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Russell

Age at interview: 20
Age at diagnosis: 19
Brief Outline: Russell was diagnosed with psoriasis when he was 19. He developed blister-like psoriasis whilst on holiday in the summer of 2013. He manages his psoriasis largely through a combination of a steroid cream, moisturisers and some lifestyle/diet changes.
Background: Russell is 20 and an undergraduate University student. He lives in shared accommodation. His ethnicity is White British.

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Russell was diagnosed with psoriasis about 1 year before the interview. He described himself as having only “a touch” of psoriasis and knew that others had it worse. Dry skin affects both of his parents and he is also prone to this. Whilst Russell was away on holiday in the summer of 2013, the skin on his hands and feet blistered. He looked up the symptoms online and thought that it might be psoriasis; this was confirmed by his GP when he returned to the UK. The doctor prescribed Russell a steroid cream and heavy-duty moisturiser which helped on this occasion. These treatments also worked for a second flare up on his hands. He has also tried a number of natural and homeopathic remedies, including manuka honey which has also been used in his family to treat other fairly minor skin complaints.

Russell feels confident that he is able to manage his psoriasis with the topical medicines in combination with lifestyle adjustments such as cutting down some foods and getting more sleep. In particular, he finds that having less dairy and yeast in his diet helps a great deal. He says that the very early signs of a flare up can be a warning sign that he should take better care of himself, prompting him to “eat well and go to bed early”. He did not want his psoriasis to stop him from enjoying his time at university, including being able to drink beer (which contains yeast) with friends, and recognises that stress cannot always be controlled.

The timing of his psoriasis was considered by Russell to be better than if he had developed it during childhood or later in adulthood. He feels that the university years are a time involving a lot of changes generally and that he is at a “peak in terms of adaptability”. He finds the tasks involved in managing his psoriasis, such as moisturising and making fairly minor lifestyle adjustments, are easier to “add” onto the other activities and changes that he is making at this time. Russell is aware that his psoriasis may become worse over time but he hopes that he will continue to be able to manage it so successfully.
 

Russell was on holiday when he had his first major flare-up of psoriasis. He looked up his symptoms and worried about what it could be.

Russell was on holiday when he had his first major flare-up of psoriasis. He looked up his symptoms and worried about what it could be.

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I was with my girlfriend and she looked at that and was like “Don’t read too much into the internet” because well you know there’s so much out there and things like that and I knew she was right and kind of knew the same myself but it’s much more difficult to see that when you’re the one who’s googling something that you think you have. So it was nice in that way to have someone else sort of telling you to be rational and reasonable because it's harder when it’s about you, if that makes sense.

Was there anything else when you were googling that you thought it might have been?

Nothing from memory, no, no. I think the only other thing I kind of assumed it was either just dry skin or maybe, or maybe eczema and then obviously there’s always the irrational part of you that thinks it was some horrible tropical disease that you’ve picked up but when you kind of rationalise it you know that it’s probably not and of course it wasn’t, so.
 

Russell has had two main flare-ups and saw different GPs for each. Although they had different ‘bedside manners’, both diagnosed it as psoriasis.

Russell has had two main flare-ups and saw different GPs for each. Although they had different ‘bedside manners’, both diagnosed it as psoriasis.

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One of them was, I can’t remember which time round it was but one of them was very, very business-like about it, it was the first time. ‘Cos I went, I went in there thinking I need to explain every detail, everything about the timeline and be very, very precise about it all and the doctor was more or less “Yeh it’s psoriasis” and I’d say a few more details, “No it’s psoriasis.” She was very, very business-like. And I sort of came out think oh that’s quicker, quicker than I expected. yeh I just felt they were quite shut-off about it whereas the next time I went round the doctor, they were both female but they were both so different, the second was much more kind of sat down, listened, engaged like listened to everything I had to say first and then kind of made a diagnosis whereas the first lady kind of cut me off when she knew what it was. so they were two quite different experiences, I’m not saying I came out the first one crying or anything but I did think oh that’s sounded business-like for a doctor.
 

Russell says he “never felt particularly embarrassed” about psoriasis but sometimes wondered what people thought when they saw his hands.

Russell says he “never felt particularly embarrassed” about psoriasis but sometimes wondered what people thought when they saw his hands.

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Occasionally I’d feel a bit sort of sheepish about my hands because you kind of, because it looks so flaky and it looks, I think it looks worse than it actually is. so if you're kind of talking to someone or you have to shake hands or something you’re a little bit self-conscious because you’re thinking “Oh what are people going to think of me”, I’ve got horrible dry flaky hands, they’re going to think that I don’t take care of myself or that I’m not a very healthy person or I’m not a clean person and obviously the irony is that you’re, well, it’s not related to any of those things, I shower every day, I’m clean and what not and there’s nothing you can really, there was nothing I did to bring it on. but nobody else knows that and it’s not something you bring up in conversation like justifying that you are a clean person or justifying that it wasn’t your fault that you came down with it or whatever. And so in that sense it was a good place to have it because it was much more severe on my feet than it was on my hands.
 

Russell finds his university life involves a number of psoriasis triggers, including drinking alcohol when socialising.

Russell finds his university life involves a number of psoriasis triggers, including drinking alcohol when socialising.

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But also being a male student, beer as well is a big contribution of yeast and once I’d sort of spoken to him and had this conversation it made a lot of sense and I did start to see a difference and there’d be times last year if, perhaps I, I don’t go out sort of every night I’m not one of those people but I do like to go out occasionally and stuff. And of a week perhaps where you go out once or twice, I went out twice and our sort of my staple drink was, would be kind of beer. I could see it over the next couple of day’s I’d wake up and I could see like the beginnings of a patch and maybe it was because I was more sensitive to it in terms of I was watching more what I ate. Because previously I’ve had quite a fast metabolism, I do quite a lot of sport and I’m quite active so I don’t, I’ve never really watched what I ate and my weights never really fluctuated – I think I’ve been the same weight for about five or six years and I’ve never really paid much attention to it so it could just be the fact that I was now slightly more sensitive to what I was putting into my system but I’m convinced now if I have a couple of nights out in a row or a couple of late nights in a row with maybe a night out with drinking interspersed in that, I can see it in my hands. just either in the beginnings of kind of a dry spot or something and so again it’s a little bit of a kick to drink some more water, have a few nights off, get some early nights, try and eat some good food over the next few days and to start moisturising again. And invariably that kind of keeps it at bay. the only thing that doesn’t at that point is sort of stress is the only other input that I can’t really have too much, well I can but at the same time I can’t, have too much of an influence on because there just seems to be so much going on all the time. 

So how ever early a night, however well you eat and whatnot – there’s only so much it can do ‘cos I’m one of those people that can’t really say no to doing stuff so I still run around like an idiot, trying to do everything that I can but I wouldn’t have it any other way – I’d take a little bit of dry skin to kind of enjoy my university experience a bit more.
 

Russell says he manages his psoriasis well with steroid creams and avoiding triggers, so he doesn’t go to the GP often.

Russell says he manages his psoriasis well with steroid creams and avoiding triggers, so he doesn’t go to the GP often.

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‘Cos the first time it was more like we think it’s psoriasis, we think you should try this if it doesn’t work come back again and we’ll try something else. And then the second time I went back, in my head thinking I know what I want, I know what I need and the doctor more or less agreed, I didn’t sort of say “I need this cream” but I explained that it had worked before and they said well if it worked before it’s probably going to work again but if it doesn’t, then we’ll come back. And yeh that’s basically where I am at the moment so it has worked so I haven’t gone back. So in terms of other treatments or therapies I’ve not tried any and I don’t really know any others but it’s been treated as a kind of as and when you need it. 
 

Russell talks about the types of moisturisers which work best for his skin.

Russell talks about the types of moisturisers which work best for his skin.

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I think some of the kind of scented ones tend to work less or kind of the high street brands ones tend to work less you need the kind of like the heavier, more medical, homeopathic ones like the kind of the because I was prescribed a I think it’s like a water based moisturiser for along with the steroid cream kind of like aqueous cream you can buy over the countered very similar to that, I think maybe just one step kind of more serious [laughs] or more heavier than that yeh but those ones seemed to work best, the high street ones or the ones that are sort of I don’t know fancy, flowery or whatever tend to work less but I’ve no idea why, but I think the other ones tend to be a bit more kind of, pack more of a punch.
 

Russell finds a steroid cream work well for his skin.

Russell finds a steroid cream work well for his skin.

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And I was just picking at it and making it worse and it was getting close to the point where it was starting to bleed and stuff and I kinda thought I should, I know what I need, I need to go back, I need basically the steroid cream and I told the doctor and they said “well if it worked last time, we’ll try it again this time” and try and keep it on, I think they gave me a slightly bigger they told me to, they told me to use it for longer and they gave me slightly more of the steroid cream and half of it has remained unopened but I still have it and I’m glad that they did give to me so a couple of times when it’s flared up I’ve put the steroid cream on it for a couple of days and that sort of takes it right down again. when I say flare up in that sense, nothing compared to both times I went to see the G – just when I think that this, it’s going to get, it could potentially get serious. 

There’s no real way of kind of saying that better other than just like my intuition of how bad it looks to me at a particular time and other factors will come into that sort of, if I know it’s a busy time of year so if it flares, flares up during a week with two or three deadlines in – I know I’m not realistically going to bed early, getting lots of sleep and whatnot, I’m probably going to be up late, eating rubbish, getting stressed about work so I’ll resort to the cream. So it’s nice to have it there but since going back that second time to the doctors I haven’t needed to go back and haven’t felt the need to go back. Sort of having the steroid cream and enough moisturiser and knowing a bit more about food, diet and what I should be putting into my body and what I can do to change it in that sense, I kind of, I’m much better equipped now to handle it myself without having to kind of go and ask for the help of the doctor. If it got really bad again I’d have no qualms in going back to the doctor.
 
 

Russell talks about how he uses his topical steroid for psoriasis.

Russell talks about how he uses his topical steroid for psoriasis.

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Can you tell me a bit about how you decide how much steroid cream to use or for how long you use it?

I think they said don’t use it for more than two weeks straight without having a break of a few days. So I try to sort of adhere to that rule but I don’t think I ever did more than kind of two weeks, a couple of days off and then another two weeks and them maybe a day or two more but I think that’s pretty the max. Just because at the beginning you can see such a stark change very, very quickly and then again it’s just a case of personal judgement as to where I stopped seeing a change and then I thought oh I should probably give it a break. Yeh so basically when I stop seeing any kind of change.

And do you, how much would you put on a patch? Is that again sort of judgement?

Again yeh judgement, it always, it’s quite thick it’s more like a gel really than kind of like your average kind of your average Nivea or whatever. so it’s quite hard to rub in, in a sense. The first time I definitely put too much on so you’d be sat there with like really oily, gel-y hands and like, I’d sat there, I’d sit there for maybe ten or fifteen minutes and then I’d have to wipe some excess off because it’s you can't really sit down for hours and hours and hours and even then it’s probably still not going to sink in. so again just a case of judgement but, but quite thinly was, was probably best because it was a very, very thick yeh don’t think I have a better answer to that.
 

Russell thinks psoriasis might have “bothered” him more if it had affected other body parts and at a different time in his life.

Russell thinks psoriasis might have “bothered” him more if it had affected other body parts and at a different time in his life.

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Do you think there’s an emotional side to having psoriasis?

For me I don’t think there has been but that’s because of what I’ve said before of where I have it, it’s not in obviously places and secondly when I had it – I had it at quite a convenient time, that it didn’t stop me doing anything. if perhaps those two, those two things had been different – if it had been in an obviously place, if it had come at the worst time of year when it would have stopped me doing stuff then I would have had a different experience, it would have been more unpleasant, I won’t say pleasant ‘cos it’s not pleasant, but it would have been more unpleasant and I’d of been affected more by it and it would have made me a bit more upset, it would have held me back more and I would have had more negative emotions and negative experience associated with it. so as it is, I’d say no – for me it’s not an emotional thing, it’s more of a practical thing, it’s something I have, its there and I have to deal with and I’ve had a year now of learning how to deal with it and I know like I say what works best for me in terms of kind of lifestyle choices, whether they’re placebo or not, and what creams – just through trial and error work for me or not. So yeh I think it’s more practical than emotional for me.
 

Russell was diagnosed with psoriasis when he was 19. He thinks this was a good age to learn about managing the condition, including avoiding triggers.

Russell was diagnosed with psoriasis when he was 19. He thinks this was a good age to learn about managing the condition, including avoiding triggers.

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I think having it now – it’s been, I seem to keep saying it’s a good time, but quite a good time to have something. Because as a child you’re reliant on your parents to kind of sort it out, to do it. As an adult, I don't really know, maybe it’s less – as an older adult, you might be less adaptable, that might not be correct but my impression at the moment seems to be that at this point in your life, particularly whilst at university, you’re at your kind of peak in terms of adaptability because everything around you is changing so much and university is such a kind of manic time with so much happening and so much change going on and you grow up massively and your personality changes and you develop into a person essentially over the course of three or four years, or in my opinion you do anyway. And I think it kind of gets subsumed in that, is that a word? I think it’s a word, I don’t know. [Laughs] it gets kind of meshed into that university experience for me so it’s just another aspect of a lot of change that’s going on at the moment, if that makes sense. So I feel like I’m best equipped to cope with it right now because I’m kind of at a peak in terms of adaptability so I can just take it on in the same way that kind of you’d add a meeting to your calendar or something or you decide that you want to start playing a different sport this year and you add it on. I’ve gotta sort of put some cream on at night, you just add it on in that sense. So it’s not something that’s come, it’s not something out of the blue, it’s something I can sort of tag onto a lot of other things so it just kind of becomes part of life.
 

Russell saw a homoeopathist and was given advice on diet.

Russell saw a homoeopathist and was given advice on diet.

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And she sort of advised me to sort of speak to her speak to her homeopathic medicine man, so I went along one time and had a little chat, to see what he said like I said before about trying different creams and stuff I was quite open to any kind of suggestions and willing to hear anything. And I don’t eat badly but I could eat better kind of thing, like I know my housemates last year ate awfully, like really, really badly [laughs]. So in comparison I looked very, very good but in a wider comparison I’m probably more average. so went along to, to him and he said, after I explained sort of roughly what I ate and my diet and whatnot, it was dairy, too much dairy and too much yeast. ‘Cos thinking back on it, it is quite easy to see that I do eat quite a lot of bread and so much stuff has yeast in it without you even realising it. So I tried a bit to reduce my dairy intake so I try and eat less cheese which is heart-breaking as it is, probably did help. I switched to an alternative dairy for milk and still have, kind of, when you go out for a, for a coffee or something like that obviously you have dairy milk and that’s fine and I don't avoid it when I’m out but when I’m at home, I’ll have kind of like coconut milk or on cereal or something like that just an alternative. So I’ve cut back a lot on how much cheese I eat, how much milk I drink and I don’t eat yoghurts so much anymore. And I still eat bread but not nearly as much as I did before, it’s kind of like the occasional piece of toast when there's nothing else in the house so I kind of use it as emergency food or when you get back after a night out and you need something to eat and you can’t be bothered to cook chips or anything like that, so I have like a toasties from the toastie machine. so I do still eat bread but it’s, I still eat all of them, the foods that he said I should cut out, but in vastly less quantities and it really does help. 
 

Russell tried different honey-based creams. He first used one for another skin condition (molluscum contagiosum) he had when he was younger.

Russell tried different honey-based creams. He first used one for another skin condition (molluscum contagiosum) he had when he was younger.

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Could you tell me a bit more about the Manuka honey that you mentioned?

Yeh, as I say we, the first time I ever encountered it was when I had those warts thingy-ma-jig because my mum spoke to someone at work or one of her friends and it was something like that and they said it was good and so we ordered some on the Internet and I used some of it but it did nothing for that but I think we had this, we had a pot of it so we kind of used it and it was good for other dry skin stuff so when, again when this flared up nearly like ten years later, we knew that to be a good kind of a good treatment or it had been in the past. And yeh so I just started using that again and I do feel it’s quite, quite good. I tried another cream as well and I can’t remember what it was it was just , some kind of honey type cream, not Manuka but it was something like that that I weirdly found in the [city] market, the Christmas market, and I tried a little bit of it on, on the stall and found that a couple of days later it was slightly better than it had been but so I ordered like a small pot online and thinking oh I might as well try it because well I’d kind of got to a certain point of it clearing up but it hadn't quite gone and this was in it would have been a year ago so December 2013 so I had been diagnosed in the September, I’d used the steroid cream, all the blisters had gone, there was still marks and it was still quite dry and I wanted to stop using the steroid cream because I didn’t want to use to for too long at a time and I'd been warned off kind of keeping on using it so I decided to stop using it and try and use other moisturisers instead. ‘Cos that way I could always go back to the steroid cream if it got really, really bad so yeh in December it was still there so I thought I’d try the stuff, that was probably when I started trying the Manuka honey again any other kind of moisturisers and this other honey thing I found on the market which was claiming homeopathic but it did absolutely no good whatsoever, unfortunately. 
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