Current treatment (since June 5th, 2012):

• Clobetasol propionate topical solution, USP 0.05% applied to the scalp after morning shower and before bed, Monday-Friday
• Fluticasone Propionate Cream, 0.05% applied to the forehead and face after morning shower and before bed, Monday-Friday
• Clobetasol Propionate Cream, USP 0.05% applied to spots on back, arms, legs, and chest, Monday-Friday
• Hydrocortisone ointment, 1% applied inside ears, eye lids, daily
• Dovonex (calcipotriene 0.005%) cream, applied to spots on back, chest, arms, and legs after morning shower and before bed, Saturday and Sunday.  I have been skipping morning application, however, before going to the beach or getting sun (as instructed).

Soaps and Shampoos:

• Paul Mitchell Tea Tree Special Shampoo and separate conditioner
• Grandpa’s Pine Tar Soap
• Neutrogena T/Gel Extra Strength therapeutic shampoo, applied 3-5 times a week, usually followed by Paul Mitchel Tea Tree shampoo.
• Dermarest Psoriasis Shampoo Plus Conditioner, applied 2-3 times a week, instead of T/Gel.  Haven’t used in over a week.

Additional treatments:

• Cetaphil moisturizing cream applied multiple times a day, particularly after morning shower, and after work before dinner.
• Almond oil, NOW Solutions brand, 100% pure, conventional (non-organic), applied after morning shower on weekends, and before sun bathing to entire body including scalp.
• Paul Mitchell Tea Tree Hair and Body Moisturizer, applied liberally to hair after clobetasol treatment.

Diet and Lifestyle

Back in April I purchased Healing Psoriasis by Dr. Pagano, and immediately switched to the Pagano diet.  That was followed by immediate constipation, which led me going to my PCP.  Despite the bowel issues, cutting red meat and gluten had a surprising effect on my energy levels and general well being.  Laxatives and extra fiber in the form of chia seed helped get things moving again.  I also completely cut out coffee and alcohol.

That lasted until late May / early June when I reintroduced gluten and resumed my normal coffee and alcohol habit.  Cutting alcohol was easy so long as I didn’t go out or see any of my friends.  I had never really noticed before just how much of my social activities are fueled by alcohol, and how much pressure there is to partake.  After the first couple weeks it seemed to get easier, but soon I was having a sip of wine here and there, and that soon turned into a glass or two, and now I’m back to going out and having a few drinks with the boys as we prowl around then city.

When I started on the new creams in early June, however, the diet mostly went out the window.  I have managed to stay away from red meat (with the exception of lamb), and all shellfish, but I’m certainly not eating as well as I had been back in May.  It’s time to resume the good Doctor’s diet, and cut the alcohol and coffee.

By far, the most difficult things to cut out are:

1. Coffee
2. Jalapenos, salsa, and spicy stuff in general
3. Wine
4. Tomatoes

Replacing coffee with juice in the morning worked for a while, but juicing at home takes too long (with prep and clean up), and buying juice out was adding almost $10 a day to my expenses.  On some level I am committed to spending whatever it takes to get better, but adding $300/month just for juice is out of control.

OK, let’s move on to some photos!

The spots on my shoulders and lower back are a light pink and are almost completely gone. The ones in the middle are harder to reach, and I obviously have not been doing a very good job at rubbing in the clobetasol. Those spots in the middle also itch like crazy by mid-afternoon.

Psoriasis seems to like areas near the spine. The larger spots all started smaller and grew into each other.

Things were a bit worse before starting on the clobetasol propionate cream. Now you can see that the areas that are easier for me to reach are reacting well, but the spots in the middle are still red and scaly.

This past week we had a serious heat wave.  You can clearly see some sunburn on my neck.  I plan to go out later today for a bit of sunbathing by the river.  SPF for my neck, and almond oil for everywhere else.  I really hope the natural sunlight is helping, but it is impossible to tell yet.

My scalp is doing much better.  The topical solution I’m using is clear and smells of rubbing alcohol.  There is a slight sting when applying it that quickly vanishes. Most of the red areas are gone, but there is still an itch and some scales in the back.

My forehead has almost cleared up completely.  It cleared up really well last week too, but then started to return after the weekend.  Now it looks almost normal.  People I met yesterday couldn’t tell, although the lights were dim and forgiving too.

To keep me from becoming too delighted in the progress, last week introduced a new surprise. And now for something completely different:

Keeping things interesting: new tiny spots clustered around the lower abdomen.

This cluster of small spots appeared very quickly (over the course of 48 hours), sometime on or near June 13th, 2012.  These little fuckers itch worse than any of the larger variety, and they sit right where my pants ride.  ARG!!!

Here’s a closeup of the left hip area.  Initially this new spot-cluster stuff was confined to the area above the crotch and below the belly button, but it has recently started to appear under the armpits as well.  More so on the right than the left.

Left hip area: these are much smaller and much closer together than any previous spots. Nearly identical on right hip and everywhere in between.

Since this new development appeared within a week of starting use of the new creams, I wonder if it is possibly a reaction of some sort.  Or could it be that since the creams were healing the spots on the rest of my body, the psoriasis simply exploded on a relatively untouched patch of skin.  Prior to these new spots, there had only been two larger ones in the vicinity.  You can actually make out the light purple remains on the larger photo above.

Time to return to the dermatologist again.  Hopefully I can get an appointment before my trip to Oregon in July.

That’s all for now folks.