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Psoriasis (young people)

Psoriasis topical treatments: dithranol

Steven, Lucy and Adam have tried topical treatments containing dithranol. Dithranol is a short term treatment for psoriasis on the legs, arms and/or trunk of the body. It’s a strong chemical and can only be left on the skin for a limited period of time before it needs to be washed off. Adam heard about dithranol online and asked his GP for it. He doesn’t think the GP was aware of the risks and Adam ended up leaving it on too long which burnt his skin badly. Some types of dithranol treatments are applied in hospital where the treatment is supervised by medical professionals.To limit the chances of side effects,

Steven’s dermatologists suggest he slowly increases the strength of the dithranol topicals he’s using and does test patches each time. Lucy uses a dithranol scalp solution which she can keep on overview because it contains a lower percentage of the chemical. She alternates using the dithranol solution on her scalp every other night before bed and a home remedy of olive oil on the other night.
 

Steven’s dermatology nurse gives him detailed instructions about using dithranol topical treatments which are different to those in the leaflet.

Steven’s dermatology nurse gives him detailed instructions about using dithranol topical treatments which are different to those in the leaflet.

Age at interview: 22
Sex: Male
Age at diagnosis: 14
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So, how do you go from the gradations of the medications that you’ve brought in, like how’s the timing of them work?

So these ones I have been to the hospital twice last week. Kind of every, twice a week, beginning of the week just to check in with the nurse and she just checks that my skin’s okay and it isn’t blistering or anything like that, cos that’s quite a common side effect. And then she says, “Right, go up to the next one”. I have to test it on a really small patch of psoriasis that I’ve got. And then when that’s, you kind of test one with the next dose and carry on with the same dose. And then when you, like the next day, if everything is okay, you go up to the next dose. So it’s kind of controlled under her, there are labels on it with like dates and stuff. She said, “Just kind of ignore that and like whatever I say, do”. You have to be careful, because I mean she said me, there’s a little leaflet I’ve got and she crossed out every time it says half an hour and left it on for an hour. Because depending where you get different treatment from depends on what they can, how long they can tell you to have it. And what happened with me with the doctor, told me, GP, said “Use this for half an hour.” Went to the hospital and she said, “Oh, sleep with that in overnight.” And you just have to kind like make sure that the doctor kind of y’know, has got, can tell you that. 

I think if you’ve got treatment that you find is working, but it’s not kind of like working-, you’ve kind of got a bit stable with it – it might be worthwhile asking the doctor, “Is that the longest you can leave it on for? Can you do something else with it?” Because if that’s working, I did have that with one of them a few years ago, it was working, but it wasn’t quite clearing it. I said, “Is that all I can do?” and she went, “Oh, you could wrap yourself up in cling film,” glamorous, really glamorous. Wrap yourself in cling film for like an hour and keep that in and kind of like makes it more- working. And then wash it off. And then that did kind of really help me. So it’s worth, if you’ve got something that you know works kind of like asking if there’s any other way you can do it. 
 

Adam had a bad experience using a dithranol topical treatment when he didn’t follow the instructions.

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Adam had a bad experience using a dithranol topical treatment when he didn’t follow the instructions.

Age at interview: 24
Sex: Male
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I got this one that, and then I didn’t read the instructions on how to put it on. And basically I put it on, and then the instructions, like you’re meant to wash it off after 10 minutes. I don’t know what it’s called. I can’t remember. But I didn’t. I put it on and I went out for the day. And I came back and I had burns all over my body from having just put this, put this on myself. And, which made it all the worse, cos then I was just like devastated, kind of like that, and nothing was working.

Is that something that you then had to get more treatment for? Did you have to go to the hospital or GP or something?

No, I just had to basically, cos I went straight to the doctor and he was like, “holy shit” [laughs] or something like that. And like my skin wasn’t peeling or anything like that. It was just very raw and red almost, and just like having quite bad sunburn is what basically happened. And I just had to kind of like wait for it to go away and just had to moisturise. And I think it took about a month or six weeks to go down. I took pictures of it at the time. I’ve got them somewhere, yeah.

Did you use that treatment again afterwards?

No.

No?

No, never touched it.
 

Steven’s current topical treatments are very time-consuming as he has to leave them on for an hour before washing it off.

Steven’s current topical treatments are very time-consuming as he has to leave them on for an hour before washing it off.

Age at interview: 22
Sex: Male
Age at diagnosis: 14
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This, at the moment, I think is the most intensive I’ve ever had something. So I started with the first one, you have to like test a little patch of your skin just to check you don’t have a reaction to it. So that was the blue. That’s the blue [holds cream up to camera]

And then you, I’m leaving it on for an hour. Sitting at home, not doing very much. It was difficult cos I went away last week, I had to kind of like find an hour to take away from everything to kind of like sit and do nothing. Then washing it off and I got told, I said, “Oh, should I be using like the real, you know, the nasty shower gel?” and she was like, “Whatever you like”. But I kind of thought, like okay, let’s be sensible here. Let’s not go crazy and start like throwing stuff at it. Let’s be like kind of like sensible. And I’m using my shampoo as well to try and like do a win double of like [gestures around head] everything. And then I was on that for four or so days and then carried on with that on the rest of my body and then picked one – the same test patch – to go up a dose. So now I’ve gone red [holds up the red packaged cream]. And I’ve now been on the red for a few days and last night went up to the purple one, tried that on my test patch. It’s quite intensive and when you think like an hour at home, it’s quite a big like thing. You have to have that hour of like, in the end of it, really it’s gonna be an hour and a half, cos by the time you’ve like had your shower afterwards and you’re not supposed to like rub. It’s quite a general thing like the doctors all said to me like, “Don’t rub your skin with your towel when you get out the shower”, especially if you’re using like emollient shower gels, because if you rub it then it rubs it off the skin and that kind of like ruins what you’ve done. So I’ve got like a bath robe that I kind of now like hide in for like half an hour afterwards, just to like gently dry off. I think this is the most intensive treatment I’ve had. Almost more than going to the hospital three times a week for light therapy, because it was three times a week, it was 10 minutes: you’re in, you’re out, you’re done. You moisturised and you got a bit sunburnt, but you weren’t like spending a dedicated hour of like sitting at home doing nothing. I think it’s possibly the worst, apart from sleeping in stuff actually. 
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