David L. Cram - Coping with Psoriasis: A Patients Guide to Treatment

An Addicus Nonfiction Book

Copyright 2000 by David L. Cram, M.D. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, or otherwise, without the prior written permission of the publisher. For information, write Addicus Books, Inc., P.O. Box 45327, Omaha, Nebraska 68145.

ISBN: 1-886039-47-X

ISBN: 9781886039476

Cover design by Peri Poloni

Typography by Linda Dageforde and Jack Kusler

This book is not intended to serve as a substitute for a physician, nor does the author intend to give advice that is contrary to that of an attending physician.

Library of Congress Cataloging-in-Publication Data

Cram, David L. (David Lee), 1934

Coping with psoriasis: a guide to treatment / David L. Cram

abcm.

An Addicus nonfiction book.

Includes bibliographical references and index.

ISBN 1-886039-47-X

PsoriasisPopular works. I. Title.

RL321.C73 2000

616.526dc21

00-008220

Addicus Books, Inc.

P.O. Box 45327

Omaha, Nebraska 68145

Web site: www.AddicusBooks.com

Printed in the United States of America

10 9 8 7 6 5 4

Other books by David L. Cram, M.D.

The Healing Touch: Keeping the Doctor-Patient Relationship Alive Under Managed Care

Understanding Parkinsons Disease: A Self-Help Guide

To all those with psoriasis who have felt hopeless and forgotten

Index

I am honored to introduce this unique book on psoriasis. Written by a physician who for many years treated psoriasis patients, one might expect the book to be limited to treatment. Although he does present an excellent and thorough review of all treatments and treatment resources, Dr. Cram offers much more here.

The author explores new territory, documenting the ways in which psoriasis affects psychological health. For the first time the psychology of psoriasis is clearly defined and given much-needed attention. Through personal stories told by psoriasis patients, Dr. Cram reveals that the significant emotional effects of this disease are as real and important as the physical effects.

This book sends a clear message. A person with psoriasis has the power to make effective decisions on coping and should become an equal partner with a physician in selecting appropriate treatment. To this end, Dr. Cram offers comprehensive resource listings on where to find medical help, products, support groups, and additional information. By focusing on how one can adopt effective strategies to regain control of life, Dr. Cram invites the person with psoriasis to make positive decisions.

How fitting that Dr. Cram, a physician who pioneered the development of psoriasis treatment centers, has now written a book that looks at psoriasis from the patients perspective and in such a compassionate and insightful way. This book is an extremely valuable resource for anyone with psoriasis. It not only provides the framework for a more productive dialogue between physician and patient, but also adds more compelling evidence for the number one need of psoriasis patientsto have access to treatment by committed physicians who understand the disease.

Gail M. Zimmerman

President and CEO

National Psoriasis Foundation

F ew of us know the impact of severe physical and emotional suffering unless we personally experience it. Fewer still understand how profound that suffering can be for those patients afraid to reveal or accept the source of their misery. Wanting to feel normal, they try to avoid reality. In so doing, they often go to great lengths to hide their innermost thoughts. They make excuses for behavior dictated by depression and fear. Shame, anxiety, and denial may often lead them to an isolated existence, where they suffer in silence.

What kind of condition can so powerfully change peoples lives that they live in a state of denial and loneliness? The condition is psoriasis, a common disease that occurs in varying degrees of severity and affects millions of Americans. A cure is not yet in sight.

Why does psoriasis generate so much emotion? It attacks our most visible body part, the skin. Because its lesions are often unsightly, psoriasis can take a heavy toll on the psyche, destroy relationships, and generally make life miserable.

Despite major advances in our understanding of this condition, psoriasis remains difficult to treat, posing a major challenge for patients and doctors alike. Many doctors fail to recognize the psychological scars of the disease and may, out of frustration, dismiss patients because attempts at therapy are unsuccessful. This only compounds a patients feelings of rejection, despair, and loneliness. To cope, patients may devise elaborate strategies to hide the lesions they cannot erase. For example, they may avoid health clubs, where they will have to reveal their skin. Or they may use clothing as a disguise, never wearing shorts or bathing suits. Their anguish can be intense as the disease affects everyday life, yet out of embarrassment, some still refuse to seek help. Some may even contemplate suicide as a way out.

In recent years, many effective forms of therapy have been developed to treat the symptoms of psoriasis until a definitive cure is found. However, the disease tends to recur after treatment, so patients need a great deal of support and encouragement to help them cope. It seems no sooner do they breathe a sigh of relief at seeing their skin clear up than the disease returns, and they must endure treatment all over again. Further, emotional stress may actually induce or aggravate this condition. In treating psoriasis, physicians must pay close attention to both the physical and psychodynamic aspects of this disease. Psychodynamics are the motivational forces, both conscious and unconscious, that determine human behavior and attitude.

We may take this a step further. Psychodynamics may offer us a better understanding of the true nature and course of the disease and the patients response to treatment. It is possible that the patients belief in recovery alone has a positive physical influence. At the very least, a healthy outlook will encourage the patient to continue therapy. Any doctor who undertakes the treatment of psoriasis must do so with a positive attitude and cheer the patient on to do the same.

I wrote this book to shed some light on the treatment of psoriasis. The chapters that follow explore both the physical and emotional aspects of this disease. I am grateful for the case histories, shared by four patients with severe psoriasis. These brave individuals, by revealing their innermost thoughts and emotions, give us unique insight into how much of a controlling factor psoriasis can be in their lives and the lives of those around them. Through their experiences, we can better appreciate how some people cope with this distressing disease.

There is hope. With appropriate treatment, psychological support, and self-help, the majority of people with this disease can lead happy and productive lives. I hope this book will serve to encourage those with psoriasis to forge ahead with confidence, knowing that they are not alone.

Psoriasis keeps you thinking. Strategies of concealment ramify, and self-examination is endless. You are forced to the mirror, again and again; psoriasis compels your narcissism, if we suppose a Narcissus who did not like what he saw.

John Updike