Dematologist #4, the Saga Continues!

General
1

Howdy, everyone.

I saw my 4th dermatologist yesterday. This one was specifically chosen by my rheumatologist. It has been difficult to nail down ( pardon the pun ) whether or not my nail dystrophy is, in fact, due to psoriasis. I am currently on Stelara, loading dose on board so far, without any relief.

This dermatologist was really thorough and said that, in his opinion, he is 70% sure that the nail changes are due to psoriasis, but that they were "mild" at this point. He did mention that people with nail changes were much more likely to have PsA than patients with skin psoriasis without nail changes.

Then I mentioned the issues I have in my gluteal cleft. Oh the indignities of showing your butt crack to an adorable male doctor who is only slightly older than your oldest kid ! He checked my knees, elbows, scalp, etc. Nothing happening any of those places.

He prescribed a steroid cream for my hiney and said that it was also mild, but did look like it could be psoriasis.

He wanted to do a punch biopsy of a scaly patch on my arm and so we did. Results to come in a few days.

Upon the end of the visit he did say that he could not say 100% that I have psoriasis and that I was "a bit of a mystery." He is sending notes to my rheumatologist. Wonder what they will say....

2

My nail involvement probably helped with diagnosis. My nails have a lot of signs--they have the little pinprick dents, ripples, "zippers" and loosening from the nail beds. There is slow improvement since I started Enbrel. The zippers are gone and my two pinky nails are no longer pulling away from the nail bed-they actually look normal again.

I hope the stelara starts working for you. From what others have said it can take a few months, so there's hope! I know what you mean about that butt crack issue. Oh, so painful! I never knew what that was until I came on here. Fortunately, though, my steroid cream applied for a couple days would put it into remission! Good luck with Stelara and getting some solid answers!

3

They did a punch biopsy on a spot of skin that I was sure previously had psoriasis, nut appeared completely clear at the time of biopsy - results were definitely psoriasis, so I’m hopeful for you that you get such a definitive answer!