0:01

Welcome to Our Skin, a personal

0:03

discovery podcast. I'm your host,

0:05

Holly Fry, and it is wonderful to have

0:08

you here with us. Connection is

0:10

what this show is all about, specifically

0:12

connecting about things that we are sometimes

0:15

afraid to talk about. Today, we're going

0:17

to be exploring the ups and downs, past

0:19

and present, personal and universal troubles

0:22

we have with our skin. Our

0:24

skin is our most visible organ. What

0:27

happens on our skin affects the rest of

0:29

our lives, especially when dealing with a

0:31

chronic condition. Getting diagnosed

0:33

with one of these, like psoriasis, can be

0:36

overwhelming, but you're not alone.

0:38

Each episode features a personal story

0:41

of resilience and grace, but our

0:43

personal stories are threads in a larger

0:45

tapestry, and there are lessons for

0:47

us in the history of how we treat our skin

0:50

and the progress we've made together. Caring

0:53

for our skin is caring for ourselves.

0:55

Whether you're seeking inspiration for your own journey

0:58

or curious about the history of our

1:00

skin, you'll find empathetic, transformative

1:03

conversations here on Our

1:05

Skin. Today.

1:08

We are joined by well being coach, mindfulness

1:11

guide, and skin empowerment leader Rena

1:13

Ruperelia. I am so glad

1:15

to welcome her today. Rena

1:18

has lived with soriasis since she was in high school,

1:20

but she didn't start sharing about

1:22

her experience until twenty years

1:25

later. She first noticed symptoms

1:27

of sriasis when she was just fourteen, and

1:29

at the time, of course, as a teenager,

1:31

that experience was deeply isolating,

1:34

Like many people facing a chronic condition.

1:37

For a while, she tried to hide what was going

1:39

on, hoping that maybe

1:41

someday things might change on their own. But

1:43

when they did not, Rena hit a point

1:45

where she couldn't get by on hope alone. Her

1:48

symptoms had continued to intrude into

1:50

her life for decades, and she knew it was time to

1:52

find treatment. So that, of course, sounds

1:54

really easy, go to a doctor, get a prescription

1:57

treatment treatment, But just as a

1:59

lot of syriasis is patients have experienced,

2:01

the path to treatment for Rena was anything

2:04

but easy. She found herself battling

2:06

a reluctance to open up to her doctor and

2:09

hesitancy from having used treatments

2:11

in the past that just didn't work at all, or perhaps

2:13

even exacerbated things. One

2:16

of the sources of strength that Rena was able to

2:18

draw upon during this difficult time. Was her

2:20

mindfulness practice something that we're going to

2:22

ask about for sure in our interview today.

2:25

And she has also started sharing with others and

2:27

putting her journey out there online and

2:29

finding that her story empowers

2:32

others as well as herself in the process.

2:35

So eventually, Rena fortunately found

2:37

a doctor that understood and her

2:39

soriasis became more under control.

2:41

So Rena had a new message to

2:44

share with her followers. Open up

2:46

to your doctor and you might be surprised

2:48

what they're able to do to help. And

2:51

your story, Rena ties in perfectly with the

2:53

history that we're going to discuss today, which is going

2:55

to take us on a step by step

2:57

tour of the evolution of Sorias's Street

3:00

from ancient times to our modern medicines.

3:03

And I am so excited to talk to Rena

3:05

today about her experience because there

3:07

are a lot of barriers for people that seek

3:09

treatment, from stigma and embarrassment to

3:12

doctors who maybe aren't always that knowledgeable

3:14

about skin conditions. It is a lot

3:16

to take on as a patient and as a

3:18

person. So Rena, welcome to

3:21

our skin I'm so delighted that you're here.

3:23

Thanks for that beautiful introduction, Holly,

3:26

that was perfectly summarized.

3:29

I'm glad. I never want a misstep. It's

3:32

always that awkward thing when you're telling someone else's

3:34

story while they're sitting there. So

3:36

I'm glad it all vibed right. I

3:39

would love it if you would take us back to your

3:42

first inclinations when you were like, I might

3:44

actually need to seek medical treatment

3:46

for this skin condition. But first I

3:48

want to ask how did your symptoms manifest

3:51

initially?

3:52

Yeah, they actually tie

3:54

in perfectly together. So, like

3:57

you mentioned, I was in high

3:59

school. We were just about

4:01

to go into high school. So it was like

4:04

two months before the summer. I was in

4:06

England seeing my family, living

4:08

my best life, and all I just kept thinking about

4:11

was I can't wait for the first day of grade

4:13

nine.

4:13

I'm going to meet all these new people.

4:15

I'm so excited and thinking about

4:17

all the boys and all the fun and all the

4:19

things. But my

4:21

skin had a different plan. So

4:24

I just remember I was in England

4:26

and I looked down at my stomach

4:29

and I had these red dots.

4:31

They look kind of like chicken pox. I didn't

4:34

know what they were.

4:34

I thought maybe bug bites, but as

4:36

the weeks went on, the days went on, they were growing

4:39

and kind of spreading, but they

4:41

still look similar.

4:42

So I ran to the.

4:43

Doctor and I was like, you

4:46

got to fix this. Like I'm about

4:48

to start high school. I

4:51

need to get rid of this now. So

4:53

he's like, oh, you just have chicken pox. Like

4:55

it's just chicken pox, right, he didn't

4:57

know it kind of looked like it.

4:59

I was happy. I went home,

5:01

asked no questions.

5:01

But again, as I mentioned, as the days went on, the

5:04

weeks went on, it started growing even kind

5:06

of and spreading, and the scales went from these

5:08

like red dots to these silvery scales.

5:11

And eventually I went

5:13

back again and he said,

5:15

oh, I think you may have psoriasis.

5:18

I didn't know.

5:19

There was no Google then, right.

5:21

It sounded like a dinosaur. To be honest, I had

5:24

no clue how to even spell

5:26

it. I didn't know what it was, never heard of it.

5:28

All I cared about was ken you get

5:30

rid of it. And that's

5:32

kind of I think when my

5:35

life changed, especially when

5:37

it comes to my skin. So that

5:39

was the moment, and the line you

5:42

know that I always remember is I

5:44

can't confirm for sure. You know you can try

5:46

this cream, and there's no cure, but

5:49

we can find a way to manage it, but we

5:51

have to wait for the dermatologist.

5:53

That's just what a fourteen year old wants to hear too.

5:56

It's like we're gonna have a lot of guesswork ahead of us,

5:58

no problem. I wonder

6:00

at that age, especially, kids are not

6:02

sharing the things that they're embarrassed or self

6:04

conscious about. Did you know anyone else

6:07

that was dealing with anything similar or

6:09

did you feel like the only person on earth

6:11

that had this condition?

6:12

Yeah, what a good question. I

6:15

thought I was the only person on

6:17

earth with the condition. I kept hearing this

6:19

story, and I still hear it to this day. Your

6:21

aunt had it on her finger. She got rid

6:24

of it by wrapping it up with this, this, and this.

6:27

Your grandmother rather has eggzema

6:29

as well as my father. But to

6:31

be honest, no one was really talking about

6:33

it. There was just that story about my aunt wrapping

6:35

up her hands, which I said, like, I

6:38

still here to this day, and

6:41

she was able to get rid of it. I have brought myself

6:43

up with everything and anything, and

6:45

I still had it, So it.

6:47

Did a Nobody

6:49

knows if that was even what she was dealing

6:51

with right, like she may have had an

6:53

allergic reaction to something. There's no there's

6:56

no actual science data to put.

7:00

But it's brutal. Yeah, it truthfully

7:02

all jokes aside. I just remember just thinking

7:04

like what is this?

7:05

And I did feel like I

7:07

was the only one, and so there

7:10

was so much that went into that. Again,

7:12

like you mentioned, as a fourteen year old

7:14

girl, I was really worried

7:17

about my image and fitting in looking

7:19

like everyone else. I didn't want

7:21

to have this thing or

7:23

this skin that made me quote unquote

7:26

different.

7:27

Right, you did not think you were turning

7:29

into an X man. You just thought you were.

7:32

I wish that's what happened, If

7:34

I'm honest.

7:35

By the way, I'm mistique now just funny

7:38

exactly. I'm

7:40

wondering too, though you mentioned like the

7:43

words that were terrifying were like, we don't really

7:45

know, we're gonna try some things. What

7:48

challenges were there in those

7:50

initial treatment stages. I know, even just

7:52

like talking to a doctor as

7:54

a teenager about anything is already

7:56

tough, so then to be in this loop where you're

7:58

having to give feedback and time about what

8:01

doesn't doesn't work and what things feel

8:03

like. What was that all like probably very

8:05

scary.

8:06

Absolutely, And I will

8:08

say, although I've gotten better with having the conversations

8:10

now, it still continues to be challenging,

8:13

right to figure out what's gonna work, what's not gonna

8:15

work, because treatments need reevaluation

8:17

and change often, which I didn't know but

8:20

in the beginning stages the

8:22

first Okay, so after I actually got diagnosed

8:24

with SIISIS, which in itself was a

8:27

horrible experience because I was feeling so

8:29

vulnerable and the doctor, the dermatologists

8:32

at this point, came in, took a look at

8:34

my skin, didn't really talk to me. I

8:36

waited three months for this appointment.

8:38

Side note, like three months, you know, I'm like, he's going

8:40

to cure me, or they're going to cure me.

8:42

Wherever it is. This person is

8:44

going to cure me.

8:46

And when I went to the actual office, like

8:48

I said, he took a quick look, then brought

8:51

all of his students in.

8:53

And they also, I guess my mom must have given

8:55

them permission.

8:56

And I'm just sitting there right like a specimen on

8:58

the table like it was.

8:59

I just remember feeling humiliated, embarrassed.

9:02

I was covered at this point as well, because it was all over

9:04

my legs, now spread from my stomach to my

9:06

back to my arms, and they're all kind

9:09

of just looking at me.

9:10

And eventually he gives.

9:11

Me this crude cold tar and it's

9:14

exactly what it sounds like. It's like this green,

9:17

kind of dark brown, slimy paste

9:19

that smells like mothballs. So you

9:22

slather it on at night. It stains

9:24

everything and then you wake

9:27

up in the morning and you wipe it off with

9:29

towels. My mother had to help me, and

9:32

it really smelled number one, but number

9:34

two, the skin didn't really clear.

9:38

I still had like so I'm you

9:40

know, South Asian, so I have more melanated,

9:42

darker skin. And then I ended up with these

9:44

like light patches where the psoriasis

9:46

was everywhere. The hyperpigmentation was

9:49

brutal, but it never went away. It was still itchy

9:52

all day under my clothes. All I remember

9:54

is just wanting to scratch my skin off. And

9:56

so the beginning parts of treatment included,

9:58

you know, something like that. I went for like light

10:00

treatment like a lot of people do. I did

10:02

cortisone creams and it was always

10:05

sticky fingerprints everywhere, you

10:07

know, smelling not very good and

10:09

Also I was in these clothes

10:12

that just covered every part of my

10:14

body, like where this risees showed, so

10:16

that I didn't want to do gym class.

10:18

I was.

10:18

People are like, aren't you hot? Like I just remember

10:21

that question, aren't you feeling hot? Like no, I'm fine, I'm

10:23

fine, I'm always cold. Meanwhile, yeah,

10:26

sweltery link sweltering. It

10:29

was like my favorite time of day was coming

10:31

home after school, taking

10:33

off everything and going for like a scratch fest

10:36

and like it was so bad

10:38

for the skin, but I was just it was

10:40

the only relief I had.

10:41

So I lived a lot of that.

10:43

First part of my journey with just creams

10:46

and potions and anything. Nothing

10:48

took it away because work for me, I guess it's different

10:50

for everyone. For me, it meant clearing the skin completely

10:53

and nothing was working.

10:55

You have also talked before about

10:57

how transformative it was when you finally

10:59

found a doctor who actually understood

11:02

How did you know? Because I think this is

11:05

whether you're dealing with a chronic condition or not. Finding

11:07

that right doctor that you click with is

11:09

really really hard. How did you

11:11

know when you had found the doctor that

11:13

was right for you? What were the green flags where you're

11:16

like this one's different.

11:17

Yes, that's a really good question. It's

11:20

really ideal to find the right doctor.

11:23

But depending on where people live, depending

11:25

on the access they have, it

11:28

might not be possible to find

11:30

the right doctor because

11:32

there might not be a choice of people around. You know,

11:34

I live in an urban center. We have dermatologists

11:37

everywhere, so I do have choices. But how

11:39

I knew doctor yadav is my doctor

11:41

here in Toronto.

11:43

She was different.

11:45

She was very, very confident. So first of all

11:48

we had like an offline conversation. We were

11:50

like creating a piece together and

11:52

then kind of when we finish the work, she

11:54

said to me, you know, Rena,

11:57

you don't have to live like this, Because

12:00

I was like, I am happy in my skin. I

12:02

am here for it. I'm taking care of myself.

12:05

But if I have some risis, it's fine. But I was uncomfortable,

12:07

like I didn't have a goal for clear skin. At that point,

12:10

I had given up. And she when

12:12

she said I can help you, something in

12:14

me was like, what you can

12:16

help me?

12:18

What like are you?

12:19

And she was so confident And

12:22

that's the part of it. I think that

12:25

really worked and clicked

12:27

for me. There was that her ability to say like

12:29

I want to help you, like we will find something

12:32

that works and you

12:34

don't have to feel this way,

12:36

like, yes, you found a way through, and yes you

12:38

feel empowered and okay with the way your skin is,

12:41

but there's hope.

12:44

It sounds almost like this is the first time

12:46

you really felt like taken

12:48

care of by a doctor. Like doctors

12:51

are always there to take care of you, but it's a different thing

12:53

when you're like I feel taken care of.

12:55

Yes, that's like on

12:58

the money.

12:58

There absolutely when

13:01

someone gives you that feeling

13:03

of self assuredness, she really does

13:05

want to make her patients feel

13:08

better and give them a better quality of life.

13:10

She takes that extra step, And I think that is

13:12

the person I fell cared for. And yeah,

13:15

scene and she understood

13:17

like it was tough, like I was having a rough

13:20

time.

13:21

One of the things that you talk

13:23

about, it's like the animating idea of

13:25

all of your work is you deserve

13:27

to feel good. And it's such a

13:29

simple and basic concept, but I

13:32

think for a lot of people that's very hard

13:35

to really internalize, especially when they're

13:37

dealing with a chronic condition. There's

13:39

all of this weird mental and emotional

13:41

baggage that comes with it. Sometimes

13:43

there's whether you're conscious of it or not. People

13:46

will think there's something bad or

13:48

wrong about them, or that they did something wrong

13:50

in their skincare or in their

13:52

health care. But this idea,

13:55

if they could just get it into

13:58

their minds, is something to embrace, deserve

14:00

to feel good. But I want

14:02

to know how that has shaped your particular

14:04

brand of activism.

14:06

Ugh.

14:07

I also found it to be such a powerful line,

14:09

hence why I put it on the website, because

14:11

it was something I didn't believe. I

14:14

thought, because I was sick and

14:16

I had this skin condition, that feeling

14:18

good was beyond my reach. It

14:20

was beyond what was possible for me, and

14:23

that I didn't deserve it.

14:25

I didn't deserve this.

14:26

Feeling of peace of ease in my body,

14:29

regardless of what my skin looked like. And

14:31

so as I started

14:34

taking care of myself and

14:36

opening up more about my story online,

14:39

I started to challenge what

14:42

I believed what was possible for me as

14:44

an individual and as a human. So

14:47

it was really important for me to

14:49

take care of myself and

14:51

learn how to do that.

14:53

Even if my skin.

14:54

Was flared, I was still deserving

14:57

of a massage.

14:58

I was still deserving going to a

15:01

beach. That was something that I wouldn't

15:03

do.

15:03

You know, if someone had a pool party or we went on a vacation,

15:06

I would go tan on the

15:08

other side of the beach because

15:10

I didn't want anyone to see me. And I

15:12

had to learn to tell myself, you

15:14

deserve to be here, You deserve to be

15:17

part of this as well. You deserve to dance,

15:19

you deserve to wear these clothes like you are

15:21

deserving of these things as well. Your skin

15:23

doesn't make you unworthy. Your skin

15:25

doesn't make you less than. What

15:27

are the things that somebody who cares

15:29

about themselves, who gives a damn about themselves

15:32

would do?

15:32

What does that look like?

15:35

And so that started as me putting

15:37

out these challenges when I first started my page.

15:40

You know a lot of people and

15:43

I don't think this is just with skin. Will say when

15:45

my skin is clear, then I will

15:48

dot dot dot, wear the shorts,

15:50

go to the beach, go to the wedding, and sandals.

15:52

These like tiny little things that maybe

15:55

a lot of people don't think about. I was thinking

15:57

about them all the time, and so it

15:59

was starting to challenge myself. And

16:01

then as I started to feel good and

16:04

see that a lot of these barriers were only

16:06

built up in my mind. Like most people were receiving

16:08

me in a good way. This was an

16:11

evolution, and so feeling

16:13

good or feeling better and giving

16:15

myself the opportunity to challenge

16:18

what I thought I didn't deserve really

16:20

helped me break into Yeah, starting

16:23

to feel good and giving myself things

16:25

that would help me feel whole and content.

16:28

I also wonder because with any medical

16:30

condition, it's

16:32

for the most part, especially something like this, that

16:34

can progress and shift. It's

16:37

not like it all happens at once. It's something

16:39

that's slowly growing over time. So your

16:41

brain is sort of adjusting to you. I guess this

16:43

is the new normal, and you're not

16:46

really cognizant of how much you've given

16:48

up until you like have one great

16:50

day and then you're like, what it could be

16:52

like this all the time. So I think

16:54

that's also important for people to remember, right,

16:57

this is kind of a mantra you need to maintain.

17:00

Yes, like you said, there was this

17:02

feeling when I found the right treatment and

17:05

my skin started to clear. I

17:08

didn't know it was possible

17:11

to feel this way, And I'm so grateful

17:13

that for me that I was open to treatment

17:16

and that I was open to trying something new, because

17:18

it really has made all

17:21

the difference.

17:22

Rina, thank you so much for sharing your story with us.

17:25

When we come back, I have some history I'm

17:27

going to share with you, some of which is going to sound

17:29

very familiar. After this

17:31

break, we will take a look at siasis treatment

17:33

throughout our history, starting with Hippocrates

17:36

in ancient times, running all the way

17:38

through to advanced treatments that are available

17:40

today.

18:00

We've covered in previous episodes. Ciriasis

18:02

has always been with us. The ancient

18:05

Greeks were well aware of it, although they did not

18:07

call it psoriasis for quite a while. The

18:09

physician Hippocrates, who lived around

18:11

four sixty to three seventy BCE, is

18:14

often credited with being one of the

18:16

first to document treatments for skin condition

18:19

that we now recognize as psoriasis.

18:21

One of his go to remedies was pine

18:24

tar. That's right, thick, sticky,

18:26

and pungent pine tar. Pine

18:29

tar has actually been used for centuries as a

18:31

topical treatment because of its supposed

18:33

ability to reduce inflammation and

18:35

relieve itching. So over the

18:37

centuries it's been applied to the scalp the

18:39

trunk, the limbs, pretty

18:41

much anywhere of those suffering from psoriasis,

18:44

and while in some cases it actually

18:46

could provide some relief, it obviously

18:49

comes with some downsides. The heavy,

18:51

dark substance could also irritate some

18:53

people's skin, so that is the opposite of

18:55

the desired effect, and there's that

18:57

strong, lingering odor not super

19:00

pleasant. With the advent of

19:02

the Industrial Revolution, pine tar's

19:04

cousin which Rina mentioned, coal

19:06

tar, came into the picture, and coal

19:09

tar is of course thick, heavy

19:11

oil that's derived from coal. It

19:13

emerged as a ciasis treatment due to

19:15

its similar anti inflammatory and anti

19:17

itch properties, and by the early twentieth

19:20

century, coal tar had become

19:22

a staple in the dermatologist toolkit.

19:25

So each of these types of tars are

19:27

distilled the same way from their origin substances

19:30

using extreme heat. Basically,

19:33

if coal or wood is burned at really

19:35

really high temperatures in an absence of

19:37

oxygen, the result is a tar

19:39

that can be put into soaps, lotions,

19:41

foams, other kinds of topical applications.

19:44

And actually why tars sometimes

19:47

work on poriasis is not still

19:50

super well understood. But coal

19:52

tar, as we know from Rena's story is still

19:55

recommended today by the American

19:57

Academy of Dermatologists, and the best

19:59

that we can tell is that these

20:01

tars slow down skin cell

20:03

growth, which can reduce the severity

20:05

of the plaques that often accompany pariasis.

20:09

But these are, after all products

20:11

that also have industrial uses, so

20:13

they are not necessarily gentle. Side

20:15

effects can be very serious, including

20:18

in some people an increased risk of certain

20:20

cancers, and some people, such

20:22

as anyone who's pregnant, is not recommended

20:25

to use these kinds of treatments. So Rena,

20:27

I was a little bit shocked that the ancient Greeks

20:29

were like, yes, let's put pine tar on people. I

20:32

didn't know until working on this show

20:34

that people were still using col tar, and you

20:36

are an example of that today. Did

20:39

you know that pine tar was in the mix?

20:41

I had no clue.

20:42

I am I'm shocked, but I have used

20:45

pine tar, which is interesting.

20:47

I feel like someone gave it to me because I did

20:49

have it. You know what, people are always like, hey, if

20:51

you tried, does have you tried?

20:52

That's I'm shocked, like an old wives

20:54

remedy that they're like, I prepared some Yeah,

20:57

apparently they're going all the way back to Hippocrates.

20:59

With that, you

21:02

also mentioned some light therapies That

21:04

goes back to nineteen twenty five, when

21:06

an American dermatologist named

21:08

William Gekerman discovered that combining

21:10

coal tar with ultraviolet light

21:12

therapy was particularly effective in

21:14

treating pariasis. That method,

21:17

still known as gekermann therapy, involves

21:19

applying coal tar to the skin and then

21:21

exposing it to UVB light,

21:24

and that combination helps slow down rapid

21:26

skin cell turnover, which is what characterizes

21:29

psoriasis. It provides significant

21:31

relief to a lot of patients, but

21:34

we can't pat ourselves on the back too much. Long

21:36

before Geckerman's discovery, sunlight

21:39

itself was already recognized as a valuable

21:41

ally in the fight against sariasis.

21:44

Ancient physicians noted that exposure

21:46

to sunlight could help alleviate the

21:48

symptoms, especially if it

21:50

was used in conjunction with topical

21:52

treatments. However, not everyone

21:54

could afford to spend hour sunbathing, and

21:57

of course we know excessive sun

21:59

exposure has its own set of risks, including

22:01

skin damage and an increased risk of skin

22:04

cancer. Light therapy,

22:06

which I want to ask you about because you've done It

22:08

can be used alone or in combination with topical

22:11

medications or tablets that will increase

22:13

your sensitivity to UVB or

22:15

UVA light. The latter of those

22:17

is prescribed for young or more sensitive

22:19

patients, and those sessions, according

22:21

to our research I've never done one can last just

22:23

a few minutes, and they're typically given two

22:25

or three times a week for like a six to eight week

22:28

run. But the effectiveness and options

22:30

depend on a wide range of factors,

22:32

including the type of severity of psoriasis,

22:34

other health conditions, as well as any medication.

22:37

So you mentioned light therapy.

22:39

Tell us about that. It sounds in theory

22:41

to someone that's not done it very nice, like, oh, you need

22:43

a sunbath, let's do light therapy. But

22:46

what is it actually like?

22:47

I know, imagine, yeah, you go into this beautiful

22:50

zen spot. No, actually it's like

22:52

that at all.

22:54

So, like you mentioned, in addition

22:56

to the coal tar that I was putting on

22:58

every night, now three times a week, we

23:00

were going to this light therapy. So it's a chamber

23:03

essentially, and you're in there

23:05

for like ten seconds, but I remember,

23:07

to get there it would take an

23:09

hour, and to get back it would take an

23:11

hour because it was so far. So it's

23:14

just like going into a tanning booth, but a standing

23:16

up tanning booth. You kind of do this for ten fifteen

23:19

seconds. It wasn't a few minutes. It was very quick,

23:22

and that was that, and it works. It

23:24

worked for me at least, and it's worked for people

23:27

who I've talked to. But eventually

23:30

you're just like, I don't this seems a

23:32

bit odd just to drive for a ten second stand

23:34

up session and come home.

23:35

Some people bring them into their house, right,

23:38

thousands of dollars, you know.

23:39

So for me it did help,

23:41

but I got really tired very quickly,

23:44

so after the first stint I was done.

23:46

Well.

23:46

It's good that you mentioned that, though, because it

23:48

is a cool therapy. It does work for a lot of people,

23:50

but it doesn't mean that it's easily accessible

23:52

for everybody. You know, if you're

23:55

not in a metro area, your

23:57

odds of finding one in driving distance are

23:59

probably pretty low. And

24:01

the other option is to go to

24:03

great personal expense to build one.

24:05

It's true, and not to go to the tanning booth. Because

24:07

a lot of people are going to the tanning booth. I think

24:10

it's not the same thing. It's that

24:12

like you mentioned UVB versus UVA,

24:14

So right, yes.

24:16

Don't do that, that's not your treatment.

24:20

I do want to shock you with more

24:22

things, because moving into the Victorian era,

24:25

there were some very alarming treatments going on,

24:27

including diluted tinctures of arsenic

24:29

and mercury that were used to treat various

24:32

skin conditions, including psoriasis.

24:35

These are obviously incredibly toxic and

24:37

their use usually did more harm than good.

24:40

In some cases, people were even advised

24:42

to inject these very dangerous

24:44

chemicals directly into their bodies.

24:47

That's a stark reminder though, of how desperate

24:49

people have been over the ages to get

24:52

some relief and how limited medical

24:54

knowledge was at the time, and that combination

24:56

was brutal and probably

24:58

deadly for some people. We don't really have

25:00

any hard data on how many

25:02

people died from injecting our snack to treat

25:05

skin conditions, but I bet you it happened. And

25:07

then in the early nineteen hundreds, there was another topical

25:10

treatment that came into play called dithronol. This

25:12

compound is derived from the bark of the aerobatry

25:15

and it's found to be effective in slowing down

25:18

skin cell production. And therefore

25:20

reducing the severity of plaques that develop.

25:23

However, it was not widely used in the United

25:25

States because, like other treatments, it

25:27

could discolor the skin and stain

25:29

clothing and bedding. That's not super

25:32

practical for everyday use. As

25:34

recently as nineteen fifty six, medical

25:36

literature still mentioned using mercury

25:39

in topical ointments for psoriasis.

25:42

We know now that mercury is highly

25:44

toxic and can cause serious health issues,

25:46

but even in the mid twentieth century it

25:49

was one of the few options that was really available

25:51

to doctors and patients. So throughout

25:53

history there have been various unorthodox treatments,

25:56

herbal concoctions, and then my favorite,

25:58

snake oil, which were often touted

26:00

as miracle cures. We use the term snake

26:03

oil today to talk about something that is

26:05

a fake medicine or like something

26:07

a carpetbagger would sell you that's not going to do

26:09

any good and might in fact harm you. But there

26:12

are actual snake oils that work.

26:14

The snake oil concept derives from an

26:16

old Chinese remedy that made use of the

26:18

black banded secret it's also

26:20

known as a Chinese water snake, and

26:22

that had legit anti inflammatory

26:25

effects because Chinese water snakes have

26:27

a very high concentration of omega

26:29

three fatty acids. But when

26:32

that remedy made its way to North

26:34

America via immigration, there

26:36

were a lot of Charlatans that picked up on it, particularly

26:39

in the American West, and they started

26:41

making their own version of the Chinese

26:43

cure. But they used just about any snake

26:45

they could find, including rattlesnakes. Those

26:48

do not have the same beneficial omega

26:50

threes, and that is how that term

26:52

transitioned to become snake oil

26:55

in our lexicon as something that's worthless

26:57

and possibly dangerous in terms

26:59

of health treatments. There are also,

27:01

of course, indigenous tribes that have had

27:04

their own remedies, including the use of buds

27:06

from the balsam poplar that has

27:08

been used to treat soriasis in other skin conditions.

27:11

And of course, today, as

27:14

Rena knows, there are a lot

27:16

of changes in our understanding of psoriasis.

27:19

We know it's not just a skin condition, which

27:21

is how it used to be treated. It is an autoimmune

27:23

disease. This means that the body's

27:26

immune system is mistakenly attacking

27:28

healthy skin cells. That's what leads

27:31

to that rapid skin cell turnover we've been

27:33

talking about, and that's what causes those

27:35

characteristic red and scaly patches.

27:38

Here's what I wonder as I'm talking about all of this, rena.

27:41

There are so many treatments now for psoriasis

27:43

that I imagine even that becomes its

27:45

own. While it's like they're an array of

27:47

things we can try. That is probably intimidating

27:50

in and of itself. Since you have a

27:52

community around this, do you find that a lot of

27:54

people are going through trial and error?

27:56

And what is that like again

27:59

mentally in emotion? Is there a point where some

28:01

patients are just like I'm done, I'm not going

28:03

to deal with this anymore.

28:05

Yes, I found that with myself and with others.

28:08

It is exhausting, especially when

28:10

something doesn't work and you have so much hope.

28:13

You're trying everything, You're

28:15

hoping it's going to work, and

28:17

it doesn't, and then you're like, should I bother going

28:19

through the whole process of getting something

28:21

else? So, yes, people get tired,

28:24

And I always say, you know, it's

28:26

okay to take a break, but don't quit,

28:28

Like, just try as much as

28:31

you can. And I would give that same advice to myself

28:33

who went through years and years of just

28:35

giving up completely and my skin going wild.

28:37

I was like, nothing's going to work, So what's the point.

28:40

So I think people do get tired, and there

28:42

is trial and error, but take a break,

28:44

rest, give yourself a moment, and then

28:46

get back on that horse, because as

28:48

I've said, for me, I've found something that

28:51

works. And the science is so much

28:53

more sophisticated than it was, you

28:55

know, years ago. So as

28:58

you educated

29:00

me with today, I was like, I'm still

29:02

happy I wasn't born in the twenties.

29:04

Yeah, right,

29:07

And the thing is too we mentioned and we

29:09

know topical treatments don't address

29:11

the root cause of psoriasis, right.

29:14

They may help with your skin, but you're still

29:16

having an autoimmune system. This is

29:18

where, of course, a much newer

29:20

treatment comes in, which is biologics. Biologics

29:23

are a class of drugs that was first approved

29:26

in the US by the FDA in the

29:28

early two thousands, and they target

29:30

specific parts of the immune system involved

29:32

in the inflammatory process, and

29:34

by inhibiting certain immune responses,

29:36

biologics can significantly

29:39

reduce the symptoms of psoriasis and improve

29:41

quality of life for a whole lot of patients.

29:44

Biologics have obviously revolutionized

29:46

the entire treatment possibilities

29:49

for moderate and severe psoriasis. They

29:51

are typically administered by injection

29:53

or intravenous infusion, and they can

29:55

actually provide some very long lasting relief.

29:58

And as we reflect on the h of soriasis

30:01

treatments, it is clear we have come a very

30:03

long way from the days of pine tar and

30:05

arsenic thankfully, and other toxic chemicals.

30:08

Our understanding of the condition has deepened

30:10

and with it our ability to manage

30:12

it effectively. And while there is still

30:14

no cure, advances in medical

30:16

research continue to bring hope to millions

30:19

of people living with this challenging

30:21

condition. So I think

30:23

the most important takeaway from all

30:25

of this is that we really have come very

30:27

very far right. Treatment is way more

30:29

effective than it was in the early days, no

30:32

more arsenic. So if someone

30:34

has been reluctant to open up to a doctor

30:37

and see what treatments are available, now

30:39

is a great time treating

30:41

a chronic skin condition. I know we've said it a million

30:43

times, but it bears repeating. It's not a straight

30:46

line, as our dip into

30:48

history shows, but it is really amazing to

30:50

know that there's a

30:52

lot that's been done to make living with poriasis

30:54

so much more doable and so

30:57

that people can embrace

30:59

the idea that they deserve to feel good. There

31:02

are things you can do every day to feel better

31:04

emotionally and physically, and you just had to find

31:06

what works for you. So I want

31:08

to come back to that idea arena of you

31:10

deserve to feel good, because we all deserve

31:13

that. But that is also not

31:15

a straight line. What got you through

31:17

those times where treatment wasn't working or

31:19

you just weren't feeling good about the whole.

31:21

Journey, you know, I

31:23

just went through that phase in December

31:25

recently, on New Year's Eve. I

31:28

yeah, my treatment just wasn't working and I had to

31:30

And now again I've found good treatment because I went

31:32

back. I didn't give up. But during that

31:35

really hard time, I noticed

31:37

how everything I intellectually

31:39

knew just went out the

31:41

window. I didn't follow any of my own

31:43

advice. I just felt hopeless. I laid

31:45

in bed, I was swollen, I was sad,

31:48

and what helped me was asking for

31:50

help, going to my therapist,

31:53

which I'm lucky enough to have, asking

31:55

my family for support, telling my friends

31:57

I'm struggling.

31:58

I really need someone here with me, and.

32:00

Then also telling myself

32:03

it's okay, like having some self

32:05

compassion. It's okay that you're

32:07

here and you're having a hard time. You're not doing

32:09

the quote unquote things you should

32:12

be doing or could be doing.

32:14

It's okay to.

32:14

Have a moment and be sad and

32:17

grieve the pain and give

32:19

yourself what you need. But

32:21

I said to myself, you know, after

32:24

a week of this, you're

32:26

not going to pack your bags and move into the space.

32:29

It's time to get back on the horse, like get

32:31

the support that you need, like I said, and

32:34

also go back to the doctor and

32:36

talk to her about what is possible.

32:39

And we were able to find something that worked. I

32:41

was nervous because I'm like, oh, I'm going to go right back to where

32:43

I was. But yes, it's it's

32:45

truly learning to ask for help

32:48

and support and knowing

32:50

that I don't have to do it alone. That's

32:52

changed my life.

32:54

Rina, you are an angel

32:56

and your story is so powerful. If

32:58

you could send one mess to listeners

33:00

who might be grappling with their own diagnosis,

33:03

what would that be.

33:06

I think everything that we've said through this, but

33:08

it would be that there is a

33:10

hope and that there is change,

33:12

and although right now you may not

33:15

know what direction you need to go, it

33:17

is possible to find the care. Just

33:19

don't give up and be open to what

33:22

might be possible for you.

33:23

I love it. Thank you again so much. You're such

33:25

a delight.

33:26

Thanks Hollie, love to convo.

33:33

Our Skin is hosted by myself,

33:35

Holly Frye, and executive produced

33:37

and engineered by Ryan Martz. Our

33:40

senior producer and writer is Meredith

33:42

Barnes. If you enjoy the show, share

33:44

it with your friends. You can also listen

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