Regarding Healthtalk.

[Guest guest]

The Following article represents what I believe to be the majority of

P and PA sufferers situations. Unlike those 'opinions' expressed on

health talk.

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I never knew my grandfather, who came to England from Russia at the

turn of the century and settled in the east end of London, working as

a doll manufacturer. My mother tells me that he was so ashamed of his

psoriasis that he always covered it up with long sleeves and trousers

and never exposed it to the benefits of the sun. I do not know if he

ever had any treatment. He never smoked or drank any more than the

regulation cup of sacramental wine on a Friday night.

My mother was the only one of his eight children to get psoriasis,

although subsequently some of her sisters' children were affected.

She reports a childhood of nasty smelling ointments, which didn't

work, and coal tar baths. Once she went with her siblings to a local

swimming pool, where she planned to take lessons. The instructor took

one look at her psoriasis: " You there. Out! " he shouted. She cannot

swim to this day. As a miserable adolescent she wore long sleeves and

stockings all summer, trying to hide her shameful secret. She

remembers with immense gratitude when her attitude changed. A medical

student boyfriend mentioned casually that her psoriasis was looking

better. " You can't imagine what that did for me, " she says. " To think

that someone had noticed I had psoriasis and didn't mind. " She has

never smoked and regards alcohol as something approaching poison. My

brothers did not have psoriasis as children, although they have

developed it since and neither of them drink or smoke.

I developed psoriasis around the age of 7, and by the next year had a

major exacerbation. My concerned parents wanted to do all they could.

I was undressed and examined by a series of strange male doctors. I

remember best the psychiatrist--an idiot, I thought, because he did

not even want to examine my skin. He found nothing wrong with me

apart from my psoriasis but prescribed six weeks' bed rest--at the

age of 8. It was a good thing I enjoyed reading. Other doctors

prescribed smelly ointments, to be worn under bandages--I was the

only child in my primary school class with long sleeved summer frocks

and thick lisle stockings--and I smelt. There were other ointments,

which burnt my healthy skin, and more undressing, to sit with goggles

in front of ultraviolet lamps.

I well remember the advent of steroids, first used under polythene

occlusion. That meant I went to school wrapped up in rustling plastic

bags like a frozen chicken, except that I was hot and sweaty under

the layers. But they worked miraculously. I was delighted to have

smooth elbows for the first time for years--until the terrible

rebound when it all came back, worse than before. How I cried, and I

determined to have no more treatment. I would explain it to everyone,

so they would know that it was not catching, just hereditary.

But how do you start explaining to the friendly policeman on the

zebra crossing after a hot weekend who called, " Burnt yourself then,

love? " while I was crossing the road? By adulthood I was more or less

adapted--with a few ups and downs, such as when I too was thrown out

of a local swimming pool in spite of the support of my doctor

husband. " It's just not aesthetic for you to be seen in the water.

After all, we have a lot of children here. " Pregnancy usually cleared

my skin, but the psoriasis returned in the labour ward, to such an

extent that even the gynaecologist noticed. Or that was the case for

four pregnancies--but such is the unpredictability of the condition

that in my fifth pregnancy the pattern reversed.

Having put up with so much I wanted my children to be spared. I did

not want them to suffer from both disease and treatment as I had. But

my youngest had a bad exacerbation at the age of 9 and I had to

decide whether and how to treat her. Fortunately, we now live in

Israel and even our nearly bankrupt sick fund recognises the efficacy

of the Dead Sea, as do many other sick funds in Europe. The fund was

willing to pay for us to stay in a nice hotel and bathe in the Dead

Sea and sunbathe in the solarium. She enjoyed it, and after a week

her psoriasis was nearly gone--not to come back again for many

months, and then not so bad as before. But we cannot spend all our

time at the Dead Sea.

The BMJ recently had a leader and subsequent correspondence about the

alleged connections between psoriasis, smoking, and alcohol. In my

family we can trace four generations with psoriasis and none of us

has smoked or drunk more than one unit of alcohol a day. We have had

to learn the hard way how to cope with a disfiguring condition and

the humiliations that it imposes. Coping is not helped by studies

that attempt to put the blame on the patient, especially in a

condition that classically appears in childhood. In fact, as my

mother said on reading the latest literature, far from psoriasis

being due to smoking and alcohol, it is much more likely that

psoriasis sufferers are driven to drink and cigarettes by their

condition and the way that others react to it.--SUSAN WEINGARTEN is

an archaeologist in Israel

Weingarten