methotrexate/nail cuticle thing

Posting in social since it isn't really ITP related. I know a few of you have used methotrexate. I have a mildly gross nail/finger thing that might end up being psoriasis, and that is just a guess from ruling out other stuff. The doctor might want to try methotrexate for it. I'm not much of a drinker and don't mind not drinking while it's treated. But I know this is a serious med and not sure if I want to go there. We haven't discussed dose or methods yet. This is a dermatologist. She isn't very familiar with lupus or ITP. I've been healthy for a while, platelets good since 2008 and just one brief lupus flare in early 2015.

I've had recurring inflamed cuticle area for years, it comes and goes, different fingers. This time it isn't going away, it's been at least six months and one nail is very damaged (new, that never happened before) and a second nail seems slightly damaged. Other fingers are ok. Might have similar problem on a toe. They don't know if the toe is related. I've been treated with an oral med for yeast (candida) with zero improvement. I'm waiting on the results of some biopsies/cultures to rule things out.

So I'm asking for your thoughts on a)using methotrexate for something that ultimately is cosmetic and relatively minor but annoying and unpleasant and b) if you've seen a nail/cuticle thing like that before and have any guesses which I bet would be better than this doctor's guesses.

Thanks, Erica

Erica:

I'm sorry I ever used Methotrexate. I did the pills for about 6 to 8 months, then switched to injections for a while. The drug never did anything to help, and the side effects were awful. I had diarrhea often and would barely make it to the bathroom. I'd get stuck in the bathroom at work. My bowels haven't been normal since and I've been off of it for a few years. I got sick all the time with bronchitis and pneumonia and the drug caused a nodule on my lung that needs checked once a year with an MRI. I was healthier before I used MTX.

It's a tough decision but you're right, it is a heavy duty med.

Thanks Sandi. I'm glad I asked. I will have them try other options first that might help with psoriasis if that's the probable diagnosis. I finally have fairly stable bowels and I don't want to risk that much less my lungs. Erica

The lung thing is a common side effect. As soon as my Pulmonologist saw my X-ray, he told me to stop the drug immediately. My Rheumatolgist agreed. You might not get the same side effects, but the problem with this drug is that the risks can be worse than the benefit.

Turns out they want to prescribe soriatane, it is one of those vitamin A type drugs, like used for acne. Supposed to be for severe psoriasis and symptoms return when discontinued. Side effects could include dry eyes, sun sensitivity, hair loss. I am thinking no, let's try something else first. I mean really, how is this the first thing to try and they can't even be sure it's psoriasis.

Dermatologists good grief. This practice mainly does cosmetic stuff. Gaaaaaaa! Erica

Erica, my son has been taking roaccutane for acne. His main complaint is that his lips continually peel and crack. It's working wonders for the acne though. I hope you find a workable solution.

Erica:

In the meantime while you're trying to figure out what treatment to use, it couldn't hurt to try this:

Home remedies are valuable for relieving pain and swelling of the infected area.

Soak the finger nail in warm salt water. This helps to alleviate pain and swelling around the cuticle. Dab the area dry with a clean towel and wrap it with Band -aid for early healing.
Instead of salt you can add vinegar in warm water, before you soak your finger. Vinegar has mild anti-fungal and antibacterial properties that help to kill the germs. Dry your finger and nail once you remove it out from the water.
Mix few drops of Apricot kernel oil, tea tree oil, jojoba oil and lavender oil in a bottle. Now apply a drop or two from this mixture on the nail and its cuticle area. Tea tree oil is known for its anti-fungal qualities.

Tea Tree Oil is great for things like that.

Here's more regarding psoriasis:

www.wikihow.com/Use-Apple-Cider-Vinegar-for-Psoriasis

www.healthdiaries.com/eatthis/coconut-oil-a-psoriasis-treatment-that-works.html

I know you probably think I'm crazy, but so far the medical alternatives seem pretty lousy. I've been trying more of these types of treatments and the things I've been doing are working. Try researching vitamins too...maybe a supplement will help.

Thanks Sandi. I'm planning to try some stuff like this. Remedies that are 'anti fungal' are probably not the way to go since they did culture samples from the problem area and there was no evidence of fungus or even infection. And the oral anti fungal did not help at all. I'm going to try to find a psoriasis group like this group. Erica

Erica,

Sandi wrote: Tea tree oil is known for its anti-fungal qualities.
It is also known for its proven anti-inflammatory properties:

www.ncbi.nlm.nih.gov/pmc/articles/PMC1360273/
Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties
A wealth of in vitro data now supports the long-held beliefs that TTO has antimicrobial and anti-inflammatory properties.

The fact that it is antibacterial, antifungal, antiprotozoal, antiviral and antiinflammatory should make it a good choice for a skin disorder of unknown cause.

Thanks everybody. I tried tea tree oil and there was no change. The latest and I think most likely correct diagnosis is that I have psoriasis of the nails. That is apparently very hard to treat. It is the only symptom I have of psoriasis which is rare but fortunate. And at this point it is funny looking but not crippling. The derm wants to use Acitretin (Soriatane) which from my research is way overkill with a lot of risks and not likely to have enduring effects after treatment ends and not even very likely to help. I'm going to meet with the derm again and then with my rheum and discuss. Probably watch and wait, there can be spontaneous remissions. Erica

Erica..I've just been looking at Acitretin related pages over here in the UK. It appears to be a third line management of psoriasis over here due to it's many side effect & contraindications.

Mrsb - I know! That's why I'm concerned I'm not getting good advice. It is for 'moderate to severe' psoriasis and the side effects are ones that will give me particular trouble. This doctor is out of her league. She is very young and the practice seems to focus a lot on cosmetic procedures - in the rooms there is an actual menu - it's labeled a menu - of all the procedures you can buy and the prices. It would be nice if actual healthcare came with defined price tags!
Erica

Erica:

Isn't it painful? I had eczema under my nails years ago and it hurt like heck.

Light therapy is supposed to be effective for psoriasis but you probably couldn't do that because of your sensitivity to light.

There has to be a better way. How long did you use the tea tree oil?

Sandi,
It isn't painful but it is sporadically itchy and sore, usually worse toward evening. Also really ugly.

I used the tea tree oil for about a week. There was absolutely no difference. Also in my reading there was no indication that it would be helpful for psoriasis. I still have some and I could try again. I wasn't able to find any 'complementary' type treatment recommendations for this particular issue. It is pretty rare to only have psoriasis of the nails, and not any other place, and very stubborn. It does remit spontaneously sometimes.

You are right about the light therapy. I think it would be ruled out for me.

There may be a chance to use a vitamin A cream and/or steroid cream. I'm meeting with the derm again soon, and then meeting with my rheum. I'll see what they think. It is affecting a few of my toes and that while not painful yet is getting a little uncomfortable at times and affecting my willingness to take walks and the shoes I can wear.
Erica

I feel for you. Like I said, I had eczema on my fingers like that. They would scab, ooze and bleed like crazy. I never wanted to touch anyone because I was afraid I'd freak them out. I had to wrap every finger in gauze once for weeks because it was so bad. I couldn't wash dishes because it would burn and itch like crazy. The only thing that helped were shots of Kenalog (steroid).

I'll let you know if I come across anything worth trying.