What are the ways to reduce plaque psoriasis after dialysis?

Question

Hello doctor,

My psoriasis has been flaring like crazy since starting my hemodialysis. Plaques that are around the fistula are so bad. Nurses take 30 minutes to cannulate. My phosphate level is 7.8 and calcium is 8.1 making everything worse they say. I have stopped biologics as I tested positive with TB (tuberculosis). I even have patches inside my mouth and in my private areas. My dialysis chair was covered in scales by the end of the session, and other patients were complaining.

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Managing psoriasis while undergoing hemodialysis can be extremely challenging, especially with the additional complications you are describing. Psoriasis flaring up so intensely, particularly around your fistula, and with the involvement of your mouth and private areas, is understandably distressing. Elevated phosphate (7.8) and low calcium (8.1) are concerning. Psoriasis around the fistula can make cannulation difficult, as you mentioned. The plaques and scaling could be interfering with the nurse's ability to access the fistula efficiently, leading to longer cannulation times. If the plaques around the fistula are particularly thick or inflamed, consider asking your medical team about topical treatments like corticosteroids (if safe with dialysis) or other treatments that can help reduce inflammation in the area, specifically around the fistula.

Since your biologics treatment was stopped due to the positive TB (tuberculosis) test, it is understandable that your psoriasis is flaring more. You could talk to your dermatologist and nephrologist about possible non-biologic options such as topical treatments like Calcipotriene (Dovonex) or systemic treatments that do not interfere with TB risk. Regular use of thick emollients and ointments to prevent excessive dryness can be helpful. Applying these right after dialysis, when the skin is still slightly damp, can lock in moisture. In the mouth, corticosteroid gels or ointments (such as Fluocinonide or Clobetasol) might be helpful, but they should be used cautiously and under a doctor's supervision. For genital psoriasis, gentle, non-irritating emollients or prescription treatments designed for sensitive areas may provide some relief.

It is challenging when you are dealing with visible scales during dialysis. To manage the scaling, try applying thick moisturizers (such as petroleum jelly or heavy ointments) before dialysis. This can help prevent the scales from becoming too loose and reduce the shedding during your sessions. Discuss adjusting phosphate binders, calcium, and alternative treatments for your psoriasis. Keep your skin moisturized, and consider discussing the use of topical treatments with your doctor to address flare-ups, especially around sensitive areas like your fistula.

I hope this helps.

Let me know if you have any other concerns.

Thank you.