have to explain everything to them by text or phone. I've been on it for 4 weeks now, on Monday they're looking to change it to a more powerful immunosuppressant which is hopefully (even though it has potentially harmful side effects) the beat course forward. All the best.

Posted Sat 23 Apr 2022 16.17 by lizziep (edited Sat 23 Apr 2022 16.17 by lizziep)

Hi s164823 I was on Cyclosporin for a number of years without adverse effect - the Prof told me the risks were small, I then went onto Skilirence for many years - perhaps 20 and I tolerated that really well and had no psoriasis -although it's not for everyone as it can cause stomach cramps and/or diarrhoea. Fingers crossed that they soon find something to help you.

Posted Sat 23 Apr 2022 16.29 by s1640823

Hi Lizziep, Thanks for your message! It's good to talk to someone who has had the same medication. I think they're considering putting me on methotrexate which is apparently very strong. I'm slightly anxious about the side effects but I feel like I don't have any other option.

Posted Sat 23 Apr 2022 16.39 by lizziep

Hi s16 - there are plenty of threads on here about Methotrexate - lots of people on that - I did start it, but it didn't agree with me. It's trial an error until they find something right for you.

Posted Sat 23 Apr 2022 17.21 by SharonG (edited Sat 23 Apr 2022 17.26 by SharonG)

@ s1640823 I think: The main 3 drugs appear to be Cyclosporine - Methotrexate - Acitretin - these are what they try first - if there is no improvement with any of these then I think they try biologics - not sure how many of those are available - I think it is a process of elimination which is why you need to stay where you are until they find what suits you. Please anyone correct me if I am wrong. I have refused the drugs so far but now I think it will have to be my next step as my PPP (palmar plantar pustulosis) is getting worse and I can no longer control it with steroids etc. I have had this since 1998 and it is gradually getting worse year on year - I have it on the soles of my feet making it difficult to walk! So now it is becoming debilitating so? drugs here I come lol just waiting on a dermatology appointment - that could be the 12th of never at the moment - roll ma eyes lol Biologics: https://www.psoriasis.org/biologics/ Just try not to let it get you down - we are all here to listen and help.

Posted Sat 23 Apr 2022 18.28 by Steview
A P sufferer for over 30 years, through good and bad times.

Hi again, for info methotrexate and cyclosporine are both strong immunosuppresive meds. Cyclo is often used as a short term treatment to at least get you in a stable position when other treatments can take over. It is also possible to have a combined treatment of cyclo and mtx to try to get a quick fix with cyclo then letting mtx carry on the work. That was the case for myself many years ago, around a year on cyclo and mtx then mtx for about 10 years. It worked well but everyone reacts differently of course. Acitretin is a different type of med although not an immunosuppresent. Normally if you have tried at least two of those then biologics are the next option but you have to go through all the hoops first, they can be great meds. I know it is hard at the present with your situation, I spent many months in hospital when I was a little younger than you so know what you are going through. Times are different now, science and P meds have moved on in that time. There are people to talk to or just sounding off on here may help. Take care.

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