[This blog was originally published on Everyday Health in August 2014. I referenced this article in my recent entry Another Inconvenient Psoriasis Treatment as I consider Goeckerman (tar + phototherapy) treatment.]
Skin treatments can be especially inconvenient and uncomfortable. Recently my dermatologist prescribed an at-home treatment I had never heard of before, wet wrap therapy (WWT). As I listened to the instructions I thought, “Easy for you to say, but it sounds really messy.” At first I protested, telling him that I would need to travel over the weekend. My four-day weekend road trip would interrupt the two-week trial run. No matter, he said I could take what I needed with me. A doctor can give instructions in a few minutes, print out an article to read, and go on his way. The patient, on the other hand, is left with the burden of carrying them out day in and day out.
Over the years I’ve tried many different skin treatments and regimens. Some of them have been quite easy to administer — as easy as popping a couple of pills a day. Others involved travel, gooey messes of ointments, or smelly concoctions. Some worked better than others, none has been effective long term
What follows are some of the most inconvenient and uncomfortable skin treatments I’ve tried in treating psoriasis, eczema, and other skin conditions.
As a child I slathered liquid coal tar in a petrolatum base all over my body each night, sleeping in greasy pajamas. My sheets, clothes, and even bathtub were stained from the tar residue. When I visited the La Brea Tar Pits in Los Angeles I told my kids, “That’s what my tar treatment used to smell like.” They wrinkled their noses at me. Imagine putting that all over your skin at bedtime as an eight year old.
Over the years I’ve undergone various light treatments. As a child my mom took me out of school three days a week and drove me thirty-five minutes each way to the hospital. Since those early days I’ve traveled up to forty-five minutes each way to clinics for broadband ultraviolet B treatment (UVB), narrowband UVB (NUVB), and Psoralen with ultraviolet A (PUVA). One memorable time I drove through snow and ice to get to the clinic, only to find out that the light box nurse didn’t make it to work. I could not restrain my displeasure, giving the clinic administrator an earful.
After high school graduation, while others departed for graduation trips, I drove to a psoriasis treatment clinic near Stanford University. For six weeks, five days a week, I took a bus from my relative’s house to the daycare clinic. There I would stay for five to six hours. The day started with scalp treatments, then progressed to applying a paste with anthralin on EVERY psoriasis sore I had. That took a while and even frustrated the nurse when I did not improve as quickly as she wanted. I wore pajamas over the paste and couldn’t go anywhere. After the required time elapsed, I washed off the paste, took a dose of ultraviolet light, and rode the bus back to the house.
Injections at the Hospital
A couple of times I needed to go to the hospital for injections. The pills upset my stomach for days at a time so my doctor thought I could inject it in my hip, as some cancer patients do. Methotrexate was the first. The injection hurt more than any other I had before, and, unfortunately, did not help my upset stomach. After a few weeks of losing a day or two of work a week, and little improvement, I stopped the treatment.
In the early 2000’s biologic treatments came to market. One of the first is called Amevive. When it first came out I had it administered in the oncology clinic intravenously. The injection itself did not take long, but the waiting, prep, and staying after to make sure I did not have an adverse reaction to the treatment took a couple hours. The worst part? My skin got worse, not better, over time.
Chinese Herbal Remedies
I’m Chinese American so when someone asks me if I’ve tried Chinese medicine I just smile. I grew up near San Francisco, which has a large and active Chinatown. As a child my family drove into “The City” to buy groceries and, yes, visit the Chinese herbal doctors and medicine stores. Boiling the herbs made the house smell and took hours to prepare. But drinking the bitter medicine proved to be much worse. Don’t tell my parents that I sometimes poured it down the drain.
Another Chinese medication involved snake powder. I mixed it with water and drank it. After a couple weeks I started gaining lots of weight and retaining water. Suffice to say that some of that toxic mixture also ended up in the drain.
I did have one success story, however, with Chinese medicine. When I went to China after college graduation one doctor gave me a solution I put on my skin twice a day. For the duration of my trip my psoriasis cleared completely. I couldn’t find that solution again, and once I returned home it stopped working anyhow.
Wet Wrap Therapy (WWT)
Over the past few weeks I have administered wet wrap therapy at-home and on the road. The treatment is primarily for eczema, but it helps my psoriasis too. WWT involves bathing, slathering (my doctor’s word not mine) a medium strength topical corticosteroid ointment on my skin, then covering it with wet clothes. Over the wet clothes I put a layer of dry clothes which helps keep the wet clothes damp. After about an hour I re-wet the wet layer of clothes. Some leave the wet clothes on overnight, or for some hours. I usually leave it for about two to three hours in the evening. The treatment moisturizes the skin, allows the medicine to penetrate the skin, and cools inflammation.
Worth the Trouble?
For all the inconvenience skin treatments might present, some have worked quite well. Currently, wet wrap therapy is amazingly effective at calming my skin irritation and itch. After two weeks I returned to see my dermatologist to show him the results of the WWT experiment. He was amazed at how well it worked and wished he had prescribed it earlier. Now I am testing how often I need to do the treatment to keep my skin conditions under control. My skin’s become sensitive to coal tar, but I had good results in the past and heard great results from others. At this last visit my doctor mentioned that some using a therapy called Goeckermann (coal tar with phototherapy) can go into remission. While I didn’t do well with methotrexate or Amevive, and I haven’t used phototherapy in a while, going to the hospital or clinic can be a life saver if effective for you (some have used phototherapy at home to make light treatment much more accessible). Despite the ill smells, cost, and time involved, complementary treatments such as Chinese medicine offer alternatives to conventional approaches that many people are seeking.
As inconvenient or uncomfortable skin treatments may be, I have no doubt I’ll keep trying them. It’s worth the trouble as long as there’s hope for relief.
What are some inconvenient or uncomfortable skin treatments you’ve tried for your psoriasis? Were they worth the trouble?