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Psoriasis is a debilitating skin condition that can affect the elbows, knees, scalp, lower back, face and indeed, any part of the body., including the genital area.. It may also affect the fingernails and toenails making them thick and discoloured. The condition is evidenced by red scales and inflammation of the skin which becomes very itchy and distressing.

This occurs when the cells of the skin rise too quickly from their source below the surface of the skin before maturity. There is often a family history of psoriasis. Around thirty percent of sufferers will also experience joint inflammation and this condition is called psoriatic arthritis.

I was in my early twenties when I became aware of a reddening of my elbows and knees. At first, I took little notice but then the scaly patches and the itching began. These then spread to my knuckles, ankles and some small patches on the lower legs. No amount of moisturising lotions or the like seemed to make any difference. Finally, I went to my physician who diagnosed my condition as psoriasis.

I began a regime of applying corticosteroid lotions and creams and using coaltar solutions to the affected parts of my body but even these appeared to have little effect.

At times, I experienced significant physical discomfort. Itching and pain interfered with basic functions, such as sleep. This in turn left me feeling constantly tired and unable to cope with day-to-day chores, thus putting a strain on my family relationships. I began to feel self-conscious about my appearance and had a poor self-image that stemmed from fear of public rejection. Psychological distresses in turn lead to significant depression and social isolation.

Sometimes the condition got worse and then improved so I was then able to identify a number of things that produced flare-ups including infections, stress, and climate changes. There were also certain medications that seemed to trigger outbreaks or worsen existing patches.

The years rolled by and the disease continued to progress until I had large patches of psoriasis on my knuckles, elbows, finger joints, knees, lower legs, feet, and even the webbing of my toes. I also had it in my scalp and covering a large portion of my back. I lived in misery with the constant itching and discomfort.

Around six months ago, I received a phone call from my mother telling me she had just been diagnosed with psoriatic arthritis. Because this condition is genetic and I already had the skin condition, it was important that I see a rheumatologist to be tested. Of course, it was no surprise when I found that I too had psoriatic arthritis.

Blood tests conducted for this condition may rule out other conditions such as gout or rheumatoid arthritis. There is a particular antibody normally present in rheumatoid arthritis that is not present in psoriatic arthritis. These tests will often also show elevated erythrocyte sedimentation rate or ESR which measures inflammation. They often show mild anaemia and elevated levels of uric acid.

My rheumatologist prescribed Methotrexate, an immunosuppressive drug. This medication has been used very successfully in the treatment of psoriasis and psoriatic arthritis. I take a low dose of this drug once weekly.

Methotrexate works by binding to and inhibiting an enzyme involved in the rapid growth of cells, thus slowing down the rate of skin cell growth. It was originally used in the treatment of cancer but was discovered in the 1950s to be effective in the treatment of psoriasis and was eventually approved for use in this condition in the 1970s.

Methotrexate is generally well tolerated in small doses but it does potentially have a number of side effects. For this reason, it is imperative that a patient on this drug follows the instructions of their physician very carefully. People taking this medication need to have regular blood tests to be sure that the body is processing the drug safely and not creating other problems, particularly in the liver.

I have been on Methotrexate now for around four months. During the first six weeks or so, I noticed little reduction in my pain levels although the skin condition did show signs of subsiding. However, in the past couple of months, my need for painkillers has definitely been reduced and the skin condition is almost gone.

My family laugh when they see how excited I get about having knuckles now instead of great patches of scales. I can even go barefoot without the embarrassment of the condition in the webbing of my toes. Some people used to think I had a severe case of tinea and would look at me as though doubting my hygiene habits.

The only downside I have is a feeling of tiredness and the fact that I am prone to infections. This is caused by a reduction in my white blood cell count. However, under careful monitoring by my doctor, these symptoms are reduced by antibiotics when needed and a good multivitamin.

Despite these downsides, my life has greatly improved and continues to do so. I am kept aware of all the possible side effects and regular blood testing keeps my physician and my rheumatologist informed about any concerns. Hopefully, I will be able to live a far better quality of life in the future.