Am I an annoying patient?? GP / DOCTOR / NURSE QUESTION

severe skin problems are linked to higher rates of suicidal ideation and suicide. The constant itching and pain can lead to sleep deprivation and mental health problems.

Don’t feel guilty about advocating for yourself. Treating this issue before it gets worse means you may utilize fewer system resources overall.

there is a reason that my US insurance company pays for my ridiculously expensive biologics medication and it isn’t to be nice. It’s because the algorithms tell them that treating my skin condition properly will be cheaper than covering my care if my skin gets severely infected or I have a mental breakdown and end up on the psych ward.

I would definitely phone the dermatology nurses. If you don't have their number, call the hospital switchboard and ask to get through. Dermatology are used to treatments not working or sudden flare ups, they aren't going to think badly of you and would, if they have the capacity, far rather treat you before it gets even worse.

Can your GP chase dermatology for an appointment? Sometimes hospitals take more notice of a GP saying something is serious than the patient.
Have you been to PALS to see if they can help with getting an appointment?

Sorry you obviously know that but I don't understand why the gp isn't going down that route too.

I saw your previous threads, I'm sorry things haven't improved. I'm no expert, only my own skin condition to go off, but surely the gp should be helping you treat these as open wounds rather than a typical psoriasis flare?? Mine was much less open and sore than yours and it took 6 months of daily treatment to get to a point it could be controlled with OTC meds, steroids and shampoos. You are still at square one and need to get the wounds healing before you can treat the cause, in my non expert opinion.

Capasal sorry. Stupid autocorrect

I have seborrhoeic dermatitis on my scalp and it looks like your picture, wet as well. I use capital therapeutic shampoo

That sounds rough! I had a similar thing a few years ago and getting appointments with dermatology was like pulling teeth. My suggestion would be to be keep ringing dermatology secretaries to chase up appointments- don’t be afraid to be persistent! I think sometimes a lot of people don’t realise just how miserable and uncomfortable skin conditions can be. I did speak to my GP and they wrote a letter to the consultant asking them to see me asap so may be worth a shot too?

I ended up getting started on immunosuppressant injections in the end which have been an absolute god send- might be worth having a discussion about whether this would be a possibility for you. I’d also exhausted, tablets, light therapy, creams etc..

good luck x

My dad has that and has steroid injections and phototherapy.

He uses all the t gel, zinc, emollients under the sun and not yet found one that works.

Have you been swabbed/biopsied op? My dad has had that all done so he knows it's psoriasis but there's a condition linked to celiacs disease that can cause skin conditions.

Keep harassing dermatology is my advice. That looks so sore. I get guttate after a throat infection but I consider myself very lucky in that it goes away for a bit after four months or so. I end up covered head to toe in itchy spots. If it's itchy by advice would be a bath with apple cider vinegar (although it looks like yours are open wounds so probably not ideal but may help if they heal enough) or put a sock filled with oats in a bath. Dead sea salts are also something I've used and meant to be good. A lot of research points to gut health and a lacking of specific strains. I'm pretty certain ones is lactobacillus rhanasmos or something along those lines. A good probiotic could help maybe. There are biologics available for psoriasis, and UVB treatment. If finances allow could a UVB light be an option in the interim? I'm so sorry you're dealing with this. It's a vile disease and I can only tell you what I've learnt and offer virtual hugs.

Doctor married to another doctor here, and of further interest to you, with a best friend, yes, yet another doctor, with severe psoriasis and psoriatic arthritis.

I can assure you that you're NOT an annoying patient. Psoriasis can vary from mild and easy to treat to appallingly disabling and unresponsive all treatment, with everything in between. The more severely affected patients may need to be on heavy immunosuppressants and/or biological medicines which are usually monoclonal antibodies which modulate the immune system. The side effects and the cost of some of these can be pretty high so they need to follow a stepwise approach to treatment in accordance with NICE guidelines, local prescribing contracts etc, but not your primary and secondary care doctors will be desperately hoping to make you better. They'll be annoyed with the pathological processes, they'll be annoyed that your immune system isn't responding to the less destructive treatment, they'll be annoyed with themselves that they've failed to treat you, but they will NOT be annoyed with YOU. I can assure you of that from personal experience of being a doctor and treating patients.

Hope this helps settle your mind a little. 🙂

Dermatitis herpetiformis?

www.coeliac.org.uk/information-and-support/coeliac-disease/dermatitis-herpetiformis/

Have they tried you on biologic medications (adalimumab or similar)? If not that’s what I’d be asking for as they tend to be very effective. I have a coworker with psoriasis that started on them and was fully clear in about two months.

They are expensive though. I’ve been out of the UK for a few years now so I’m not sure how the NHS is handling stuff like that. You might have to jump through some hoops and it’ll probably move at the usual snail-like pace of the NHS but it would be worth it.

Have you tried any light therpy? Worked well with steroids. You will already know this but try not to stress the more stressed you are the worse it gets

It’s such a wait for dermatology (not complaining, I understand completely this isn’t life or death) and at the moment I can’t even rest my head on my pillow because my scalp is too painful.

You can’t sleep because you have treatment-resistant open wounds on your head. I’d say you need to make a greater fuss, to be honest. It’s not ‘just’ psoriasis.

dermnetnz.org/topics/pityriasiform-seborrhoeide

Could be a severe form of seborrhoeic dermatitis. Try ketoconazole shampoo (nizoral is a brand) and do not use normal shampoos or soaps.
Consider topical steroids. Ask about oral antifungals - to be used for some weeks

OP you must not feel guilty about using the service.
That skin condition needs expert help. Dont let them fob you off with just steroids.
Does water make your scalp worse ?

As a nurse I would definitely want you to keep coming back. We don't want you to be in pain and we don't know if you don't tell us. The "that" patients are the ones that kick off at you because their breathing is rubbish but carry on smoking 20 a day.... not someone who needs help and will listen to advice x

Did dermatology send any scales off for testing? You might have both a bacterial and fungal skin infection going on. And it might not be the usual local ones in the British Isles but something you picked up on holiday. Even if it is psoriasis, an opportunistic bacterial/fungal infection could have taken hold. You really need them to run some tests. I’d call dermatology, tell them it’s gotten worse and try to book an appointment as soon as available.

I would keep harassing the dermatology department, call to get an email address. From experience you’re much more likely to get a response.
GP is going to limited in why they can do for you for your psoriasis but may be able to offer something to help you get a restful nights sleep or manage the pain adequately. A re-referral can be done if you had been discharged from dermatology already.

There is a lot more that can be done for psoriasis and you might even need DMARD or biologic treatment. The GP cant prescribe this, it has to be done by a specialist. Your poor scalp looks so sore and you shouldn't have to suffer like this. May I ask, do you get aches/pains in any of your joints at all or any nail irregularities? It's just that a rheumatologist might be of more use to you than dermatolgy right now.

In any case, you really must book another doc appointment asap. You aren't wasting anyone's time at all and you are NOT being a pain. You are in an active flare and it mustn't be dismissed or ignored.

Perhaps a specialist charity

www.psoriasis-association.org.uk/

www.nhs.uk/services/service-directory/the-psoriasis-association/N10500153

Contact your dermatology consultants secretary and see if they can sneak you into a cancellation appointment