Acitretin

I've got the pustular version of PP, been dealing with it since September this year. Feet appalling, hands not much better. I've lost a couple of toenails and all my other nails are psoriatic too. I also have plaque psoriasis basically everywhere but my face and flexures/groin. I was started on 25mg Acitretin in October but quickly dropped to 10mg because I got a dry skin flare from it around my follicles. Rather than hairloss I've got extra growth - more leg and arm/hand hair which is curlier than usual. Kind of like when you get a rogue beard or tash hair that grows out thick and kinked. It's all personal choice but to be honest if all my hair fell out but my psoriasis cleared I wouldn't care. I used to be very active but my feet are so bad I've barely left my bedroom in four months. Being a slaphead would be a small price to pay. Admittedly I'm a 53yo bloke so baldness isn't a stigma in my age group. I've just started PUVA treatment which I had a serious adverse reaction to but which also seems to have created almost 100% clear soles with just two treatments. It's been a crap week dealing with what are effectively deeply sunburnt feet but now that they've peeled (like a typical start of season sunburn peel) I'm feeling more positive. Have a look at my thread in the Talk about Treatments forum for more details. Another option would be narrowband UVB - this is slightly less intense than PUVA. It will take longer and you'll need more sessions but is sometimes more available.

Oh man that sounds gnarly but stoked this treatment is looking like it could be the answer for you. I’ll look into it have got an appointment with a new dermatologist soon looking for different treatment. Cheers mate, all the best.

Yeah, it's sucked these past few months. I'm a very outdoors person and climbing the walls as a result. Also doesn't help that my main hobby/exercise of cycling is also my source of decompression and mental wellness. Good luck with the appointment, hope it goes well. Palmoplantar psoriasis can be a tough one to shift, the key is having a dermo willing to try combinations of therapies. Not sure where you are in the world but there's been some good research and results with Apremilast for it. If I can't continue with the light treatment due to the adverse reaction I think I might push for that next but the next step on the NHS treatment protocol is heavy systemics (methotrexate and ciclosporin) which I'd like to avoid.

Cheers mate, good luck. What sort of adverse reaction are you getting from it? Is it the sunburnt feet? I know man, I love to surf and exercise and live for the water, can get very depressing when you can hardly walk and run around with the kids also. No more bare feet need the cushion of shoes for everything. Thanks for the advice. I’m in Margaret river Western Australia!

From Acitretin I just went really dry with tiny flakes of scale around follicles on large areas (thighs, calves, forearms, upper arms, lower back). Also developed very rough skin on knees and elbows, like running your fingers lightly over a nutmeg grater. Believe that's keratoderma pilaris. Of course all this could just be coincidence as this is the first onset of any of these symptoms for me. For the light treatment yep it's like sunburn. I had one session which was fine. On my second session they upped the dose by about 40% and the day afterwards my hands and feet (that was all I had done) were red hot and swollen, just like a bad sunburn. After six days I started to get a very thin peel on both feet with no evidence of fresh scale or pustules. Because of Christmas and new year I've missed a couple of appointments (due to have it twice a week) but I'll see then on Friday for reassessment. It might just have been one of those "just rip the plaster off" cures of short term agony but they did say it was an unusual and extreme reaction so early in treatment. It wasn't terrible other than the fact it kept me bed-bound over the whole Christmas period and messed up our plans. If the result is clear feet I'll put up with a day or two of pain after each treatment.