Psoriasis Doctor

Question:

I would guess that the reason the insert says not to use on guttate, is because the company would fear that people would not take the time to put it on each individual spot. I would think that because guttate is so time consuming to treat w/ a topical, that the legal guys suggest this for possible exposure in the case where a patient (when applied improperly) could hold the company responsible for damage done to ‘normal’ skin.   Guttate, from my limited experience usually (and according to my derm), ‘usually’ goes away w/o much assistance.  My guttate, which incidentally appeared after a throat infection, DID go away, but it took 3-4 months. I was using UVB at the time, but eventually covered those spots after a short time and left only the plaque type to be treated by the UVB. I didn’t want UVB exposure all over my body if it wasn’t needed and the guttate was retreating on it’s own.   peeWEE

Response:

>>Interestingly enough, the insert leaflet said that Dovobet should >not be used in cases of guttate psoriasis (which I had). Presumably >this is because the wide area requiring coverage could lead to patients >using too much ? >Nope, don’t think it can be that because guttate doesn’t inherently >mean you have X amount of coverage and the online info says no more >than 30% coverage. More likely is the risk of getting it on unaffected >skin with the smaller guttate spots than with plaque. The problem with >that thought is that the component parts are certainly prescribed for >guttate. I was curious about this myself after reading your post, so >I’ve sent a question in to the company. I’ll let you know what I hear >back.

OK, this is getting interesting. The corporate site with a copy of the package insert online is Canadian: http://www.leopharma.ca/C1256AD9004FB242/(AllDocsByDocId)/6263737982F… (must be viewed with IE to work properly if anyone wants to look) That insert begins with a disclaimer that the product insert can vary from country to country. The Canadian one does not say use with guttate is contra-indicated. And a VERY polite and helpful Doctor affiliated with the company in Canada that I contacted through the site confirmed that there is no such limitation there and no reason for one that he is aware of. The only place I found one was online in a British pharmaceutical journal http://www.pharmj.com/Editorial/20020504/products/products.html So-o-o-o-o. To find out anything else I would need to know what country/affiliate you are purchasing it from and try to find someone there to ask (which was the final conclusion of the helpful doctor from Leo Canada). Pass me the info from the insert, via email if you’d rather not say what country you’re in publicly online, and I’ll see what I can do. FWIW, it certainly sounds like there is not a big reason for concern specific to guttate. Which it sounds like you’d already concluded. I still bet that the reasoning was more the likelihood of getting it on unaffected skin than amount used. Um also FWIW, the Canadian package insert confirms the twice a day regular regimen which IS normal for dovonex. No reason to mess with success in your case of course, but just thought I’d give the headsup. Let me know if you want me to dig further. Kim The Psoriasis Newsgroup Resource FAQ can be found at               http://pfaq.cjb.net but will also be coming soon (twice a month) to a            newsgroup near you…

Response:

My dermatologist told me to use it once a day (in the morning) and to use a cold-tar lotion called Exorex (I think) at night. It worked almost immediately – i saw a distinct lightening within 24 hours and the flakes and raised bumps had almost entirely levelled out within 5 days, apart from my legs which don’t seem to be making the same progress. Interestingly enough, the insert leaflet said that Dovobet should not be used in cases of guttate psoriasis (which I had). Presumably this is because the wide area requiring coverage could lead to patients using too much ? Deirdre

Response:

>Hi Kim >My GP prescribed Dovobet for my psoriasis, and i was told to use it twice a >day, as for the blotchiness, in my past experience the only time i had blotches >is after i have been on a sunbed, which clears most of  my p well, but leaves >white scars which disappear with time. I had always thought that this was >because the healthy skin is tanning more than the diseased area, as the lesions >are so scaly and the skin shedding then these are not getting tanned as >much..well this was my theory anyway.. >With steroid medication, I am usually left with very faint pink skin where the >lesions have been.. but the scaliness returns very quickly with the stopping of >the medication.. >When my p heals on its own.. (without any sunbed or medication) then no >blotchiness appears whatsoever..they just shrink and dissappear without any >trace..

Thanks for posting the info. I’d been wondering on the Dovobet because it’s pretty well established that Dovonex itself really has to be used twice a day and continually to be effective, while you usually want to minimize the steroid use and pulse use it rather than continual. There’s a well established history of them working better in combo than either alone, so the combination therapy in itself made sense otherwise As to blotching, I sometimes get darker blotches left behind, somtimes lighter ones but can get them even when I let a spot clear on its own (usually lighter then). Which it will be usually follows treatment (not always UV/non UV though), but it’s interesting that yours does that too but leaves no blotch when clearing ‘unassisted’. Kim The Psoriasis Newsgroup Resource FAQ can be found at               http://pfaq.cjb.net but will also be coming soon (twice a month) to a            newsgroup near you…

Response:

Hi Kim My GP prescribed Dovobet for my psoriasis, and i was told to use it twice a day, as for the blotchiness, in my past experience the only time i had blotches is after i have been on a sunbed, which clears most of  my p well, but leaves white scars which disappear with time. I had always thought that this was because the healthy skin is tanning more than the diseased area, as the lesions are so scaly and the skin shedding then these are not getting tanned as much..well this was my theory anyway.. With steroid medication, I am usually left with very faint pink skin where the lesions have been.. but the scaliness returns very quickly with the stopping of the medication.. When my p heals on its own.. (without any sunbed or medication) then no blotchiness appears whatsoever..they just shrink and dissappear without any trace..

Response:

> I have been on UVB for nine treatments. I really like it (it’s really hard > to schedule in though) > In Canada, the local hospital has these big UVB machines. I am on three > times a week and I started out with a 25 second zap. > I completely stopped the itching and the patches seem to be shrinking. More > importantly however, the scaling stopped in a lot of places and I am left > with "blotched skin". > Does this blotching go away, or is it scarring from all the scratching I

Yes they go away… I don’t see why your complaining…I’d rather have blotching the the red scaly sores..

Response:

– Hide quoted text — Show quoted text -> I have been on UVB for nine treatments. I really like it (it’s really hard > to schedule in though) > In Canada, the local hospital has these big UVB machines. I am on three > times a week and I started out with a 25 second zap. > I completely stopped the itching and the patches seem to be shrinking. >More > importantly however, the scaling stopped in a lot of places and I am left > with "blotched skin". > Does this blotching go away, or is it scarring from all the scratching I >Yes they go away… I don’t see why your complaining…I’d rather have >blotching the the red scaly sores..

Well since he WASN’T complaining, merely asking a question, don’t you think that is more than a bit out of line…? And even if he was complaining, last I knew that was supposed to be part of the purpose of the group – a place to complain when you needed to, where people understood your perspective and so provided support rather than slaps and put downs. Kim "I’ll give you something to complain about" Malo The Psoriasis Newsgroup Resource FAQ can be found at               http://pfaq.cjb.net but will also be coming soon (twice a month) to a            newsgroup near you…

Response:

I have got to the "dark blotch" stage myself after using Dovobet cream (which is, by the way, brilliant stuff).  I was just wondering should i stop using the cream now – do the blotches need it in order to heal further or will they go away by themselves. Obviously I don’t want to continue putting cream on if I don’t have to ! Thanks D

Response:

>I have got to the "dark blotch" stage myself after using Dovobet cream >(which is, by the way, brilliant stuff).  I was just wondering should >i stop using the cream now – do the blotches need it in order to heal >further or will they go away by themselves. >Obviously I don’t want to continue putting cream on if I don’t have to

The sort of hyperpigmentation left behind when a lesion clears isn’t going to be helped by continuing to medicate. See the first Q&A at: http://www.psoriasis.org/f230.htm And you don’t want to use any psoriasis med when you don’t have to to minimize side effect risks and delay any reduced effectiveness that can happen over time with continual use. Good to hear the Dovobet worked well. One question if you don’t mind – how often were you told to use it? Twice a day as with plain dovonex? Thanks Kim The Psoriasis Newsgroup Resource FAQ can be found at               http://pfaq.cjb.net but will also be coming soon (twice a month) to a            newsgroup near you…

Response:

4 weeks ago today, I got these spots on my legs. For the most part it is cleared up, but I still have some bumps, and the places were the bumps are gone now are dark pigments spots. In some lights they are invisible, but sometimes they look very very dark. I had them from my ankles to my groin. And a few on my arms.  ICK. I am 36 and had never heard of guttate psoriasis before.   Staci Once upon a time JM Fraser proclaimed: – Hide quoted text — Show quoted text -> Thanks everyone for your contributions today, (this evening). Until I > actually read the last posting I hadn’t realized that I too have these > "dark blotches!" I look like a leopard and have been told that it’s > ‘cute.’ Will be reading the upcoming posts with interest. Watch Filter > ON! > Strange people don’t have P do the!. lol > JM > Diedre, how long have you had guttate? Does yours come back often? I > think I have it, but I haven’t been to the derm yet(July 3rd). I > have been reading all I can on the subject, and it is confusing to > me. How often is it a one-time thing?

Response:

Diedre, how long have you had guttate? Does yours come back often? I think I have it, but I haven’t been to the derm yet(July 3rd). I have been reading all I can on the subject, and it is confusing to me. How often is it a one-time thing? —    Staci "Go to Heaven for the climate, Hell for the company."       – Mark Twain Once upon a time Deirdre proclaimed: – Hide quoted text — Show quoted text -> My dermatologist told me to use it once a day (in the morning) > and to use a cold-tar lotion called Exorex (I think) at night. > It worked almost immediately – i saw a distinct lightening within > 24 hours and the flakes and raised bumps had almost entirely > levelled out within 5 days, apart from my legs which don’t seem > to be making the same progress. > Interestingly enough, the insert leaflet said that Dovobet should > not be used in cases of guttate psoriasis (which I had). Presumably > this is because the wide area requiring coverage could lead to > patients using too much ? > Deirdre

Response:

Thanks everyone for your contributions today, (this evening). Until I actually read the last posting I hadn’t realized that I too have these "dark blotches!" I look like a leopard and have been told that it’s ‘cute.’ Will be reading the upcoming posts with interest. Watch Filter ON! Strange people don’t have P do the!. lol JM – Hide quoted text — Show quoted text – >Diedre, how long have you had guttate? Does yours come back often? I >think I have it, but I haven’t been to the derm yet(July 3rd). I have been >reading all I can on the subject, and it is confusing to me. How often is it >a one-time thing?

Response:

>My dermatologist told me to use it once a day (in the morning) >and to use a cold-tar lotion called Exorex (I think) at night.

Thanks for the reply Deidre. It’s coal tar BTW. Not to correct you for the sake of correcting you, but in case you ever look for an alternative. Exorex is the right name, but there are also other, much cheaper coal tar products available. >It worked almost immediately – i saw a distinct lightening within >24 hours and the flakes and raised bumps had almost entirely >levelled out within 5 days, apart from my legs which don’t seem >to be making the same progress.

Legs can actually be among the most stubborn places for a lot of people. Had you ever tried coal tar or dovonex or steroids on their own to compare the results? I’m just wondering what really caused such rapid results. Tar on its own works pretty quickly for me at least, and steroids can also be quick for many,  but Dovonex on itself is usually slower in effect. Oh well, just curious. >Interestingly enough, the insert leaflet said that Dovobet should >not be used in cases of guttate psoriasis (which I had). Presumably >this is because the wide area requiring coverage could lead to patients >using too much ?

Nope, don’t think it can be that because guttate doesn’t inherently mean you have X amount of coverage and the online info says no more than 30% coverage. More likely is the risk of getting it on unaffected skin with the smaller guttate spots than with plaque. The problem with that thought is that the component parts are certainly prescribed for guttate. I was curious about this myself after reading your post, so I’ve sent a question in to the company. I’ll let you know what I hear back. Kim The Psoriasis Newsgroup Resource FAQ can be found at               http://pfaq.cjb.net but will also be coming soon (twice a month) to a            newsgroup near you…

Response:

It does go eventually.  I had a huge plaque on my thigh which cleared completely but left a mark for a long time.  No sign of it or psoriasis now on that site. I used Alphosyll tar lotion for some time (before new treatments arrived) to prevent it returning.  It’s been clear for about 10 years now.

– Hide quoted text — Show quoted text -> I have been on UVB for nine treatments. I really like it (it’s really hard > to schedule in though) > In Canada, the local hospital has these big UVB machines. I am on three > times a week and I started out with a 25 second zap. > I completely stopped the itching and the patches seem to be shrinking. More > importantly however, the scaling stopped in a lot of places and I am left > with "blotched skin". > Does this blotching go away, or is it scarring from all the scratching I > djs

— Checked by AVG anti-virus system (http://www.grisoft.com).

Response:

But if you are using UVB treatment ask the dermatologist about other lotions to use.

– Hide quoted text — Show quoted text -> It does go eventually.  I had a huge plaque on my thigh which cleared > completely but left a mark for a long time.  No sign of it or psoriasis now > on that site. I used Alphosyll tar lotion for some time (before new > treatments arrived) to prevent it returning.  It’s been clear for about 10 > years now. > I have been on UVB for nine treatments. I really like it (it’s really hard > to schedule in though) > In Canada, the local hospital has these big UVB machines. I am on three > times a week and I started out with a 25 second zap. > I completely stopped the itching and the patches seem to be shrinking. > More > importantly however, the scaling stopped in a lot of places and I am left > with "blotched skin". > Does this blotching go away, or is it scarring from all the scratching I > djs > — > Checked by AVG anti-virus system (http://www.grisoft.com).

— Checked by AVG anti-virus system (http://www.grisoft.com).

Response:

I have been on UVB for nine treatments. I really like it (it’s really hard to schedule in though) In Canada, the local hospital has these big UVB machines. I am on three times a week and I started out with a 25 second zap. I completely stopped the itching and the patches seem to be shrinking. More importantly however, the scaling stopped in a lot of places and I am left with "blotched skin". Does this blotching go away, or is it scarring from all the scratching I djs

Response: