Tag Archives: Royal Free Hospital

PSORIASIS BLOG – FRUIT OF THE LOON

FRUIT OF THE LOON

Christmas 2012 … (cue clanging chimes of doom)

OK, I may as well get this out of the way early on. I had a few mental health issues over the Christmas period. It was horrible, but I suppose at least it will enable us to examine the links between mental health and psoriasis, which I am coming to realise have a very intimate relationship. It’s one not many people know about and those who do don’t really acknowledge it:  like a staff room affair or the Catholic Church and paedophilia. Of course, this was the whole impetus behind the much needed See Psoriasis, Look Deeper campaign, so my breakdown has been rather timely. Come to think of it, too timely. Perhaps they put something in my Horlicks to set me off in order to draw attention to their scheme? Like a piece of psychologically primed product placement.

Anyway, if I may my candour on this will stop there. I have friends and family for whom this period was difficult and whilst I don’t mind breaching my own privacy it’s not acceptable to do so with theirs, so I’ll be scant on the detail if I may. But let’s put it like this, it was quite serious: it wasn’t a sadface-put-on-my-Facebook-profile-because-I’m-feeling-a-bit-needy sort of crisis; it was a wearing-underpants-on-my-head-and-sticking-two-pencils-up-my-nose-I’m-just-off-to-Hartlepool-to-buy-some-exploding-trousers kind of discombobulation. I’m alright now, mending slowly, and received great support from people very dear to me. I have been taken off acitretin which doesn’t help lighten one’s mood apprently. The dermatology department at the Royal Free, who have cared for me so well, dropped everything to facilitate my stabilisation. The psychiatric care I received however (mostly at a different hospital), was a real eye-opener to how mental illness is treated in this country, and will be something I blog about in detail when … when I’m a bit further away from it all. I’m still a trifle raw and also don’t want to give the impression that I am currently incapable of rationality, because that couldn’t be further from the truth. Some distance is necessary before I address this very serious issue though. Suffice to say for now then, that the whole system for dealing with a psychological crisis seems designed to ensure that if you aren’t mental when you go in, you sure are by the time you come out. Fortunately I had a wife at home who could rescue me; many others aren’t so fortunate.

Skin-wise this relates, as obviously a lot of one’s deep seated frustration and self-esteem issues are related to the fact that one has spent much of one’s life looking in the mirror at a scaly red flake monster. When I say one, by the way, I mean me, but I’m trying to be all professional and distant because that’s sexier (referring to myself as “one” is fine and sane – it’s when I start describing myself as “both of us” you’ll know that I’ve flipped). In addition, when one’s feelings venture into this kind of territory the temptation is to hit the bottle. Hit? I did a bit more than that. When I wasn’t working I administered Grievous Bottley Harm, nutted a Chablis and kicked the shit out of some very nice malt scotch whisky. Curious how when I am working I manage not to drink at all – when I am on stage I don’t drink till after a show, when I’m doing a telly job I don’t drink during the whole shoot … but when I’m left to my own devices and thoughts, I unleash a torrential downpour of liquor that would kill a horse (and therefore probably add lustre to the flavour of certain burgers on the market until relatively recently).

What the drink did, of course, was to facilitate the outpouring of all sorts of things that need dealing with sensibly rather than splurging out amidst random thoughts and slurred vowels. What I do know, as I write this, several weeks sober, is that what it didn’t do was help. It made things worse. Which is why it is ridiculous that I always turn to it when I want to make things better. So I have stopped.

Watch this space.

I’ve been tentative about publishing this as it all sounds a bit bloody needy, and frankly, could have potentially damaging professional consequences (nobody wants to hire a self-confessed nutcase who drinks too much). Oh well, what the hell: I’m on the mend, I’m working (and therefore, potential employers, distinctly available and able, fear not), I’m dry and have thrown myself into a ridiculous Doctor Who based project to prevent me from staring at my own navel for too long.

Meanwhile, Dr Mizara is being very clever at tying everything together. There are various things that haunt me from the past but they are done and dusted and I really need to get over them. I need to stop concentrating on the things that frustrate and worry me and instead enjoy the very many things that make my life a blessed and fortunate one. The experts tell me I need to love myself as well, but I was always told that that made you go blind. I clearly have a lot of hard work to do, but they say you have to hit rock bottom in order to get yourself straight so maybe it’s good for me even if it’s not particularly enjoyable to experience. It’s like exercise. Or John Craven’s Newsround. Or a Bran Flake.

Onwards, then, and I’ve only got upwards to go …

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 …

PSORIASIS BLOG – Treatment Update Six

Treatment Update Six

November/December 2012

Oh, and a timely reminder to read the disclaimer here – please don’t post a reponse to anything here until you have had a look.

All that is lodged in my memory from Doctor McBride’s session in early November (I’ve been away having fun … I mean working, since) is that my progress has regressed at tad. And I have regressed further since then I am afraid to say. That’s obvious from the physical side: then, I had a few light patches on my arms, and now (at the time of writing I’m seeing her again in just a few hours) there are shadows on my arms and sides. Shadows with a dusty surface and a reddish tinge. Let’s be fair, I’ve not looked after myself as much as I did when I was at the Edinburgh Fringe; wheatgrass shots and fruit/veg smoothies each morning, a strict exercise regime that had me in the gym nearly every day, no alcohol, pretty early nights. Since then I’ve let myself go a little bit, so surprise, surprise my Cholesterol is at a whopping 6.7 (I had it down to 4.5!!) which is not good, whilst my Triglycerides (fat in the blood) are at 3.6. I can’t remember if that is good or bad but it’ll be interesting to see how they compare to the blood I gave yesterday. “Gave”? I make it sound like I am benevolently donating something as opposed to having my plasma sucked from me so that it can be broken down into numbers in order to discover what level of the Unhealthy Scale I have ascended this month. I asked Dr McBride if we could hold off with statins and so keep my daily intake of pills below the hundred mark and in return I would endeavour to get as healthy as before; I am convinced that self-discipline might be a better long term option than pill popping.

Well, I think I have probably failed.

“Can you tell what it is yet?” It’s my arm, with a creeping barrage of mild psoriasis doing its best to ruin an otherwise perfect and robust limb.

I went to a Doctor Who convention (don’t snigger at the back) in Chicago (see, I got to go to Chicago for free, oh ye sniggerers) at Thanksgiving, where I ate American food and drank American drink. The latter is like English drink but weaker, not as nice or three times more expensive, but not especially better or worse for you. The former is like English food but with added dollops of fat, syrup, sugar and insanity. Like sweet potatoes? Not until they’re topped with marshmallow you won’t! So I have put on weight and developed very, very dry(but not red, sore or painful – I’m dusty rather than crusty) patches on my arms and sides. My scalp could single-handedly provide the snow for the world’s entire collection of nativity displays. So bad has it been that I have adopted an entirely beige clothing policy in order to minimise the embarrassment and camouflage the cascade of detritus. My lips have also been drier than a sarcastic Martini but that is because of the acitretin (which, coupled with ubiquitous Stateside air conditioning has left my gob like the lunar surface but with slightly fewer golf balls).

Now, of course, we don’t know if food is a trigger (probably not) but general physical well-being is definitely important. However, my visit to Doctor Mazara yesterday (2nd December) indicates that various personal and professional stresses are responsible for my mild flare up. I don’t need to go into the whys and the wherefores (especially not after my last, rather maudlin, blog), but the fun times in Chicago have been karmically balanced by some less joyous developments. As ever I have tried to greet each unwelcome visitor with a smile and Dr Mazara helps me to do this by offering good advice; only control what you can, life isn’t always easy, and accept the fact that one has to work to keep one’s personal life happy and that the profession I’ve chosen generates frustration and upheaval. Irrespective of what is happening, we are responsible for our own moods; dwelling on the uncontrollable gets us nowhere and taking life by the scruff of the neck and staying positive can work wonders. So that’s the prescription – open the advent calendar doors and make sure there are only happy scenes behind them.

There are certain things I have to do to change the things that aren’t going so well, and I am working on them. Dr Mazara cites coming to her and getting to grips with the emotional side of the disease as positive steps and examples of why one shouldn’t bottle one’s feelings up. Interesting, having gone to her feeling fairly rotten I reacted well to the idea that just being there and talking openly was a marked improvement on how I would have approached this a year ago. In plucking a positive (and you’ll note, one that put me in a good light) from all the surrounding difficulties she managed to spin me out of my self-indulgent miasma (by indulging me!). My visits to her have made me a little raw when I think about the disease, but she assures me that this is a good thing. Great – crying makes one better apparently. That’s no good if you’re on a bus! Oh well then, there’s no alternative fellow sufferers – never mind the pills, just watch Old Yeller or Bambi once a week and you’ll be fine.

So – let’s see what my physical readings are when Dr McBride goes over my bloods later. I also have agony in the joints of three of the fingers of my left hand. I am worried this may be the result of some kind of related arthritis, but let’s not panic … he said, having been panicking all month. But that’s the point, I don’t know if it is or not until I find out, and the only way to find out is to do something about it. Don’t fret about what might be, only deal with what is (oh no, I sound like Yoda except all my words in the right order are). Accentuate the positive. No humbug this Christmas then …

PSORIASIS BLOG – Treatment Update Five

Treatment Update Five

9th October 2012

This is slightly out of date as I took a while to post it whilst I checked the accuracy of the scientific content (and then edited most of it out).

I’m not especially well at the moment. We’ll come to why a little later.

 

The human equivalent of psoriasis – unpleasant and irritating for no reason that benefits anybody.

A double dose at the Royal Free today. I was to be seen by Dermatology and Immunology in their quest to map every pathway of my body in order to best navigate my road to recovery. Immunology first – I had to wait almost as long as it takes Kelvin McKenzie to issue an apology, which only goes to show I fortunate I am that the dermatology department usually see me extremely quickly. The immunologist was pretty certain I will be discharged when I revisit in six months’ time after my GP tests the effectiveness of my Numococus and Tetanus levels (basically more needles, a dead arm, and thinking I’ve been terribly brave for enduring something most adults wouldn’t even mention, let alone expect a hot water bottle and fruit cake for experiencing). I am also on the waiting list to get a definitive answer regarding suspected penicillin allergy: we only have anecdotal evidence and supposition about this, but we can’t be too careful (see here for more). This may take a while, and in the meantime we have had the go ahead for Dr McBride to prescribe me preventative prophylactic antibiotics – penicillin free, and called cefalexin, which will hopefully stop me getting a sore throat and causing my immune system to behave as if it’s Michael Gove and my body is a working class child’s future.

Warning! The two paragraphs below in italics have lots of science and very little wordplay, so might be worth ignoring if you’re only here for the “hilarity” of my jokes about shedding skin and being unable to move without suffering from abject pain. They are, as Jennifer Aniston would say, the science bit:

It’s like this – I gave another armful of blood after my last visit to see how my immune system is doing. It turns out that I have low Numococus and Tatanus readings (these are two of the levels they check to see how robust ones’ immune system is). Now, lowness doesn’t necessarily mean it isn’t very good:  it may mean that I haven’t been exposed to anything related lately and so I am going to have to get my GP to give me injections to see if the levels rise and my immune system fights them correctly. The low levels I have at the moment should boost by three times if my immune system is working correctly: if the levels stay low, that’s where I have a defect.

The mannose binding lectin deficiency is definitely there. MBLs are part of the innate immune system. A low MBL reading can be found in one in ten people prone to streptococcal throat infections. And that’s as far as immunology is with psoriasis, though the specialists at the Royal Free have seen a link between psoriasis and low MBLs that they are examining right now. We patients are a work in progress, and the disease is far from being fully understood, and so this is a potentially fascinating avenue to explore.

 

“Oy, dangly thing, your days might be numbered.”

And so to Dr McBride, who had gone to the trouble of phoning me when I was stuck in immunology at the time that I should have been with her; and when I did finally make it, saw me pretty much straight away and indulged my fretfulness about various aspects of the disease. One of the suggestions from the immunologist was that removing my tonsils might be a good idea. Dr McBride tells me that my chances of not getting a streptococcal infection (which would in turn cause a flare up of my psoriasis) would be reduced by 50%: do I want to go through such a painful and stressful operation to play such odds? Tonsil removal is something kids can cope with pretty well, but it can have a drastic and debilitating effect on adults (much like Barney The Dinosaur then). We’re going to persevere with the antibiotics and hope they hold any infections at bay for the next six months while the acitretin gets to work. I have been upped to 25mg of that and my ciclosporin intake reduced by 25mg per day. I have noticed a stubborn dryness to my lips since going on acitretin, and indeed that was one of the mooted side effects. So I’m never more than 5 feet away from a tub of mint infused Vaseline at the moment. I moisturise my lips too.

Other than that, I’m responding pretty well to the acitretin. My Triglycerides are at 1.6 which is good; they would rise if I was reacting badly to the medicine, and my kidney function is good, as are my Vitamin D levels. I take a booster dose of the latter every two weeks because Dr McBride thinks I spend too much time indoors at my typewriter and therefore do not enjoy the benefits of the sunlight. I haven’t told her that I sleep in a coffin and have an aversion to garlic so hopefully my dark secret remains my own. My cholesterol though, has shot up again, to 6.4. We’ve talked about getting statins from my GP, now it’s time for action. They help with psoriasis, and obviously the tendency for my cholesterol to err of the high side is untenable long term. So that’s another shelf of the medicine cabinet to be filled. Cabinet? Who am I trying to kid? Wing, more like. I am also being referred to an ENT unit to have a gander at my tonsils to see what they think the risks and efficacy of such a manoeuvre would be. (Post Script : After talking this over with my wife, I have paused on this and will speak to Dr McBride again – I brought my cholesterol level down with a good diet and exercise once before, so should I not aspire to do it the natural way once again rather than add another dose to the increasingly long list of Pills I Have To Pop?).

Then we got talking about how I was feeling. This took an interesting turn and resulted in a difficult conversation that nonetheless concluded with some helpful insight. Which I’ll share with you next time …

 

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.