I have a 63 year old female patient who has been diagnosed with palmoplantar psoriasis. She has no noteable previous medical history. She is taking Simvastatin (20mg) and Losartan (100mg).
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She had a previous flare up of the psoriasis in 2008, the flare up started immediately after her daughters wedding. She is convinced this incident was helped by accupuncture.
Her current flare up has lasted since February 2009 and is showing no signs of improvement. I see her every 3 weeks to reduce the build up of callous around her medial heel area, apices of toes and 1st IPJ's. Her right foot is worse affected than her left. She has no pustules present but suffers from intensive pruritus which cause her to scratch until her skin bleeds. She has deep fissures around her heels and areas of raw skin, particularly around her heels and in her MLA, her forefoot is not as badly affected as the rearfoot.
She has seen 5 Dermatologists and has tried various creams and ointments including 2 coal tar preparations (one containing salacylic acid) which she describes as "messy and unproductive" and hydrocortisone cream. For the past few months she has been using Simply Feet cream and Dermatonics Heel Balm which has 25% urea, her right foot has improved but her left remains a problem. She has tried accupuncture again as she felt this helped the original flare up but has had no success this time. She is now suffering from mild to moderate depression as a result of the problems her feet (and hands) are causing her and is getting desperate. She is willing to try anything (she has even in the past bathed her feet in her own urine after reading it might help!!!). I realise photos would have been a plus here, I will get photos when she is in next time and post them.
This lady is not keen on taking tablets at all. UV therapy has been mentioned to her but it is not available where we live.
If anyone had ANY ideas or experience of this at all it would be very much appreciated. I hope I have provided enough information for you:eek:
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