Author Topic: Miconal and PPP  (Read 20600 times)

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Offline _Alison_

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Miconal and PPP
« on: Friday January 11, 2008, 10:58:27 PM »
Hi everybody.

It's been a looooooong time since I posted and I hope you don't mind me coming back just cos I got a question.

I have PPP and to be honest, have given up trying to improve it.  Creams, lotions and potions haven't worked, neither did light therapy.  Acetretin was doing not bad until I was told to increase the dose and took one of the "very rare" side effects and had to stop it.

Anyway, was at the dermatologist yesterday and saw a new chap.  He's wanting me to try Micanol (Dithranol) to see how that goes.  Got the prescription today and while reading the patient leaflet, I noticed that it says that Dithranol MUST NOT be used in pustular psoriasis!!

Now I don't know whether to use it or not.  My feet are bloomin sore at the moment and the instep of one foot has split right across so there's effectively an open wound there.  The areas of skin that are blistered are very thin and delicate and if I do use the Dithranol, I don't know if it's to go on these areas or not.

Has anyone else used this cream on PPP?

Should I trust what the Derm says over what the patient information leaflet says?

Help!!

Thanks all,

Alison

Offline totalfolly

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Re: Miconal and PPP
« Reply #1 on: Saturday January 12, 2008, 12:17:30 AM »
Alison, I'd call the derm and ask, pronto.

I'm sorry your feet are so sore.  :hugs:  And welcome back!

totalfolly
 

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then by all means paint, and that voice will be silenced."
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Offline CalamityJane

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Re: Miconal and PPP
« Reply #2 on: Saturday January 12, 2008, 02:29:35 AM »
Hi Alison, welcome back. I do remember you (I think), from Scotland? With curly hair?

If I have the right person, what an awful time you are having. I'm so sorry. I'd call the Derm, and the Pharmacist and check it out. I cringed when I read
Quote
instep of one foot has split right across so there's effectively an open wound there.  The areas of skin that are blistered are very thin and delicate....


I remember my bad foot being like that, so sore, split, peeling areas all on the same foot. My PPP has been in remission for almost a year.......due to 2 weeks of Doxycycline. It was a surprise to everybody, docs, and derms, but the relief is tremendous. If you can take that, please try to get a script for it.

In the meantime, make some calls......also, see if there's a website listed on that patient pamphlet. I can understand you giving up, but I really wish you could stick with us.......y'never know!

Jane :hug: :hug:
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Offline _Alison_

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Re: Miconal and PPP
« Reply #3 on: Saturday January 12, 2008, 02:33:56 PM »
Thanks guys

Yes Jane, that's me!!  Always knew I was unforgettable!!  ;D

I've lost track of what I've tried for PPP and none of it has done any good.  I'm sick to the back teeth of slapping Dermovate on - I must've been using that for over three years now and it really doesn't do anything at all for it.

Unfortunately, me and antibiotics do not get on due to other medication I have to take and allergies.  I have to be on death's door with an infection before the doctor will venture to give me antibio's.

I've not had a chance to get up to the chemist yet to ask him, but I will get there today.

I've looked on the wonderous world wide wide and everything I can find says NOT to use Miconal on pustular psoriaris (but does PPP come under the same flag as general pustular psoriasis?  I guess so - it's just one is isolated to a certain area of the body....??)

I must admit, I'm a bit scared to try using it in case it makes things worse.  Any worse and I'll be getting the axe out to my feet!

I'll let you know what the chemist says though.

bunnie

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Re: Miconal and PPP
« Reply #4 on: Saturday January 12, 2008, 02:51:34 PM »
Hi Alison, sometimes a good derm who knows exactly what he is doing, will often prescribe these treatments in an unlicensed way, because he knows in certain cases that the meds will work. I am at present using a topical in an unlicensed way myself. Do try it , trust the derm, we really have to sometimes. He wouldn't dare prescribe that Alison without knowing all that preperation contains, it's more than his job is worth let alone his career. I know erxactly how you feel , I have been in this situation many times with meds, but I learnt to trust his judgement. Give it a shot, uuse it as prescribed, and I hope it brings you quick relief.
Bunnie

Offline _Alison_

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Re: Miconal and PPP
« Reply #5 on: Saturday January 12, 2008, 05:16:54 PM »
Thanks Bunnie - that's exactly what the chemist said!!  So, I'll brace myself and start with the Miconal and see how it goes.  I'm kind of dreading it in case it stings all the split bits!

bunnie

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Re: Miconal and PPP
« Reply #6 on: Saturday January 12, 2008, 07:50:55 PM »
I somehow think you will find it soothing Alison, and I'm so glad the pharmacist agrees with me! Put the cream on and if you have some gel-o-net put that on top then some tube gauze, the cream will absorb better. The doctor could prescribe those for you if you explain what it is for.
Bunnie

Offline _Alison_

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Re: Miconal and PPP
« Reply #7 on: Saturday January 12, 2008, 11:17:31 PM »
Thanks - the Miconal is slightly different though.  It's a short contact cream.  You've only to leave it on for a certain length of time then wash it off and it's only to go on affected areas - no room for error apparently!

Still haven't managed to do it because I had to go out tonight but I'll get round to it tomorrow hopefully.

Fingers crossed it's OK.

bunnie

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Re: Miconal and PPP
« Reply #8 on: Saturday January 12, 2008, 11:44:02 PM »

Hi Alison, I see what you mean...
http://www.psoriasis.org/treatment/psoriasis/topicals/anthralin.php
Quote
Anthralin (MiconalĀ®) is available as a paste, cream or ointment that often needs to be mixed by the pharmacist at the doctor's direction. The treatment temporarily stains the skin, but stains disappear about a month after you stop using the medication. If you are using this medication, apply carefully and talk to your doctor first, as anthralin may irritate non-affected skin. Like tar, anthralin is seldom used today.
I think this cream made up at the pharmacy has Miconazole in it. This is an antifungal Alison, I know because I use it as a cream and orally. The doctor must think you have a fungal infection in there (which is more than likely,) because people with open wounds on their skin are very prone to fungal infections. It feeds off the Keratin protein in the skin. Maybe he has chosen this cream with this in it as a precaution even?
Just a thought too....If your topical steroid was having no affect , again that could be because of a fungal infection. Usually, (in my experience anyway) if you are using steroid topical creams and the situation does not improve quite dramatically, you can almost be assured it is because of an underlying fungal infection. (Fungal infections don't always show up on biopsies. That happened to me too.) Steroids actually make a fungal infection worse, and therefore the skin doesn't heal. I think your doc may have acted wisely in this situation.
Bunnie

Offline CalamityJane

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Re: Miconal and PPP
« Reply #9 on: Sunday January 13, 2008, 02:16:51 AM »
Hi Alison, I wish you good luck with it. I still think a call to your chemist would not be amiss in your situation.

Quote
Like tar, anthralin is seldom used today.

I was using tar up until my remission, minus a couple of months. The tar did help my PPP--it's cooling and soothing. I believe it's still freely used today for PPP.

Quote
Usually, (in my experience anyway) if you are using steroid topical creams and the situation does not improve quite dramatically, you can almost be assured it is because of an underlying fungal infection.

I agree Bunnie, usually, there are dramatic improvements with topical steroids for skin conditions. However, in my experience PPP does not respond dramatically to even the strongest topical steroids. All the pics in my gallery are of my foot when the strongest topical available were being used. My foot was also wrapped during those applications. In fact, my foot was almost constantly wrapped. But that was MY foot, and my experience with PPP, topical steroids, Dermovate, and tar. My original diagnosis of PPP and the strong topical steroid, took some many, many days to see improvement.......then it just scarpered to a different place on my foot to start it's misery all over again. I do not think I had a fungal infection then, in fact, before being diagnosed w/PPP, I was prescribed a very expensive anti-fungal, which did absolutely nothing!

Good luck Alison......hopefully it will help, and that will be telling. I do not believe it will do you any harm, and worth a try.


Jane
« Last Edit: Sunday January 13, 2008, 02:27:50 AM by CalamityJane »
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Offline CalamityJane

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Re: Miconal and PPP
« Reply #10 on: Sunday January 13, 2008, 02:25:35 AM »
Replying to this thread again, for admin -- I think this is an important discussion on PPP and it's treatment. I think it should be moved to the PPP thread......or cross referenced? Can you do that?  Sorry I don't know the protocol for this sort of thing.......... :-\

Jane
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bunnie

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Re: Miconal and PPP
« Reply #11 on: Sunday January 13, 2008, 11:44:23 AM »
Hi Jane,
Quote
I still think a call to your chemist would not be amiss in your situation.
Alison has been Jane, see posts 4 and 5. It was from alison's next post that I looked up the preperation, and I posted again. It seems this preperation has miconozole in it, maybe, as i said in the post, because it is there as a precaution or that the doc thinks there is a fungal infection there. I understand from what alison has said that it must not be wrapped.
Bunnie

Offline _Alison_

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Re: Miconal and PPP
« Reply #12 on: Sunday January 13, 2008, 06:02:22 PM »
I'm not sure if it has an anti-fungal in it - the active ingredient is dithranol but I can't find much more information on it than that.

Anyway, I've done my first treatment with it.

What can I say?

MY FEET ARE ON FIRE!!!!!!!!!!

Offline CalamityJane

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Re: Miconal and PPP
« Reply #13 on: Sunday January 13, 2008, 06:25:16 PM »
I'm not sure if it has an anti-fungal in it - the active ingredient is dithranol but I can't find much more information on it than that.

Anyway, I've done my first treatment with it.

What can I say?

MY FEET ARE ON FIRE!!!!!!!!!!

Oh no! Just found this link:

http://en.wikipedia.org/wiki/Dithranol

Don't know whether it will help or not. I can imagine how your feet feel. :(  It's a real shame that you cannot give antibiotics a try. Doxy and Keflex had very good results w/forum members. There's nothing I wish more than for some real relief for you. You are a dog-walker also. It must be murder trying to get around. It nearly drove me to tears of pure frustration at times.

Quote
Unfortunately, me and antibiotics do not get on due to other medication I have to take and allergies.  I have to be on death's door with an infection before the doctor will venture to give me antibio's.

Well m'dear, you are not at death's door, but you are certainly at the end of your tether, and I so understand that.

Quote
Alison has been Jane, see posts 4 and 5.

Sorry bunnie :-[ My comment re wrapping was for steroids and to illustrate that for PPP topical steroids often do not have a dramatic effect, even when wrapped.

Jane
« Last Edit: Sunday January 13, 2008, 06:33:07 PM by CalamityJane »
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bunnie

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Re: Miconal and PPP
« Reply #14 on: Sunday January 13, 2008, 07:14:37 PM »
http://www.pharmacyboardkenya.org/index.php?id=13&dpgndg1=253
Scroll down to to the 7th on the list no:-H99/206 it says the active ingredient is miconozole or is this a different cream?
Have you been tested for allergies to some antibiotics Alison? What other meds are you on? I nearly lost my life with taking cefusporins, I have a real allergy to them.We know now that I am better off on penicillin based antibiotics. They can easily test your blood to see which is the most suitable for you, and if it were me I would be pressing for that, because I think this stuff sounds so time consuming apart from anything else. What do you think?
Bunnie

Offline _Alison_

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Re: Miconal and PPP
« Reply #15 on: Sunday January 13, 2008, 07:35:31 PM »
This stuff is time consuming and awkward.  You shoulda seen the state I was in trying to apply it to both sides of my feet whilst keeping the already treated foot off the floor and away from anything else - this stuff stains terribly apparently.

I'm on steroids for Addison's disease and antibiotics really upset my cortisol levels.  I'm allergic to penicillin, erythromycin and clarythromycin and their derivitives make me extremly sick - to the point that it's not worth taking them - they're up before they're down properly.  I'm allergic to sulfonamides (which includes anti-flammatories and antibiotics amongst other things).

I should be shot but apparently you can't get that on the NHS!!!!

I'm not sure if the link you've got is the same stuff.  Here's what I've got.

http://en.wikipedia.org/wiki/Dithranol

Oh, and I'm allergic to emulsifying ointment too believe it or not!!!

bunnie

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Re: Miconal and PPP
« Reply #16 on: Sunday January 13, 2008, 09:23:34 PM »
I'm allergic to just about everything too Alison, but I have been tested proving there is an actual allergy.I have about 3 red bands on my wrist everytime I go into hospital! Blood was taken to find which drugs I could have and which not from that blood testing. I presume you are taking the steroids to boost your
cortisol levels?
Bunnie

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Re: Miconal and PPP
« Reply #17 on: Sunday January 13, 2008, 09:49:31 PM »
Yeah, I don't produce any cortisol or aldosterone, so gotta take two lots of steroids for replacement. I normally tick along nicely, but adding in certain other drugs knocks the steroids off so I try not to take anything unless I desperately need it because it's just a hassle having to adjust steroid doses. 

I'd been given Celebrex by the doc for fibromyalgia and my face and lips swelled up like a balloon and I was covered in this mad red itchy rash.  In fact, it took over a year to get rid of the rash in certain areas - it was like the allergy threw up ezcema that I'd never had before.  At the time, my doc said I was allergic to anti-inflammatories, but I've since discovered that it's not anti-inflammatories as a group, but sulfonamides as a group - and they cover a wide range of drugs.

The initial crippling burning has now settled down to a more "severe sunburn" feeling.  Letting my feet get icy cold has helped a bit.  Just a pity I'm sitting here shivering in the process!

Let's see what day 2 brings.

bunnie

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Re: Miconal and PPP
« Reply #18 on: Sunday January 13, 2008, 11:40:10 PM »
Oh Dear Alison you poor thing you! I understand the problems with the Addisons, what a bummer that is with regarding the ppp. What you mentioned about the reaction you had from the sulphonomides, and the manifestation appearing like eczema, is typical of these autoimmune diseases. You can have more than one manifesting totally different, and one can be idiopathic (self your ppp) and the other stimulating an autoimmune response from non-self factors in this case Sulphonomides. Again it has proved the point concerning how long the manifestation lasted even though obviously the drug was stopped. This occurs exactly like that, when non-self enviromental factors stimulate an abnormal immune response.
I hope it is all worth it. I read on a link that this preperation takes longer but the condition is less likely to flare afterwards. Something positive anyway!
Bunnie

Offline CalamityJane

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Re: Miconal and PPP
« Reply #19 on: Monday January 14, 2008, 03:14:52 AM »
Hi Alison, yes, I agree with bunnie, you poor thing! I so feel for you, I can just imagine how it feels. Apparently that stuff is OK for plaque psoriasis, which I don't think you have. However, I do understand that one ointment/pill can have multiple uses.

I don't know anything about Addisons or cortisol levels, but I do know that I'm allergic to all the Penicillen family, and sulphonomide drugs.....so says my skin, and the allergist. However, I'm OK with Tetracyclines, of which Doxy is one. If you can take that family of drugs, perhaps it's worth a try?

I was thinking of you as I walked my dog today. I just want you to have the same relief I got (purely by accident). Or to see if that would give you relief.

Bunnie is far more knowledgeable than I am regardings drugs and their interaction with various diseases and problems.

You are in my thoughts and I have my fingers crossed. I would not use that ointment again, if it were me. I'm such a chicken!

Jane :hug: :hugs:
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