It all started 12 years ago (in 2005). I was 30 and I experienced then probably the most stressful year of my life. That year I lived some 5 extremely stressful events which all lead to some dramatic metabolic changes in my body. P started with a couple of inflammations on the scalp (i.e. medically identified as seborrheic dermatitis at the beginning) and some irregularities of the nails. I previously had had an accident on two nails and I assume that the Immune System (i.e. IS), which was probably already overactive due to the metabolic changes, set the basis for the onychomycosis/P in the nails. No important changes occurred over time, except some additional inflammations on the scalp and changes in nails structure. The P was coming and going at the level of nails but it remained more or less constant at the level of scalp. In 2010 I was preparing an exam and the stress I put on myself massively worsened the P in nails. That is to say, from only two nails affected at the time, it expressed in 5-6 nails. In 2012, a highly stressfully perceived event (in the end it happened that there was no need for such a stress) made that P appeared on the elbows, though not on big areas (like a circle of 1.5-2.5 cm in diameter). In 2013 I changed country and job and probably the stress related to this made P appear on the exterior parts of both ankles (like a circle of 2-3 cm in diameter) and it settled in two previously made wounds.
LIGHT AT THE END OF THE TUNNEL
In 2014 I went to the Balearic Islands and I had myself exposed to sun for 7-8 full days (5-6 hours a day without any UV protecting cream). The P cleared up entirely, except on the nails. The body remained cleared for some 2 months.
In 2015 I went to the Dead Sea and I had myself exposed to the sun for 17 days (5-7 hours a day without UV protective cream on the skin, but only a highly hydrating one). The P cleared up entirely, again except for the nails, although some nails appearance improved. The remission lasted for 6 months but I must say that after my return from Dead Sea I stressed out on a professional project working long hours. I want to underline that the P on the scalp disappeared and never came back since then.
In 2016 I went again to the Dead Sea and I had myself exposed to the sun for 14 days (5-7 hours a day without UV protective cream, but only a highly hydrating one). The P cleared up again but the nails remained affected. I checked the Vitamin D level before and after the Dead Sea experience and the Vitamin D indicator…doubled. The remission lasted for 6-8 months but again, I was exposed to a lot of stress after my return from Dead Sea as I was still working long hours.
After a lot of time spent on understanding this condition, I ended up realizing that P is indeed an inflammation of the IS, but it is expressed dermatologically and only locally. Parts of the skin are more vulnerable and the IS inhibitory creams on the basis of cortisone are somehow efficient but only temporarily, as they cannot get into the deep levels of the skin and structurally affect its condition. Therefore I decided to use a UVB narrowband lamp and make local use on the different parts of the skin and allow its deep restructuring along with a highly hydrating cream I prepared myself out of essential oils (neem oil, tee tree oil, ginger oil, olive oil and garlic). In the last 3-4 months I've been using the lamp once a day x 5 min in the affected parts of the skin and the good news is that structural results have appeared like any time before. The UVB narrow band I use emits only 4.0 mW per sq cm, which makes it 1/30th of the UVB emitted by the Sun.
The inflammation and the plagues disappeared after 6-10 days and the result lasted for weeks. When inflammatory spots appeared again on the same place, I retook the exercise and the good news is that the remission is longer now. In some places (i.e. on the ankles) I can say that the skin appears as healed, i.e. I am without UV exercise in the last 3-4 weeks and the transformation of the skin appears structural. The same result appears on the elbows and on the previously permanent wounds, where the inflammation and the plagues disappeared. I will continue this way and my guess is that after a couple of more rounds the parts of the skin where P was present will permanently disappear as the structure of the skin will be changed, i.e. more Vitamin D will be locally available.
I want to add that I regularly useed hydrating cream to treat random inflamed sports on the skin and as long as the inflammation was not structural and did not affect a bigger part of the skin, the cream managed somehow to stop the inflammation and the skin colour and structure got normal after the treatment.
I must say that I stopped coffee for now 2 months and I also made progress in healing psychological issues which lead in the past to stress. Finally, I have not given up products like alcohol in the last 4 months.
MY FINDINGS FROM RESEARCHES
- The stress / anxiety leads to the activation of the HPA Axis (Hypothalamus – Pituitary – Adrenal) which ultimately leads to the release in the body of cortisol. Chronic stress means a perpetual high level of cortisol.
- P expresses because of a shift of the metabolism due to a constant pouring of cortisol into the body. Under these conditions, changes in metabolism are not sufficiently unbalanced by the traditional means the body usually has to respond.
- People respond differently to P treatment because its expression is highly subjective: the way we perceived stress is VERY subjective.
- Constant high level of cortisol implies several reactions in the body in the same time:
a) Increase of glucose or/and fructose metabolism, which ultimately means more cholesterol deposits (in essence, LDL – the bad cholesterol – which deposits on the arteries)
b) Increase of Reactive Oxygen Species, resulting in an abnormal oxidation of LDL (ox-LDL) and anti-oxidized LDL autoantibodies (AuAb-oxLDL); ox-LDL is more present in P zones that in the healthy parts of the skin.
c) Possible limited responsiveness of the Glucocorticoids Receptors because of the overexposure to Cortisol (Paradoxically, Cortisol is a trigger of inflammation and an anti-inflammatory element)
d) Possible inhibition of Adenosine and Adenosine Receptors A2A, which are by their nature anti-inflammatory. As a matter of fact Methotrexate, one of the first medication for P allows for 1) the accumulation of Adenosine level in cells, 2) the activation of Adenosine A2A and 3) the inhibition of Adenosine deaminase (ADA), whose over-expression is, in my opinion, one of the main cause of P through the change in metabolism it generates. In my case, the P appeared after long sleepless/stressful nights, which are equivalent with a conflict of between a high level of Adenosine (accumulated throughout the day) and the high level of ADA (the hormone which consumes Adenosine and restore its level to normal at the end of the night), thus generating a structural change of the metabolism. Last but not least, it is well known that coffee 1) decreases the accumulation of Adenosine in cells and 2) decreases the responsiveness of Adenosine Receptors A2A to Adenosine, which as I said are by their nature anti-inflammatory.
- The increase of metabolism seems to affect more some specific parts of the skin and I guess the most vulnerable parts for P expression appear to be those with the highest TEWL factor (i.e. Transepidermal Water Loss) – palms, soles, face, genitals the areas of the skin around the joints. The "dryness" allows for the over-expression of the oxidative stress on LDL and it probably affects the LOCAL EXPRESSION of the Vitamin D.
- The ox-LDL accumulation locally accumulated may be understood by the body as a "toxin" which is to be eliminated. Since the Vitamin D expression (totally or locally expressed) is impaired, the ultimate way to eliminate the "toxins" is through the activation of the IS (i.e. macrophage cells get activated, which leads in turn to inflammation through the inflammatory cytokines, starting with TNF-α.). The increase of ox-LDL combined with the limited capacity of AuAb-oxLDL to downregulate the ox-LDL makes the IS to respond by promoting a constant response of the pro-inflammatory cytokines (TNF-α, IL-6, IL-23, IL-17*). They remain structurally activated as they do not have counterparts to balance their activity. *Late researches show that the main culprit in P might be the activation of IL-23 which leads in turn to the constant activation of IL-17. The medial treatments currently available tackle the IL-23 activation but there are two bad news: 1) While reducing inflammation, IL-23 plays a role in fighting the cancerous cells, which puts the body of risk and 2) remission lasts for a limited amount of time.
- The locally expressed deficit of Vitamin D increases Reactive Oxygen Species and makes the elimination of the “toxins” even more difficult, as the Vitamin D appears to operate as a “smoother” throughout the process. Hence, such a deficit keeps the toxins on-site and constantly activates the local expression of the IS.
- Vitamin D is generally deficient in patients with P. Although it's not clear whether the Vitamin D deficiency is a cause of an effect of P (i.e. it is both negatively correlated with the levels of LDL / ox-LDL). My guess is that the change of metabolism somehow burns the Vitamin D available in the body and prominently affects the parts of the body with a higher TEWL factor. The latter decreases as a result of the UVB treatment, leading possible to an increase of the water level in that part of the skin.
- Nails P is a bit more difficult to treat as any treatment gets difficultly to the site of inflammation, because of the material the nails is made of. Even the Vitamin D accumulation is affected, as the UV does not sufficiently penetrate the nails. 1.5 months ago I started to treat the nails in the same way I've been treating the skin but with a longer exposure to UVB (i.e. 10 min). Despite the scientific background, the nails condition started to improve to the point that some nails affected for 12 years are now recovering slightly. Work in progress.
THERE ARE SOME QUESTIONS I WANT TO SHARE ABOUT P
1. Why does P appear only on some parts of the body?
It appears that some parts of the body are more prone to inflammation than others, due to over-oxidation in that specific parts of the body and the higher TEWL factor of them. Since P usually expresses only on some specific parts of the body, it means that the anti-oxidation process in the body is not entirely corrupt.
2. Why does P appear in stereotypical places (scalp, elbow, knees, ankles, nails)?
a) Scalp The skulk protects the brain from injuries and the fat between the skinhead and the skulk has a different composition to better buffer any possible shocks; hence, at the level of scalp the LDL might be oxidized faster. In addition, the skin of the scalp has a denser capillarity which explains why any cortisone cream is more effective on the scalp than on any other part of the skin. Or in my case, it can explain why after the very first trip to the Dead Sea, the skin of the scalp was fully recovered (i.e. the increase of the Vitamin D managed to permanently offset the excess of ox-LDL by improving the activity of AuAb-oxLDL). Last but not least, the skin scalp might have a different composition compared with the skin around the joints, which makes the latter more difficult to treat and the former more responsive to Vitamin D treatment. It is to be noted that there is a folklore among dermatologists which says that difficulty to treat the P increases as one gets from the head to the ankle.
b) Elbows/Knees/Ankle In those sites, the skin is the thinnest and the most elastic because it has to respond to the different movements of the arms / legs. Therefore, this makes the whole process prone to (supplementary) oxidation because of a potentially (more increased) acidic environment and a possible LDL over-accumulation in the skin around the joints. One needs to add the highest TEWL factor in the skin around those parts of the body.
o Nails The nails are the most acidic part of the body (around 4-5 PH) because through the hands we enter into contact with most of the “toxic” elements of everyday life. Therefore, in order to defend itself from “toxic” elements, the body created an auto-defensive system in the form of an additional acidity, which aims to destroy those “toxic” elements. (Acidity)
1. In order to P to express, all the 3 elements should occur in the same time
- LDL accumulation / ox-LDL accumulation
- Limited anti-oxidation, especially on vulnerable sites
- Deficient Vitamin D in general but mainly on specific sites
- Reduce LDL accumulation, in general, and on vulnerable sites, in particular – structural action
- Increase anti-oxidation, in general, and on vulnerable site, in particular – topic response
- Increase Vitamin D intake on vulnerable sites by extensive locally UV exposure and in general
My experience with P learned me that the IS gets perpetually activated because of structural changes of body metabolism. This being said, I dare to think that P can be reversible 1) should the metabolism gets back to a point of a different (pre-illness) equilibrium and 2) should the plagues are locally treated, not with creams but with moderate (3-5 min) long-term UV exposure. Again, P might be a systemic illness, but it express locally and can be treated in this way.
DISCLAIMER: This article is for information purpose only. The information provided comes from a personal experience with P and sums a couple of hundred hours of research with respect the pathology of P. Any path followed by any person on the basis of this article will be undertaken on personal responsibly.