Tag Archives: Ciclosporin

PSORIASIS BLOG – Treatment Update 10

Treatment Update 10

22/1/2013 – 5/2/2013 (2 visits)

camembert
“It’s all my fault,” said the evil but deliciously oozing cheese and cholesterol level alarmist.

OK numbers fans – my cholesterol is down to 6.8. Still higher than it should be, but nowhere near the alarming levels it was at just after Christmas. Good news for my blood, bad news for whisky and Camembert fans (both of which I consumed in abundance over Christmas).  My liver is totally back to normal (even I can’t deny that not having a drink since January 5th might have contributed to this in some small way).

According to Dr McBride lots of psoriasis patients drink a lot, and even those that don’t can get a fatty liver common amongst boozers, which is something that we have been monitoring. That said, I don’t have to have any bloods taken next time – the reason for my regular donation of plasma recently is to see if the ciclosporin is up to no good in my system. It raises cholesterol amongst other things: another reason to wean me off it. Further impetus comes from the fact that when dosage drops between a certain point (a different place, dependent upon the reactions of each individual patient) it stops working altogether and is fairly pointless. Down to 50g morning and night then, with a view to getting rid of it completely. As a result my arms are a bit sore and red, particularly the underside just around the elbow.

As all these psoriasis drugs seem to have some kind of side effect I ask Dr McBride what I might expect if I react badly to adalimumab. She rather coyly says that she’s not telling me, which is quite alarming: what could she be alluding to? Might I become Dr Hadoke and Mr Hyde: by day a bumbling, slightly grumpy man who can never find his Oyster card, and by night a rather bumbling, grumpy man who can never find his Oyster card and so kills people? Watch this space. What she does tell me is that it can leave on open to infection, hence the rapid reduction of the immuno suppressing ciclosporin. The combination of the two could leave me as open to infection as (insert name of crap football team here)’s  goal is to, um, letting in a goal.

Science-wise, I had some stuff written down about adalimumab and TNFs.  I wasn’t sure I had quite grasped what the latter was, even though I knew they were something that I had unusually high levels of, so I have asked Doctor McBride to tell me in her own words. “It’s TNF Alpha, which is Tumecrosis Factor Alpha which is raised in psoriasis. It’s an inflammatory mediator which is raised in psoriasis but also raised in depression. Sometimes when we treat people who are depressed with anti TNFs  then their mood lifts but it’s not across the board and occasionally when people take anti TNFs they can get depression. “ So there you go.

salad
“What’s that?”
“The rest of your life mate.”
“Looks a bit dull – can’t I add anything nice to it?”
“Nope”
“Oh.”

 

So, to the layman, in treating the skin adalimumab also has an impact on reducing levels of anxiety. This helps with suppressing the desire to use alcohol as an escape – not just alcohol actually. We use anything:  psoriasis suffers tend to eat a lot, smoke, drink and not talk about our emotions. We’re a dermatological jigsaw with many fractured pieces that need putting back together rather carefully.

February appointment – addendum. Good and bad news by my latest visit – cholesterol back up (7.9 – I have not been looking after myself; not Camembert but Fish and Chips and Curry) but I am now off the ciclosporin. My arms are still not looking too clever and my face and scalp need constant attention, but the rest of me is pretty good (relatively speaking). Upon my return to the hospital I will be subjected to my 16 week assessment with both Dr McBride and adalimumab wrangler Nurse Annie to see how well I am responding. Hopefully it’ll be good (though I won’t be allowed Fish and Chips to celebrate – maybe a pint of salad or a shot of cous cous .. Oh, I love being old and ill).

PSORIASIS BLOG – Treatment Update 9

Treatment Update Nine

Mid-January 2013 (various dates)

This is a summary of various visits which might be a bit jumbled as I didn’t keep especially good notes and have been in nearly every week.…

 

assets_Images_projects_Royal Free Hospital_RoyalFreeHospital-2.jpg.40f6e983dbf7b1917df0804023e1653c
The Royal Free Hospital ; not so named because Prince Charles and the Queen aren’t allowed in.

Before going in to see Dr McBride there are various things I have to do. I don’t know what they test my urine for but they didn’t rush me into hospital so it must have been quite splendid wee. They also check my weight (a tad over what I’d like to be) and blood pressure (no idea why, but I don’t like having it taken; it feels like my veins are about to burst).

I am a few weeks into my biologics treatment, and being monitored as a result of my breakdown, so Dr McBride is seeing me every week (during one check-up we have a very surreal conversation about one’s “inner chimp” … you had to be there*). Dr Mizara was away for a bit but I had a session with her when she came back which was extremely useful. I am being weaned off ciclosporin too (75g morning and night). Early in the month my cholesterol has gone up to an all-time high of 8.9 which really needs addressing. I can’t go on statins until I’m off ciclosporin as they seem to have an Israel/Palestine thing going on. I have to start the ball rolling with my GP though (place your bets now as to whether I have got around to it before the next blog). Also, my liver’s up a bit. Wonder why that could be? (Christmas Time, Mistletoe and Wine … and then some more wine … and perhaps a little more)

The reason that Doctor McBride is seeing me weekly at the moment is, I think, to ensure that I don’t start dribbling or talking to a hat (see previous blog). As ever she takes time to talk and give me insight and understanding. She and her team were fabulous over Christmas when I was in real need of help, and the aftercare is very effective. Anyway, I’ll concentrate on the purely medicinal side for now, as I think regular readers will be pretty clued up as to the gold standard TLC I get from all of the team at the Royal Free Dermatology unit. Their absence from the New Year’s Honours list was notable.

On a later visit my PAASI score is good, which is something. Another positive is that I seem to be responding well to the adalimumab. I only had my blood done before my appointment so we didn’t have the full results but the general analysis is OK. I will have to wait for the specifics. Skin-wise I’m pretty clear and people have commented on the brightness of my face (without prompting). I have had a slight outbreak on my arms around my elbows so that needs monitoring, but as far as my pink body armour goes, this is something of a giant leap. My scalp, as ever, remains incorrectly proportioned as far as the hair:scurf ratio goes. There’s a little patch of dry skin on my back but otherwise my trunk is free not only from plaques but also that reddish discolouration that is usually here reminding me that even when I’m in remission a potential outbreak is never far away.

images
I’m the human equivalent of this apparently. Twice.

Dr McBride says that I look healthy – if I was a dog I’d have a nice wet nose. Ah. Yes, regular readers, you’re right. She has said that once before. Suddenly I am reminded that though the team here remember our names and are conversant with our history and individual problems, they do not hang on every word spoken during our sessions (we on the other hand, do). I am one patient of many on just one day. They see patients on other days. I generally go once a month, so in addition to my Tuesday there are another three per month where a constant stream of disparate patients occupies my seat. So of course Dr McBride doesn’t know that she’s used that metaphor on me before. I know though, and ruefully note how effective the caring side of this process is because it’s just one tiny, isolated moment where I realise that I am not as special as I like to think. I suspect most patients with most illnesses feel that all the time as they negotiate the medical treadmill. Brilliantly, of course, as I mull this over later Dr McBride e-mails me out of the blue. The full analysis of my bloods is through, and she thought I’d probably like to know now, rather than wait until next time, that they have shown significant improvement since my first visit this year. She didn’t need to do that, but obviously knew I was a bit concerned so took a moment of her own time to reassure me across cyberspace.

I feel all special again, which puts a bit of a spring in my step. My nose feels a little wet too.

*I will blog about this at another time – Dr McBride has been reading a book called The Chimp Paradox which is useful for psoriasis sufferers. It helps us gain some understanding about the mental processes we go through that prevent us from having a stress free life.

 

PSORIASIS BLOG – Treatment Update Eight

Treatment Update Eight

Early January 2013

Please read the disclaimer if new to this blog.

First up, cliffhanger resolutions – my fingers seem to have got less painful, and no arthropathy was spotted in my X-Rays. In one bound I was free (but whilst on the starting blocks I was clearly a hypochondriac)! It could be that my new treatment regime has helped … whatever, the finger joints are not a current concern, so thank goodness for that.

The time has come to commit to the most pointy and extreme of all the treatments of psoriasis. No more creams. Light treatment – not on your nelly. Pills – your boys took one hell of a beating. It’s time for me and adalimumab to get acquainted. Dr McBride pronounces it as if she’s been saying it all her life: I think she’s been practicing at home. I’ve been practicing at home and I still can’t say it. It is used to treat arthritis, Crohn’s disease, all sorts, and with psoriasis one has to have found all other treatments ineffective before being allowed to use it (and special funding has to be applied for). I am a drain on the economy and for that I apologise. I don’t drop litter though.

A quick explanation: biologic medications are specifically designed to act in certain ways to correct a malfunctioning part of one’s physical make-up which in turn causes a disease. Insulin is probably the A List celebrity of the biologics world. As for my particular example, the impossible-to-pronounce adalimumab, I shall quote from the Psoriasis Association and hope they don’t mind : Adalimumab (Humira) works by blocking TNF-alpha, a ‘chemical messenger’ that signals to other cells in the immune system to create inflammation. People with psoriasis have too much of this chemical in their body, and adalimumab helps to lower this to a more normal level, leading to an improvement in symptoms. Adalimumab is an immunosuppressant, meaning people taking it are more at risk of infection. Because of this, people will be tested for active and latent (hidden) infections, such as tuberculosis (TB), before starting treatment, and are advised to have regular flu jabs.

 

The latest addition to my fridge

So just before Christmas, Senior Nurse Annie, who is the biologics guru and an extremely nice person, brought me into one of the rooms of the day care centre and talked me through the administration of my own injections. This sounds scary, and I’d love to play it up and make it seem so because then you’d all think I was terribly brave. But, it isn’t. You get a big thick plastic pen device, not unlike Doctor Who’s sonic screwdriver, and you unscrew a couple of handily labelled caps. In fact, they’re labelled 1 and 2 but I was so inept and struggling with #1 that Annie said it didn’t matter what order I did it in so I threw caution to the wind and pulled #2 off first. I don’t play by no rules you squares. The injections come with their own antibacterial swabs, and on day one I was to have two doses – the first administered by Annie, the second by me. I could inject into my stomach or the top of my leg. The leg seemed the best option – sturdier and less wobbly. One has to grab a wodge of skin to make it firm, swab the area, push the pen device on and depress the button on the top – like clicking a Parker before writing a letter. Except you don’t stab yourself with a biro – unless you’re a nutter or have a tight deadline for Doctor Who Magazine. There was a bit of pain and one has to wait until one hears a sort of fizzing release sound before removing the thing. I did the second dose myself and it was fine, although it does produce a little spot of blood.

As with any treatment, it is not all roses. If ever I decide to become a pregnant woman I will have to be very careful, and side effects can include upper respiratory tract infections, abdominal pain, headache, rash, injection site reactions and urinary tract infections. These joyous visitations usually occur after the first dose and decrease after that so I think I’ve managed to avoid the worst.

I also agreed to fill in various questionnaires. One of these was a slightly more detailed version of the PAASI test which studies the impact of psoriasis on the sufferer’s everyday life. The second one was a bit more grown up, and Annie thoughtfully vacated the room as I grappled with questions about erections and all sorts. Still, I hope the answers are useful to them and that my candour has helped the cause of medical science (whilst going on record that my erections are perfectly alright thank you very much – indeed, the two I’ve had over the past six months have been quite splendid).

The next dose of adalimumab was due Christmas Day (one week later) and the next a fortnight after that, so I went home with two lots, the transport of which required a cool bag supplied by the hospital. I did my own on Christmas Day but asked my retired medical professional of a mother to supervise. She did, but it didn’t stop her telling everyone afterwards how pathetic I had been. She wouldn’t have lasted long at the Royal Free.

It takes a few weeks to kick in, and I am being weaned off the ciclosporin in the meantime (75g morning and night). The injections will be done at home, fortnightly, and to that end the medicine is delivered to my home (saves the NHS paying VAT apparently), where it has to be kept in the fridge – which is why, I guess, they make it look like a pen rather than a mushroom.

And let’s hope it works, as there isn’t very far to go beyond this. I’m in the Last Chance Saloon, and there’s only one thing left behind the bar that’s doing to hit the spot (or in my case, massive amount of spots) …

PSORIASIS BLOG – Treatment Update Seven

Treatment Update Seven

11th Dec 2012

Oh, and if you’ve popped by to tell me to eat hay or give up cheese, please read the  disclaimer here before posting anything. I will publish any replies but not necessarily engage with them ; if you have your own cures or theories I am happy to air them, but won’t be batting opinion back and forth – this is a blog about my personal experience and the medication I am receiving.

 

You might well cry Mr Bond, but try having psoriasis. Dr No-Can’t-Do-Anything-About-That! Moonflaker! Skinfall (et cetera)…

I cried during Skyfall. I should have known something was amiss then. And I didn’t just cry at the emotional -oh-no-someone’s-dead bits. I got teary when anything with the vague whiff of a fan pleasing nod occurred or if Daniel Craig did something quintessentially Bond-esque. Shaken Martini (weep!), cool old skool car gets revealed (unleash the waterworks!), Miss Moneypenny (lachrymosity alert!).

I alluded to various personal and work issues in my last blog too, and yet even those now seem as if they are related to my somewhat discombobulated state. I usually take such things in my stride and frankly my profession is riddled with frustrations and disappointments, so why have I been feeling different lately? Well, I found out last night …

I had an appointment on Tuesday and saw a very charming locum doctor (Dr McBride was indisposed) who was rigorous in his examination, had a gently probing questioning style and was rather regretful when the time came to inform me of my cholesterol levels. I’d predicted a slight rise from the alarming 6.7 I was at but even I was bowled over when a colossal 8.8 had registered from my latest blood sample. That won’t do. One of the reasons is that I am currently on two medications – ciclosporin and acitretin. I am supposed to be reducing the ciclosporin and increasing the acitretin, but because my skin hasn’t been great, I haven’t reduced the ciclosporin at the speed I should be. Each medicine has a cholesterol raising side effect. Taking both at pretty optimum levels (I’m on 25mg of acitretin – the maximum dose is 35mg – and 200mg of ciclosporin) raises my cholesterol twice! The fact that I’ve been eating American food and staying away from the gym probably doesn’t help but let’s ignore that for now and lay the blame squarely at the feet of my drugs!

I have also had an X-Ray to see if the pain in the three fingers of my left hand is psoriasis related arthropathy or something else. If it is it’ll be a relief to know precisely what it is that’s causing the often intense discomfort, but that relief will be sullied by the fact that I have arthritis. So let’s see. I would rather I didn’t have something else wrong with me to be honest. I’m only 38 and I feel like a laptop that’s just this second passed its warranty period – annoying things seem to have suddenly stopped working for no apparently good reason.

And so, last night, I did a turn at a medical do, where it’s safe to say that my comedic musings went down resoundingly adequately. Both Doctors McBride and Mizara (yes, Mizara, I’ve been spelling her name wrong!) were there and spent much of a precious night off talking to one of their annoying patients. Me. During our chats I learned that acitretin can cause upsets in one’s emotional state and can increase anxiety. Suddenly everything fell into place. I’ve been worried about work, money, life, but more so than usual and occasionally quite alarmingly (I have felt like I’ve been teetering on a precipice). And so it’s a relief to discover that it’s not me being weird (I really did think I was going a bit nuts). It’s the bloody pills. So as of today I am off the acitretin, and hopefully this’ll restore me to my usual calm, cheerful, emotionally repressed, buttoned up, grumpy self! It’s a relief as I’m not massively comfortable dropping industrial amounts of pillage down my neck morning and night, and my stomach has always felt a bit dicky since I have been taking all of this stuff.

 

It probably won’t look like this but I wanted a scary looking injection picture to elicit maximum sympathy

I now have to consider – in consultation with my wife – whether I want to chance biologics; those A List, expensive drugs which are self-administered by injection. Frightening but with a reassuringly lofty, industrious aura about them. They’re injections for goodness’ sake; they are bound to work, surely, because you have to stab yourself to administer them. What would be the point in doing something so intensely medical, so brave, so … dare I say it, manly, if it just made me feel a tiny bit better? That’d be like trying to wipe a sniffle with a baseball bat studded with nails. Just sounding a note of warning, by the way, Dr McBride said that one in one hundred patients has an adverse reaction to biologics. With characteristic self-pity I remarked that that would probably be me then, and she said that that is what all psoriasis sufferers think and say. Bugger. Not only am I self-centred and paranoid, I am predictably so. Never mind – I am enjoying this because it turns out that I can blame the hallmarks of my disease for every twattish thing I do, say, think or feel now. That’s kind of reassuring. There are side effects to the biologics, but she won’t tell me about those in detail until I’ve decided whether to take them or not. I am to come back in a couple of weeks with my decision.

Crikey, that’s a first for this blog. A cliffhanger ending …

Toby Hadoke will return …

SHEDDING LIGHT AND SKIN – I Must Not Mis-Spell My Medicine

I Must Not Mis-Spell My Medicine (includes information on dermapsychology which may be useful for psoriasis sufferers).

Guess what I’ve just been spending the past hour doing? Going thorugh my blog archive and correcting the spelling of the two oral treatments I am taking. What joy. I had assumed they were spelt “cyclosprine” and “acetretine” and only an idle moment today spent reading the packaging of the medicine I have been swallowing by the bucktleoad for the past God-knows-how-long revealed that my orthographical assumptions have been malfunctioning with the same waywardness as Kelvin McKenzie’s moral compass.

So, for the record, I am on ciclosporin (pronounced sy-clo-spor-in), do you hear me? And acitretin. Ciclosporin, ciclosporin, ciclosporin. Acitretin, acitretin, acitretin.  There, hopefully that will redress the cyberspace balance of my consistent cack-headedness (though to be fair, the internet rather presumptuously asks you if you mean “cyclosporine” when you type “ciclosporin” into Google, so I’m not alone – all the web in the whole wide world makes the same mistake that I did). That said, even I don’t know if this blog is called “Shedding Light AND Skin” or “Shedding Light ON Skin”. I am not particularly enamoured of either to be honest, and might just call it plain old Psoriasis Blog from now on (I’m probably typing this for my benefit only as I suspect the rest of you simply couldn’t give a toss what it’s called).

If you want to know what ciclosporin is by the way, have a look here. Like many a psoriasis treatment it was initially used for something else (in this case, kidney transplants) and by chance it proved to have a positive side effect on this beastly malady. Hopefully one day they’ll stumble upon the fact that people who consume industrial levels of champagne and Lindt chocolate show an upturn in their battle against the psoriatic ague and so Verve Cliquot and Dark Intense become prescribed on the NHS. Why not? Stranger things have happened.

I went to see Doctor Mazara today, who was keen for me to alert my … ooh, dozens of readers (unless that’s just you clicking on to the site twelve times Mum, in which case, stop it!) to the work she does at the Royal Free. She is, as I have mentioned, a dermapsychologist, who is available on the NHS for anyone who thinks that dealing with the psychological ramifications of their psoriasis might be a useful way of combatting it. She has certainly been helping me, and this initiative to encourage people to treat the disease as not just an afflictiom of the skin, but rather something that is inextricably linked with one’s emotional state, is certainly worth a shot.

There is more information, some contact details and FAQs here (PDF), and some basic info here. In my experience, GPs are happy for psoriasis patients to come in with suggestions because it is such a complex and specialised disease. If you don’t ask you don’t get, so why not give it a bash? You have nothing to lose but your pains.

SHEDDING LIGHT ON SKIN – Treatment Update Four

Treatment Update Four

Various dates, Sept 2012

I stayed in pretty rude health throughout the Edinburgh Fringe, avoiding alcohol, eating well, and going to the gym nearly every day. I had a scare of raised glands and a sore throat so caned the antibiotics which I had been prescribed for just such an eventuality. So if I had indeed been headed for a throat infection the pills steered me to safety, as I didn’t succumb.

My hospital the Royal Free – which is not something those pesky french newspapers can claim to be this week, eh readers?

Since my return I have seen an immunologist, a heptologist, my consultant and my derma-psychologist. If there was a Panini sticker album of medical professionals I’d be doing very well indeed. I was being seen by the immunologist to see if there was any reason I couldn’t change my medication. I have been having success with Ciclosporin but it is only a short term solution (use it for more than a couple of years and your kidneys start getting into trouble). Dr McBride wanted to see what was going on with my immune system so that she could plan the next step in my treatment. To recap – psoriasis isn’t a skin condition as such, more a problem with the immune system. In taking immune-suppressing medication one can open oneself up to streptococcal throat infections, which in turn set off an outbreak of psoriasis, the very thing I’m taking immune-suppressants to combat: talk about coming full circle.

I was asked a series of questions by the immunologist about allergies and the like. One anomaly is that I was not a sickly child (though I was prone to hayfever). Traditionally an under functioning immune system would produce a less than robust infant, but I was well ‘ard. I am seeing the immunologist again in a few weeks, and he is also putting me in for a test to see if I am allergic to penicillin or not. This is an interesting one – I was prescribed penicillin for throat infections in the past, and this was followed by psoriasis outbreaks. Was it penicillin rash onto which the psoriasis attached itself? In which case, penicillin = bad. Or, was it that we didn’t catch the throat infection in time and so the psoriasis was related to that and nothing to do with the penicillin? In which case, penicillin = good! This will be useful information because I am going to be put on preventative antibiotics for six months to allow me to see if the Acitretin is working without the complication of a psoriasis outbreak caused by a sore throat. The penicillin test can take an age to come through – in the meantime, I have to be content with giving another gravy boat of blood to the ever patient phlebotomists who try not to show too much amusement at my fidgety terror of having a needle stuck in my arm.

My sessions with Dr Mazara (the derma-psychologist) are coming to a close – there are only four or five left, so we need to look at the things that had been bothering me (my shortcomings if you like) and see if our sessions have helped me to overcome them or at least deal with them in the long term. I’m not sure it’s possibly to quantify the work that she does, but it is very useful in getting both support and a perspective on various issues.

And so to Dr McBride after a month in Edinburgh. The hospital must have loved August – I bet they thought they’d got rid of me. But no – here I am again, taking up valuable time and sucking up precious resources. It must be tedious – I’m such a drain on NHS patience and morale I’m think of changing my name to Jeremy Hunt. Anyway, Dr McBride was kind enough not to show her disappointment and was actually pleased: PAASI score was 2.1 and my DLQI was 2. I’m aware that to most of you I may as well have just typed “I have 99 flibbles and a soupcon of twack” so I shall explain. The PAASI score is the Psoriasis Activity And Severity Index, which is an objective assessment of the coverage of psoriasis my body is being subjected to. The lower the score the better. In July I was at 8.7, June 12.5 and prior to that I had been a whacking great 17.2. I’ve never been this good. So she is optimistic about my potential, which is nice. Ah well, whatever happens, we’ll always have PAASI (that would have been a better pun had it been spelt, as I had assumed before discovering what the acronym stood for, PARSI, as that would have been an anagram of Paris. Never mind, I still like it).  The DLQI is the Dermatology Life Quality Index which is, I think, based on a questionnaire you fill in every time about how much the condition has effected aspects of your life (work, clothing, sport etc). I have generally been around the 2 mark, but it alters when I get a particular flare up. My cholesterol and liver also looking good. The latter I knew thanks to the heptologist I saw a week earlier, who basically said that my liver was all better because I hadn’t been drinking the ridiculous volume of alcohol I have had a tendency to drown my sorrows or toast my successes with, with rather too much alacrity.

Some Acitretin, yesterday.

Acitretin cannot be taken by people with liver disease so it’s important it is in a decent state if I am to take this medicine. I have a slightly fatty liver – this essentially warns me that if I batter it with booze to quite the extent I have done then in ten years’ time I might be in serious trouble. So I need to timetable my drinking and make sure I treat my liver with the care it deserves. We are going slowly with my treatment – the ciclosporin will be reduced to 125mg morning and night (from 150mg) with 10mg of acitretin to get me going with that. This has been preferred to the biologics: whilst ciclosporin is a general immune-suppressant (originally for use with kidney and liver transplants), the biologics is more targeted. Nonetheless, Dr McBride would rather try with Acitretin before taking that step, even if it might make me go bald. If that happens, I can blame something nature was already doing on my medication. Excellent! Perhaps its other side effects could be being a bit messy, an unimaginative lover and rather dull at parties. It’s not me, it’s the drugs, honest. Actual potential side effects, as it happens, are, according to the leaflet, sore eyes, muscle aches(it says here to avoid those by not doing any “rigorous exercise” – well, if you insist …) and dry skin. Dry skin, a side effect of a psoriasis treatment? That’s like taking something for hayfever that makes you sneeze. Ah, well, I’m game – and Dr McBride says the manifestation of the listed potential side effects is relatively unlikely. As of yet nothing too drastic (bar slightly dry lips) seems to have happened, though it does say avoid alcohol and I celebrated the completion of a hard but enjoyable weekend at the Comedy Store with a bottle of Chablis and some lovely scotch whisky given to me by my pal Jason Cook, so it’ll be interesting to see what my next lot of bloods say. It looks like the acitretin will be used on me for about six months, to really nobble the blighter, and then I will come off it. As Dr McBride says, any treatment can at best control the condition – as yet there is no out-and-out cure…

So I’m back in a month with both Dr McBride and the immunologist, but in the meantime, the Psoriasis Association has been in touch. I’ll let you know all about that next time, but October has some exciting things on the timetable…