How many "P" diagnosis actually performed by biopsy?
Question:
>But was it then treatable (manageable), and/or cured to your >satisfaction? >Ralph
Ralph, I don’t know if you haven’t read this yet, but psoriasis is not curable. It may go into remission, or may be controlled adequately by medication or UVB radiation or any of a number of other variations, but it doesn’t go away completely. Happily in my case the psoriasis of my skin has never been a major disability. At its worst, it was maybe 60 – 70% coverage, but ever since starting treatment for my related psoriatic arthritis (PA), it has been below about 10% coverage and currently is below 5% coverage. It is something I can easily put out of my mind completely. I do have psoriatic arthritis though, which in my case is the more serious side of the disease. However, most people with psoriasis do not get the related arthritis, so do not be too concerned about it. If your mom should begin to get arthritis symptoms, then she may wish to consult a rheumatologist to rule out psoriatic arthritis. LadyAndy Chat live with us at >http://tinyurl.com/4ust < (this is at iVillageHealth – my chats are on Sun evenings at 10 ET) Joint Replacement Board at http://boards.ivillagehealth.com/cgi-bin/boards/bhivhjointreplace
Response:
>Well, I agree, if there is no solution as yet, in her seeing four >dermatologists, she should see another until this is relieved, >if not cured, but one can’t go on forever in that process can they?
Yes, one can. But… >I mean it would be quite discouraging for me to continue to >do that.
…this makes sense, too. >Thats why it makes sense to me to have a biopsy, (if she >hasn’t, I don’t know yet), and look to other possible diseases >or "skin conditions," as a possible source of her condition.
A biopsy might rule _out_ psoriasis, or it might help ID the condition as psoriasis, but it’s not going to limit the condition to just a single disease. Any information you can gather might help a doctor make a good diagnosis, but you’ll have to find a doctor who’s willing to listen to your opinions. >Tell me, are all forms of "P" considered to be "infections?"
NO forms of psoriasis are considered to be infections. None. Every form of psoriasis might be _triggered_ by an infection (guttate in particular often follows a bout of strep throat), but once psoriasis starts, it can be self-sustaining, and remain long after a triggering infection has been eliminated by the immune system with or without the help of drugs. But there are lots of other possible triggers besides infection, too. >Well, that could be presumably arrogant and shortsighted if in fact >there are so many different kinds of P, some caused by infection, >some caused by emotional distress, and some caused by other >things, wouldn’t you say?
Well, not really. Psoriasis may be affected by lots of things (stress in many people, but not in others; diet in some, but not in others; etc.), but that doesn’t mean that these different people necessarily have different diseases, or even different ‘forms’ of the same disease, or even the same disease caused by different things. 80-something percent of people with psoriasis get good results from using potent topical steroids, but that doesn’t mean that the other 20% or so have a different kind of psoriasis, it just means that the drug didn’t work, for any number of reasons. As for the "caused by" phrases, above, we can be pretty darned sure that psoriasis symptoms are caused by an inappropriate immune system response within the skin, in 100% of cases. What causes that inappropriate response can often be traced to genetics, but the jury is still out on the question of which genes and why. And it may not be the same set of genes in all cases, but the mechanisms for creating the symptoms in the skin itself are remarkably similar. The classic signs of psoriasis, which I outlined for you, will "catch" a large number of psoriasis patients without need of a biopsy – _if_ the diagnosing doctor knows to look for them. The derm who said that anyone who relies on a biopsy to diagnose psoriasis doesn’t know psoriasis, was simply saying that much. If a doctor’s first impulse is to do an invasive procedure (even if only slightly invasive, like a punch biopsy of skin), he/she would actually be a better doctor to refer the patient to someone more knowledgable. >It is certainly well defined, but not by inflamation as much as, (in >the case of her legs anyway), it is by color. I take inflamation to >mean a rise in elevation of the skin in transition from >the other surrounding skin.
No. For the purposes of our discussion here, inflammation equals redness. Red as in "on fire," or "inflamed." If by "elevation" you mean "thickness," that’s covered by the "raised skin" part of the diagnostic checklist. >These are not.
Not which? Dry or moist? Sorry, I sometimes have pronoun troubles. :) >This is the case in some of her smaller patches, but not the large >ones, as those on her legs. I’m wondering though if thats because >there is a thin-ness of skin and lack of flesh in that area, being near >the "schin" (sp) bone, and by repeated scarring.
Shin skin is pretty thin skin, in general, but my shin plaques, when they’ve occured, have always been raised compared to the surrounding skin. I take it you haven’t been witness to Auspitz’ Sign in your mother’s condition? >Thats encouraging. I want to ad something here, that may be helpful >for some others, and possibley relates to this. [snip] >I finally went to her primary care physician with her, and described my >mother’s dislike for that heart doctor "for her." She hadn’t the courage >herself.
[snip] First off, I’m glad that part of the story has a happy ending. Secondly, it shouldn’t take any more courage to "fire" one of your doctors and find another than it does to "fire" the guy who rips you off when working on your car, and find another auto mechanic. By paying the doctor, your mother was hiring that doctor to do a job for her. If she wasn’t satisfied with the service, she should say so, and/or hire someone else. She shouldn’t act as if the doctor was doing her a _favor_ by seeing her. And I say it _shouldn’t_ take courage to do this, but I’m well aware that some people see doctors as somehow god-like (and some doctors see themselves this way, too), which is why I didn’t say that it _doesn’t_ take courage to do it. In this day-and-age, though, when many people have many doctors available to them within an acceptable distance, your mother probably needs to realize that it’s _her_ health, and she’s got choices. It’s been a long time since most towns had just the one doctor, and you didn’t want to annoy him by saying anything bad about him because the next-closest doctor was half a day away by ox-cart. This is, of course, true for just about any medical condition, not just heart problems or psoriasis. Hope all this helps. – Dave W. http://psorsite.com/
Response:
– Hide quoted text — Show quoted text -> Did you have a biopsy to determine that you in fact have psoriasis? > I am finding it interesting in my reading tonight to see that > sometimes this is difficult to diagnose, and sometimes requires this > to get an accurate diagnosis. > I’ve read alot about scales having a silvery look. My mothers scales > aren’t silvery, but I’ve not seen it mentioned that they can also be > yellowish. Yellowish is definately not silvery is it? > Could it be some other disease like tinea versicolor, a fungal > infection of the skin? Instead of "P" ? > I don’t know. I do know where you can find an image. > Thanks > Ralph > Why don’t you look at some pictures (google images) and > let us know what you think.
http://images.google.com/images?q=psoriasis&hl=en&lr=&ie=UTF-8&sa=N&ta b=wi – Hide quoted text — Show quoted text -> There are over 4500 images to browse. You may even find > a name to attach to your moms rash. And it may not > fall under the p umbrella. I can think of enough names to > keep you busy for weeks. You may even find something > that looks silvery. > Or you could take davew’s advice and find a few > doctors to confirm the actual condition. > Whether you go home with some gooP for it is > uP to you. > So, lets say you have a name for it and its P. > What do you really know now? > A heck of a lot more then yesterday, for sure. > What do you and her do then? How much time do you > want to expend on the newsgroup cure for it? > Is she really covered or just some mild areas? > I did notice one post on selsun blue with robin > in another thread. Maybe i should have read the > whole thread to make a real diagnosis. > Then i could have told you to get her into > a garage and up on the rack. You only get one > mom and you don’t want to blow it, now do you? > randall… time to call mom and tell her i love her
Thank you, I can tell you that this is definately not it: http://images.google.com/imgres?imgurl=www.antisense.com.au/images/sta tic/Psoriasis.jpg&imgrefurl=http://www.antisense.com.au/current_atl110 1_whatis.asp&h=152&w=260&prev=/images%3Fq%3Dpsoriasis%26svnum%3D10%26h l%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DN You gave me an idea. I have a fairly decent digital camera that will take a photograph clearly inside 18" so I will get a picture of my mothers condition, (legs), if she doesn’t mind, and post it to alt.binaries.misc or some such group. Thanks, Ralph
Response:
[snip] – Hide quoted text — Show quoted text -> Excellent clinical definition, DaveW. Describes my psoriatic plaque lesions to > a "t". Of course it doesn’t take into account the other forms of psoriasis. > Like you said, best choice is a dermatologist who has an interest in and sees a > lot of psoriasis in his or her practice. > As to the original question, my psoriasis was never biopsied; I guess mine is > typical enough never to have been in question. > LadyAndy > Chat live with us at >http://tinyurl.com/4ust < (this is at iVillageHealth – my > chats are on Sun evenings at 10 ET) > Joint Replacement Board at > http://boards.ivillagehealth.com/cgi-bin/boards/bhivhjointreplace
But was it then treatable (manageable), and/or cured to your satisfaction? Ralph
Response:
Excellent clinical definition, DaveW. Describes my psoriatic plaque lesions to a "t". Of course it doesn’t take into account the other forms of psoriasis. Like you said, best choice is a dermatologist who has an interest in and sees a lot of psoriasis in his or her practice. As to the original question, my psoriasis was never biopsied; I guess mine is typical enough never to have been in question. – Hide quoted text — Show quoted text ->Be that as it may, from memory (from a non-medically trained person, too), >here >are a bunch of bits of psoriasis diagnosis: >- Well-defined inflammation. If the redness "fades" into the normal, >surrounding skin color, it probably isn’t psoriasis. Psoriasis patches >usually >have very definite "lines" between inflamed skin and normal skin. >- Dry. Undamaged psoriasis plaques don’t ooze, and they aren’t "moist." >- Raised. Psoriasis patches are usually "taller" than normal, surrounding >skin, even when they don’t have scale built up on top of them. >- Auspitz Sign. Because of the changes to the underlying dermis in a >psoriasis >plaque, if you remove a scale which isn’t already "loose," you’ll see lots of >pin-point bleeding. Lots of little tiny dots of blood will appear where the >scale was well-attached to the dermis.
LadyAndy Chat live with us at >http://tinyurl.com/4ust < (this is at iVillageHealth – my chats are on Sun evenings at 10 ET) Joint Replacement Board at http://boards.ivillagehealth.com/cgi-bin/boards/bhivhjointreplace
Response:
> Did you have a biopsy to determine that you in fact have psoriasis? > I am finding it interesting in my reading tonight to see that > sometimes this is difficult to diagnose, and sometimes requires this > to get an accurate diagnosis. > I’ve read alot about scales having a silvery look. My mothers scales > aren’t silvery, but I’ve not seen it mentioned that they can also be > yellowish. Yellowish is definately not silvery is it? > Could it be some other disease like tinea versicolor, a fungal > infection of the skin? Instead of "P" ?
I don’t know. I do know where you can find an image. > Thanks > Ralph
Why don’t you look at some pictures (google images) and let us know what you think. http://images.google.com/images?q=psoriasis&hl=en&lr=&ie=UTF-8&sa=N&t… There are over 4500 images to browse. You may even find a name to attach to your moms rash. And it may not fall under the p umbrella. I can think of enough names to keep you busy for weeks. You may even find something that looks silvery. Or you could take davew’s advice and find a few doctors to confirm the actual condition. Whether you go home with some gooP for it is uP to you. So, lets say you have a name for it and its P. What do you really know now? A heck of a lot more then yesterday, for sure. What do you and her do then? How much time do you want to expend on the newsgroup cure for it? Is she really covered or just some mild areas? I did notice one post on selsun blue with robin in another thread. Maybe i should have read the whole thread to make a real diagnosis. Then i could have told you to get her into a garage and up on the rack. You only get one mom and you don’t want to blow it, now do you? randall… time to call mom and tell her i love her
Response:
>Did you have a biopsy to determine that you in fact have psoriasis? [snip] >Could it be some other disease like tinea versicolor, a fungal >infection of the skin? Instead of "P" ?
It could be a lot of things, Ralph. What really needs to happen is that your mom go to as many dermatologists as necessary, to get as many diagnoses as necessary and/or as many treatments as necessary to get real help. A dermatologist who used to post here once said that any derm who relies on a biopsy to diagnose psoriasis doesn’t know psoriasis. It’s difficult to diagnose without a bioposy if the person attempting diagnosis isn’t familiar with psoriasis. And it’ll be even more difficult for people who aren’t medically trained (like most of us here). Be that as it may, from memory (from a non-medically trained person, too), here are a bunch of bits of psoriasis diagnosis: – Well-defined inflammation. If the redness "fades" into the normal, surrounding skin color, it probably isn’t psoriasis. Psoriasis patches usually have very definite "lines" between inflamed skin and normal skin. – Dry. Undamaged psoriasis plaques don’t ooze, and they aren’t "moist." – Raised. Psoriasis patches are usually "taller" than normal, surrounding skin, even when they don’t have scale built up on top of them. – Auspitz Sign. Because of the changes to the underlying dermis in a psoriasis plaque, if you remove a scale which isn’t already "loose," you’ll see lots of pin-point bleeding. Lots of little tiny dots of blood will appear where the scale was well-attached to the dermis. None of the above is a marker for "that’s absolutely psoriasis," however, as other skin conditions can have a "psoriaform" appearance. There’s no shortage of case histories in the medical literature which basically say, "well, this person was being treated for psoriasis, but none of the normal stuff worked, and then he/she came to us, and we saw this symptom that had been overlooked, and that enabled us to make the diagnosis of [insert something other than psoriasis here], which, with proper treatment, was managed/healed/cured easily." If there’s one in your area, take your mom to the dermatology department of a teaching hospital. From what I’ve been told, they find "borderline" cases where the diagnosis isn’t cut-and-dried to be interesting for the medical students, so it might be more likely that whatever is plauging her will be diagnosed correctly. Hopefully. And conversely, it’s highly unlikely that "Internet diagnosis" is going to work wonders. There’s a reason that doctors are legally obligated to actually _see_ their patients before diagnosing them with any particular disease. And the photos on the Web tend to be of low quality – more than once have I thought I saw psoriasis in a photo online, only to find out by reading the text that I was _way_ off. – Dave W. http://psorsite.com/
Response:
>Did you have a biopsy to determine that you in fact have psoriasis? > [snip] >Could it be some other disease like tinea versicolor, a fungal >infection of the skin? Instead of "P" ? > It could be a lot of things, Ralph. What really needs to happen is that your > mom go to as many dermatologists as necessary, to get as many diagnoses as > necessary and/or as many treatments as necessary to get real help.
Well, I agree, if there is no solution as yet, in her seeing four dermatologists, she should see another until this is relieved, if not cured, but one can’t go on forever in that process can they? I mean it would be quite discouraging for me to continue to do that. Thats why it makes sense to me to have a biopsy, (if she hasn’t, I don’t know yet), and look to other possible diseases or "skin conditions," as a possible source of her condition. Tell me, are all forms of "P" considered to be "infections?" > A dermatologist who used to post here once said that any derm who relies on a > biopsy to diagnose psoriasis doesn’t know psoriasis.
Well, that could be presumably arrogant and shortsighted if in fact there are so many different kinds of P, some caused by infection, some caused by emotional distress, and some caused by other things, wouldn’t you say? > It’s difficult to > diagnose without a bioposy if the person attempting diagnosis isn’t familiar > with psoriasis. And it’ll be even more difficult for people who aren’t > medically trained (like most of us here).
Yes, I might suppose so. > Be that as it may, from memory (from a non-medically trained person, too), here > are a bunch of bits of psoriasis diagnosis: > – Well-defined inflammation. If the redness "fades" into the normal, > surrounding skin color, it probably isn’t psoriasis. Psoriasis patches usually > have very definite "lines" between inflamed skin and normal skin.
It is certainly well defined, but not by inflamation as much as, (in the case of her legs anyway), it is by color. I take inflamation to mean a rise in elevation of the skin in transition from the other surrounding skin. > – Dry. Undamaged psoriasis plaques don’t ooze, and they aren’t
"moist." These are not. > – Raised. Psoriasis patches are usually "taller" than normal, surrounding > skin, even when they don’t have scale built up on top of them.
This is the case in some of her smaller patches, but not the large ones, as those on her legs. I’m wondering though if thats because there is a thin-ness of skin and lack of flesh in that area, being near the "schin" (sp) bone, and by repeated scarring. – Hide quoted text — Show quoted text -> – Auspitz Sign. Because of the changes to the underlying dermis in a psoriasis > plaque, if you remove a scale which isn’t already "loose," you’ll see lots of > pin-point bleeding. Lots of little tiny dots of blood will appear where the > scale was well-attached to the dermis. > None of the above is a marker for "that’s absolutely psoriasis," however, as > other skin conditions can have a "psoriaform" appearance. There’s no shortage > of case histories in the medical literature which basically say, "well, this > person was being treated for psoriasis, but none of the normal stuff worked, > and then he/she came to us, and we saw this symptom that had been overlooked, > and that enabled us to make the diagnosis of [insert something other than > psoriasis here], which, with proper treatment, was
managed/healed/cured > easily."
Thats encouraging. I want to ad something here, that may be helpful for some others, and possibley relates to this. My mother has also had an arythmic heart for years. For the past six years the steadily declining lack of oxygen to her heart incapacitated her gradually to the point to where walking a few yards, exhausted her. She expressed to me a dislike of her heart doctor. She claimed he would not talk to her, acted as if she were a thing, instead of a person. Sort of as if she weren’t present. My mother had inquired the possibility early on whether a pacemaker might help her condition and she was told repeatedly by this doctor that that was not an option for her. I finally went to her primary care physician with her, and described my mother’s dislike for that heart doctor "for her." She hadn’t the courage herself. That doctor switched her to a doctor in her group of associates, and in less than 3 months time, after applying shock to the heart in a couple of success attempt to establish a rythm for the heart, which soon reverted, she indeed was fitted with a pacemaker and she is a new woman! Able to excersize, do her housework, and socialize to the degree she was accoustomed. > If there’s one in your area, take your mom to the dermatology department of a > teaching hospital. From what I’ve been told, they find "borderline" cases > where the diagnosis isn’t cut-and-dried to be interesting for the medical > students, so it might be more likely that whatever is plauging her will be > diagnosed correctly. Hopefully.
That is a good idea. > And conversely, it’s highly unlikely that "Internet diagnosis" is going to work > wonders. There’s a reason that doctors are legally obligated to actually _see_ > their patients before diagnosing them with any particular disease. And the > photos on the Web tend to be of low quality – more than once have I thought I > saw psoriasis in a photo online, only to find out by reading the text that I > was _way_ off. > – Dave W. > http://psorsite.com/
I understand. Thank you for your post. Ralph
Response:
Did you have a biopsy to determine that you in fact have psoriasis? I am finding it interesting in my reading tonight to see that sometimes this is difficult to diagnose, and sometimes requires this to get an accurate diagnosis. I’ve read alot about scales having a silvery look. My mothers scales aren’t silvery, but I’ve not seen it mentioned that they can also be yellowish. Yellowish is definately not silvery is it? Could it be some other disease like tinea versicolor, a fungal infection of the skin? Instead of "P" ? Thanks Ralph
Response:
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