Bit random but has anybody experienced hair loss cause by their P? 

I have been clear of P for about 6 years on adlimumab and have recently had a breakout of guttate P after being ill for a few days. At the same time as the P coming back i developed a bald patch the size of a coin in my beard, this has grown to about the size of a tea bag.

Ive had a beard since i left school, this is doing my head in!

Following on form this thread Spesolimab IL-36 for pustular psoriasis The U.S. Food and Drug Administration (FDA) has approved Spevigo for the treatment of generalized pustular psoriasis (GPP) flares in adults.

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The U.S. Food and Drug Administration is the first regulatory authority to approve spesolimab as a treatment option for generalized pustular psoriasis (GPP) flares in adults, Boehringer Ingelheim announced today. Spesolimab, marketed in the U.S. as SPEVIGO®, is a novel, selective antibody that blocks the activation of the interleukin-36 receptor (IL-36R), a signaling pathway within the immune system shown to be involved in the pathogenesis of GPP.

“GPP flares can greatly impact a patient’s life and lead to serious, life-threatening complications,” said Mark Lebwohl, M.D., lead investigator and publication author, and Dean for Clinical Therapeutics, Icahn School of Medicine at Mount Sinai, Kimberly and Eric J. Waldman Department of Dermatology, New York. “The approval of spesolimab is a turning point for dermatologists and clinicians. We now have an FDA-approved treatment that may help make a difference for our patients who, until now, have not had any approved options to help manage GPP flares.”

“This important approval reflects our successful efforts to accelerate our research with the aim to bring innovative treatments faster to the people most in need,” said Carinne Brouillon, Member of the Board of Managing Directors, responsible for Human Pharma, Boehringer Ingelheim. “We recognize how devastating this rare skin disease can be for patients, their families and caregivers. GPP can be life-threatening and until today there have been no specific approved therapies for treating the devastating GPP flares. It makes me proud that with the approval of SPEVIGO® we can now offer the first U.S. approved treatment option for those in need.”

The FDA’s approval of spesolimab is based on results from the pivotal EFFISAYIL® 1 Phase II clinical trial. In the 12-week trial, patients experiencing a GPP flare were treated with spesolimab or placebo. Most patients at the outset of the trial had a high, or very high, density of pustules, and impaired quality of life. After one week, 54% of patients treated with spesolimab showed no visible pustules compared to placebo (6%).

In addition to the U.S. approval, spesolimab is currently under review by several other regulatory authorities. To date, spesolimab has received Breakthrough Therapy Designation in the U.S., China and Taiwan, Priority Review in the U.S. and China, Orphan Drug Designation in the U.S., Korea, Switzerland and Australia, Rare Disease Designation and fast track in Taiwan, for the treatment of GPP flares. The European Medicines Agency validated the marketing authorization application for spesolimab in GPP in October 2021 and the submission is currently under evaluation.

Distinct from plaque psoriasis, GPP is a rare and potentially life-threatening neutrophilic skin disease, characterized by episodes of widespread eruptions of painful, sterile pustules. Given that it is so rare, recognizing the symptoms can be challenging and consequently lead to delays in diagnosis.

Regarding weight I totally agree. I think it's very personal and only matters if a person is happy. In my case I do know that I need to lose some weight to be healthier and happier.

I wasn't disagreeing with Caroline but was curious as to if there was any documented research that shows a correlation between psoriasis and being overweight. I've gained weight since being diagnosed and my psoriasis is better now and I currently am not on meds for psoriasis which is another reason I was curious.

I often have different opinions than others on some things, but that's all it is, an opinion. I'm the first person to say I don't know what I'm talking about.

This study suggests there is an increased risk of suicidality in patients with psoriasis in particular with the presence of arthritis.

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Background:
Psoriasis has a devastating psychological impact on patients’ quality of life. However, the relationship between suicidality and psoriasis remains unclear.

Objective:
This study analyzed and compared the risk of suicidality (suicidal ideation, suicide attempt, and completed suicide) between patients with psoriasis and the general population.

Methods:
This nationwide, population-based, retrospective, cohort study analyzed the Korean National Health Insurance Service claim data from 2005 to 2018.

Results:
The study included 348,439 patients with psoriasis aged over 18 years and with age- and sex-matched controls. The risk of suicidality was higher in the psoriasis group than in the control group (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.18-1.24). The aHR of suicidality was higher in the psoriatic arthritis group (aHR, 1.46; 95% CI, 1.39-1.54) than in the psoriasis-alone group (aHR, 1.17; 95% CI, 1.13-1.20). However, the severity of psoriasis and suicidality showed no correlation (mild psoriasis group: aHR, 1.22; 95% CI, 1.18-1.25; moderate-to-severe psoriasis group: aHR, 1.16; 95% CI, 1.10-1.23).

Conclusion:
Patients with psoriasis have an increased risk of suicidality. In particular, the presence of arthritis in patients had a more significant effect on the risk of suicidality.

This study looked at the baseline characteristics of patients with moderate to severe psoriasis achieving super response with Tremfya (guselkumab)

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Background:
Psoriasis is a chronic immune-mediated inflammatory skin disease that often leads to a diminished quality of life. Goals of treating patients with psoriasis have shifted with more focus on achieving near or complete clearance of the skin. Guselkumab, a fully human monoclonal antibody targeting interleukin-23, is effective in treating moderate-to-severe psoriasis.

Objective:
To describe the baseline characteristics of patients with moderate-to-severe psoriasis achieving super-response (Psoriasis Area and Severity Index [PASI] 100 response at Weeks 20 and 28) after commencing guselkumab treatment.

Methods:
Pooled data from VOYAGE-1 and VOYAGE-2 studies identified super-response; baseline demographic, disease, and pharmacokinetic characteristics were compared with non-super-response. A stepwise logistic regression analysis identified which factors were potentially predictive of super-response status, with significance level of 0.1.

Results:
A subset of patients randomized to guselkumab comprised this post hoc analysis (n=664); 271 patients achieved super-response vs 393 with non-super-response. Patient age at study entry and baseline body weight (≤90 kg vs >90 kg), PASI, and Investigator’s Global Assessment (IGA) score were significant predictors of super-response status, with odds ratios (95% confidence intervals) of 0.98 (0.967-0.993; p=0.003), 1.42 (1.026-1.977; p=0.034), 0.97 (0.955-0.993; p=0.007), and 0.66 (0.433-0.997; p=0.048), respectively. More patients with super-response achieved an early response: Week 2 PASI 75 (5.5% vs 1.8%) and Week 8 PASI 100 (22.5% vs 3.3%) vs non-super-response. Median serum guselkumab concentrations through Week 28 were slightly greater in patients with super-response vs non-super-response.

Conclusion:
Guselkumab was more likely to achieve early clinical responses (complete skin clearance) in younger patients, less obese patients, and patients with less severe psoriasis.

This study looked at the effect of Skyrizi (risankizumab) in the treatment of psoriatic arthritis.

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Background:
Psoriatic arthritis (PsA) is a chronic inflammatory disease that reduces quality of life. This study assessed the effects of risankizumab (RZB) on the achievement of minimal clinically important differences (MCID) in patient-reported outcomes (PROs).

Methods:
KEEPsAKE-1 and -2 are randomized, placebo-controlled Phase 3 clinical studies assessing RZB (150mg) vs placebo (PBO) in adult patients with PsA with inadequate response or intolerance to disease-modifying antirheumatic drugs and/or biologics. Patients were randomized 1:1 to receive RZB or PBO for 24 weeks; starting at Week 24, all patients received RZB 150 mg through Week 52. PROs assessed were Patient’s Global Assessment of Disease Activity (PtGA), Patient’s Assessment of Pain, Health Assessment Questionnaire – Disability Index (HAQ-DI), Short-Form 36 Physical and Mental Component Summary scores (PCS and MCS, respectively), 5-Level EQ-5D (EQ-5D-5L), Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-Fatigue), and Work Productivity and Activity Impairment (WPAI). The proportion of patients achieving MCID at Weeks 24 and 52 are reported. Odds ratios of achieving MCID with RZB treatment at Week 24, relative to PBO, were estimated by logistic regression controlling for baseline and stratification factors.

Results:
In KEEPsAKE-1, RZB- vs PBO-treated patients were more likely to report MCID in all PROs at Week 24; similar results were obtained in KEEPsAKE-2, except for SF-36 MCS and WPAI presenteeism domain. In KEEPsAKE-1 and KEEPsAKE-2, 65% and 62% of RZB-treated patients, respectively, reported MCID in PtGA at Week 24, which increased to 74% and 68%, respectively, at Week 52. Approximately 48% of all PBO-treated patients reported MCID in PtGA at Week 24 and, after initiating RZB, >65% reported MCID at Week 52. Results were similar in the remaining PROs.

Conclusions:
These data demonstrate that patients with PsA receiving RZB treatment are more likely to report clinically important improvements in PROs compared with patients receiving PBO.

Hi

I was diagnosed with guttate psoriasis in early childhood. I've been on loads of treatments over the last 20 years including topicals, light treatment and a short stint on cyclosporin. About 4 years ago I decided to stop all treatment for a while and see how my skin was, I changed my diet and lifestyle and worked on my stress levels which is a huge trigger for flare-ups. I've flared a couple of times a year since coming off treatment and always have a baseline level of active patches which I had just learnt to accept. I'm not particularly self-conscious about the appearance of my psoriasis so that helped me not worry so much about having a break from treatment. 

After catching covid in January I have been in a constant cycle of flaring up then my skin settles for a couple of days before flaring again. Over the last couple of weeks, I've had a HUGE flare-up, my skin is a mess and the patches are everywhere - on my face, in my ears on my scalp and everywhere else imaginable. I can't sleep and I'm struggling to concentrate on anything other than my skin, it really is horrid.

I am ready to try some treatment again but I want to start with topicals again rather than just being given a referral to dermatology straight away which has happened in the past.

I'm hoping someone has some advice on the best topicals to ask for so I can go to the GP armed with loads of information, I always found dovobet to be really effective, is this still an option? 

Any advice welcome on how to go back into treatment after such a long break. xx

This study looked at psoriasis and the progression of parkinson’s disease.

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Background:
Epidemiological studies have suggested psoriasis was associated with an increased risk of Parkinson’s disease (PD). However, whether psoriasis has an effect on PD progression is not explored yet.

Objectives:
To evaluate the causal role of psoriasis in PD progression.

Methods:
We conducted a two-sample Mendelian randomization analysis using summary statistics from genome-wide association study of psoriasis (N=33,394), age at onset (N=28,568) and progression (N=4,093) of PD.

Results:
One standard deviation increase in genetically determined psoriasis risk was significantly associated with faster progression to dementia (OR=1.07, 95 % CI: 0.1.03~1.1, P=4.71E-04). Meanwhile, higher psoriasis risk was nominally associated with faster progression of PD measured by time to Hoehn and Yahr stage 3 (OR=1.05, 95 % CI: 1.02~1.08, P=1.53E-03) and depression (OR=1.06, 95 % CI: 1.02~1.11, P=1.77E-03) of PD. The results were robust under all sensitivity analyses.

Conclusions:
These results suggested psoriasis accelerated overall progression of PD, and increased risk of dementia and depression of PD. A deeper understanding of neuroinflammation and immune response is likely to elucidate the potential pathogenesis of PD progression and identify novel therapeutic targets.

FDA U.S. Food and Drug Administration have approved Zoryve (roflumilast) for the treatment of plaque psoriasis in Individuals age 12 and older.

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Arcutis Biotherapeutics, Inc. (NASDAQ: ARQT), an early commercial-stage biopharmaceutical company focused on developing meaningful innovations in immuno-dermatology, announced today that the U.S. Food and Drug Administration (FDA) has approved the New Drug Application (NDA) for ZORYVE (roflumilast) cream 0.3% for the treatment of plaque psoriasis, including intertriginous areas, in patients 12 years of age or older. The first and only topical phosphodiesterase-4 (PDE4) inhibitor approved for the treatment of plaque psoriasis, ZORYVE provides rapid clearance of psoriasis plaques and reduces itch in all affected areas of the body. ZORYVE — a once-daily, steroid-free cream in a safe and well tolerated, patient-friendly formulation — is uniquely formulated to simplify disease management for people living with plaque psoriasis.

“Today Arcutis has reached a major milestone, with our ability to offer this next generation topical PDE4 inhibitor to both adults and adolescents with plaque psoriasis. ZORYVE’s combination of efficacy, safety, and tolerability, coupled with our proprietary HydroARQ Technology formulation, is designed to fit into patients’ everyday lives with no restrictions on duration of use,” said Frank Watanabe, President and CEO of Arcutis. “Additionally, ZORYVE has been shown to rapidly clear plaques and reduce itch across all areas of the body. ZORYVE is the only topical for which data focused on the treatment of intertriginous plaques — a common area affected by plaque psoriasis — have been specifically generated. This FDA approval is the fruition of our efforts, and we are excited to launch ZORYVE, with expected product availability by mid-August.”

Topical therapies remain the primary treatment option for the vast majority of individuals with plaque psoriasis, a common immune-mediated skin disease that affects approximately nine million people in the U.S. and is the most frequent type of psoriasis occurring in both adults and adolescents. Severity can range between mild, moderate, and severe, with itch being the most burdensome and frequently reported symptom.

While the disease may affect any area of the body, plaques in certain areas, like the face, elbows and knees, genitalia, and intertriginous areas (areas of skin-to-skin contact), present unique treatment challenges. As a result, individuals with psoriasis are often prescribed multiple topical medications for different areas, which makes for a complicated treatment regimen.

“In multiple clinical trials, ZORYVE was proven to be safe and effective, with improvements in disease clearance in hard-to-treat areas like knees and elbows, as well as in sensitive areas such as the face, genitalia, and intertriginous areas. ZORYVE is very well tolerated, which is an important consideration for treating a chronic skin disease such as plaque psoriasis,” said Mark Lebwohl M.D., FAAD, principal investigator and Dean for Clinical Therapeutics and Chairman Emeritus of the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai. “With this FDA approval, adults and adolescents with psoriasis and their dermatologists have a new steroid-free treatment option for use on all affected areas of the body.”

ZORYVE features HydroARQ Technology™, a proprietary drug delivery formulation that creates a non-greasy moisturizing cream that spreads easily and absorbs quickly.

“Plaque psoriasis is a challenging disease and finding the right treatment option can be complicated, especially if individuals have to use multiple treatments for different parts of their body. We welcome a new treatment option that can make a meaningful difference for adults and adolescents with plaque psoriasis,” says Leah M. Howard, President and CEO of the National Psoriasis Foundation. “Our hope is that new treatments translate into improved outcomes and help alleviate the burdens of chronic disease for people impacted by psoriasis.”

Arcutis intends to make ZORYVE widely available via key wholesaler and national dermatology pharmacy channels as a new treatment option by mid-August, and the Company is dedicated to affordable access to therapy. The ZORYVE Direct patient support program will help commercially insured individuals with plaque psoriasis get access and start ZORYVE treatment as prescribed by their healthcare provider quickly and easily by helping them navigate the payer process, lowering the out-of-pocket cost for eligible patients, and offering programs that support staying on therapy.† Arcutis will also offer the Arcutis Cares patient assistance program (PAP) – the first of its kind for a topical psoriasis treatment – that will provide ZORYVE at no cost for financially eligible patients who are uninsured or underinsured.‡

With this approval, Arcutis has access to, and plans to draw, an additional $125 million tranche as part of the Company’s non-dilutive financing agreement with SLR Capital Partners. Combined with the Company’s cash, cash equivalents, restricted cash, and marketable securities as of June 30, 2022, this additional $125 million will provide for capital resources of over $400 million to support the launch and commercialization efforts for ZORYVE, as well as continue to advance the Company’s pipeline development initiatives.

I am 63 years old and have only had psoriasis for two years. It started in my face, but after a few weeks my whole body was covered with spots, bumps and flakes. Once the diagnosis was made, the search for a remedy that would adequately combat the symptoms began.
- Skilarence gave me severe diarrhea after a few months, so I couldn't continue with it.
- Methotrexate (MTX) had little effect on my psoriasis. Because the drug can be a heavy attack on the liver and other organs, the disadvantages outweighed the benefits.

Then the biologicals came into the picture.
- Hyrimoz adalimumab (an injection every two weeks) did work a bit, but my legs especially remained full of flaky spots.
- Ilumetri Tildrakizumab (an injection every three months) has made the psoriasis spots almost completely disappear in a few months. The starting injection was at the end of March 2022 and from April 2022 the injection must be repeated every three months. The effect on the psoriasis is excellent. I barely have any flaky spots. But...

HERE COMES MY QUESTION
In May 2022 I started experiencing joint pain in varying places. It often starts at the end of the afternoon or in the evening. Sometimes in an ankle, then in a finger, sometimes a whole hand or just one toe, shoulder, knee or elbow. Sometimes it is so intense that I can hardly walk or that the pain keeps me from sleeping. The pain is almost always gone the next day and the affected joint is still a bit stiff. Almost every day there is a joint that hurts at night.

Joint pain is not a known side effect of Ilumetri, but even a rheumatologist had no logical explanation and found it suspicious that these complaints only occur after starting this biological.
Because Ilumetri is a relatively new drug, this joint pain may still be missing from the list of possible side effects. 

I am curious if there are other patients who receive Ilumetri injections and have joint complaints.

This study suggests people with psoriasis could be at higher risk of lung cancer.

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Background:
Although many studies have indicated that Psoriasis (PsO) could contribute to the risk of lung cancer, no study has reported a clear causal association between them. Our aim was to explore the potential causal association between PsO and the lung cancer risk using Mendelian randomization (MR) design.

Methods:
To explore a causal association between the PsO and lung cancer, we used large-scale genetic summary data from genome-wide association study (GWAS), including PsO (n=337159) and lung cancer (n=361586), based on previous observational studies. Our main analyses were conducted by inverse-variance weighted (IVW) method with random-effects model, with a complementary with the other two analyses: weighted median method and MR-Egger approach.

Results:
The results of IVW methods demonstrated that genetically predicted PsO was significantly associated with higher odds of lung cancer, with an odds ratio (OR) of 1.06 (95%CI, 1.01-1.12; P=0.02). Weighted median method and MR-Egger regression also demonstrated directionally similar results (All P<0.05). In addition, both funnel plots and MR-Egger intercepts indicated no directional pleiotropic effects between PsO and lung cancer.

Conclusions:
Our study provided potential evidence between genetically predicted PsO and lung cancer, which suggested that enhanced screening for lung cancer allows early detection of lung cancer.

This study looked at switches between biologics and how their pattern changed over time with the recent availability of new biologic agents.

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Background:
Biologics are the cornerstone of treatment of patients with moderate-to-severe plaque psoriasis and switches between biologics are frequently needed to maintain clinical improvement over time.

Objectives:
The main purpose of this study was to describe precisely switches between biologics and how their pattern changed over time with the recent availability of new biologic agents.

Methods:
We included patients receiving a first biologic agent in the Psobioteq multicenter cohort of adults with moderate-to-severe psoriasis receiving systemic treatment. We described switches between biologics with chronograms, Sankey and Sunburst diagrams, assessed cumulative incidence of first switch by competing risks survival analysis and reasons for switching. We assessed the factors associated with the type of switch (intra-class – i.e. within the same therapeutic class - versus inter-class) in patients switching from a TNF-alpha inhibitor using multivariate logistic regression.

Results:
A total of 2,153 patients was included. The cumulative incidence of switches from first biologic was 34% at 3 years. Adalimumab and ustekinumab were the most prescribed biologic agents as first and second lines of treatment. The main reason for switching was loss of efficacy (72%), followed by adverse events (11%). Patients receiving a TNF-alpha inhibitor before 2016 mostly switched to ustekinumab whereas those switching in 2016 or after mostly switched to an IL-17 inhibitor. Patients switching from a first line TNF-alpha inhibitor before 2016 were more likely to switch to another TNF-alpha inhibitor compared to patients switching since 2018. Patients switching from etanercept were more likely to receive another TNF-alpha inhibitor rather than another therapeutic class of bDMARD compared to patients switching from adalimumab.

Conclusion:
This study described the switching patterns of biologic treatments and showed how they changed over time, due to the availability of the new biologic agents primarily IL-17 inhibitors.

This study suggests artificial intelligence could be better than the PASI score for the assessment of psoriasis severity.

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Background:
PASI score is globally used to assess disease activity of psoriasis. However, it is relatively complicated and time-consuming, and the score will vary due to the inconsistent subjectivity between dermatologists. Therefore, an AI system capable of assessing psoriasis severity will be useful.

Objectives:
To propose a simplified PASI system (Single-Shot PASI) and associated AI models capable of assessing psoriasis severity.

Methods:
Overall, 705 psoriasis images of the trunk's front and back were used in our research. Considering the relatively small number of images, we used data augmentation techniques to expand the data. A psoriasis expert's scores were used as teacher data. Various convolutional neural network models and hyperparameters were adjusted using a fivefold cross-validation. From these adjustments, we discovered that fine-tuning Imagenet2012-pretrained InceptionV3 whose last linear layer was replaced by a two-layer perceptron (30 hidden units and five output units) exhibited the best performance.

Results:
To validate our deep learning system, 10 images were selected as test sets and were excluded from the training sets. The AI assessment of Single-Shot PASI was almost consistent with the clinical severity. We examined whether AI assistance would affect human scoring. In this study, 13 dermatologists and 9 medical students were invited as evaluators. Mean absolute differences from AI scores and standard deviation among evaluators reduced with AI assistance. In addition, the evaluator's scores got close to the teacher's score with AI's assistance.

Conclusions:
We proposed a Single-Shot PASI system and developed an associated AI system capable of assessing psoriasis severity simply by uploading a single clinical image. An easy-to-use scoring system and our freely available AI software would help dermatologists and patients with psoriasis.

Has anyone had psoriasis in their ear canal?  Did you also have an ear infection?  Not the outer ear, but the inside part a Q-Tip might reach?  Would you apply a little steroid ointment, using a Q-Tip?

Following on from this thread Piclidenoson for psoriasis report before phase 3 data release Piclidenoson may soon be available.

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Can-Fite BioPharma Ltd. (NYSE American: CANF) (TASE: CFBI), a biotechnology company advancing a pipeline of proprietary small molecule drugs that address inflammatory, cancer and liver diseases, announced today that it is planning to submit its registration plans to the U.S. Food and Drug Administration (FDA) and a Marketing Authorization Application (MAA) with the European Medicines Agency (EMA) for its lead drug candidate Piclidenoson in the treatment of moderate to severe psoriasis.

Can-Fite recently reported topline results from its Phase III COMFORT™ study which met its primary endpoint with statistically significant improvement over placebo in psoriasis patients and an excellent safety profile for Piclidenoson. Further analysis of the Phase III COMFORT™ data point towards a better safety profile for Piclidenoson as compared to Otezla, which induced gastro-intestinal adverse events in 6% of patients compared with 1% in patients treated with placebo or Piclidenoson. Discontinuation of treatment amongst patients treated with Otezla was significantly higher compared to that of the Piclidenoson treated patients.

A sub-analysis of the efficacy data that divided patients into those who had PASI>25 (more severe psoriasis) and PASI<25 (less severe) at baseline revealed that patients who started with higher PASI values at entry benefitted more from treatment with Piclidenoson as compared to placebo. This result demonstrates the efficacy of Piclidenoson in the treatment of patients with more severe disease.

In its registration plans, Can-Fite will submit the final efficacy and safety results from COMFORT™, a multicenter, randomized, placebo- and active-controlled, double-blind study that assessed the efficacy and safety of Piclidenoson in more than 400 adults with moderate to severe plaque psoriasis together with a request for registration advice to the FDA and EMA. Additionally, current chemistry, manufacturing, and controls (CMC), nonclinical data, and human pharmacokinetic data will be submitted to the agencies along with a pivotal Phase III protocol and other supporting clinical pharmacology plans.

“The additional safety and efficacy data that emerged following our topline Phase III results point to a strong market positioning for Piclidenoson among approved oral psoriasis drugs. Today, a large percentage of people living with psoriasis choose not to be treated with biologics due to reported serious side effects and the need to be treated in a clinic. Similarly, a percentage of patients using Otezla, the leading oral drug for psoriasis, suffer from gastrointestinal issues and discontinue treatment. We believe that if Piclidenoson achieves its primary endpoint once again in an upcoming pivotal Phase III study, Piclidenoson will offer a safe and effective long-term treatment for people living with psoriasis, including those with the most severe cases,” stated Can-Fite Medical Director, Dr. Michael Silverman.

Anyone here heard of or been on bimzelxs for psoriasis? About to start and keen to hear others experiences

The last dose of Methotrexate was on May 5, 2022.  The daily nausea side effect gradually worsened over the five months I tried the medicine.  My skin did mostly clear, though, leaving only very small patches and discoloration where the worst patches were, but it was mostly smooth and free of itch.

Gradually, the skin grew new patches with variable itchiness.  

I increased my dose of Humira (primarily used for Crohn's Disease since 2012) on June 9 to taking it every week rather than every other week.  

First off, I felt better, overall, quickly.  My breathing improved noticeably (I have Crohn's in my lungs as well as gut).  And my energy levels improved.  

My gastroenterologist and I came up with this plan to give weekly Humira a try, just in case it would help the rashes (or make them worse) before switching to something else.  Blood tests had shown the levels of Humira in my sample were barely inside the therapeutic range.  

I'll repeat a spirometry breathing test in August and consult with pulmonologist afterward to see if the breathing  improvement is in my imagination or verifiable.  So many doctor co-pays!  Sigh.

So . . . in the first couple of days after I take the weekly dose of Humira, the rashes look better.  They are mainly where I sweat while skating, lower legs and groin.  But they are nowhere near as wide spread and uncomfortable as they were before using Methotrexate.

I'm using a mild steroidal ointment only between a couple toes on each foot and only rarely.  I've used an over the counter hydrocortisone cream on the spots in my genital area a little more often but not daily.  If I use the steroid ointments later on, I'll be much more cautious because I believe they made the patches worse in the long run as I used them last year under the advice of the first dermatologist I saw (he was an arrogant man who did not give good advice for steroid usage).

My second dermatologist (she's very good!) is on maternity leave but will return soon. I have an appointment with her on August 2.

That's my update for now.  Thanks for reading.

This analysis updates  Ilumya / Ilumetri  (tildrakizumab) efficacy and safety for up to 5 years in patients with and without metabolic syndrome (MetS)

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Background:
Limited data are available on long-term efficacy and safety of biologics in patients with psoriasis and metabolic syndrome (MetS), a common comorbidity.

Objectives:
This analysis updates tildrakizumab efficacy and safety for up to 5 years in patients with and without MetS.

Methods:
This was a post hoc analysis of the double-blind, randomized, placebo-controlled, phase 3 reSURFACE 1 (NCT01722331) and reSURFACE 2 (NCT01729754) trials in adult patients with moderate to severe chronic plaque psoriasis. Analyses included data through Week 244 from patients who continuously received tildrakizumab 100 (TIL100) or 200 mg (TIL200) and entered the extension studies, stratified by baseline MetS status. Efficacy was assessed via Psoriasis Area and Severity Index (PASI) scores. Safety was evaluated from exposure-adjusted incidence rates (EAIRs) of treatment-emergent adverse events (TEAEs).

Results:
reSURFACE 1 and reSURFACE 2 analyses included 26 and 44 TIL100-treated patients with MetS, 98 and 167 TIL100-treated patients without MetS, 34 and 30 TIL200-treated patients with MetS, and 111 and 130 TIL200-treated patients without MetS, respectively. There were no clinically relevant differences in PASI 75/90/100 response rates at Week 244 between patients with vs without MetS. The proportion of patients with vs without MetS achieving absolute PASI score <3 at Week 244 was 53.8% vs 69.4% and 77.3% vs 80.8% in reSURFACE 1 and 2, respectively, for TIL100-treated patients and 58.8% vs 72.1% and 63.3% vs 72.3%, respectively, for TIL200-treated patients. In both studies, median reduction from baseline PASI score at all time points in patients with vs without MetS was >83% vs >89% for TIL100 and >85% vs >90% for TIL200. Pooled EAIRs of TEAEs, serious TEAEs, and TEAEs of special interest were similar in patients with and without MetS.

Conclusions:
Tildrakizumab maintains efficacy and a favorable safety profile over 5 years in patients with psoriasis regardless of MetS status.

This study compared the effectiveness of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis.

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Background:
Clinical trials study treatment outcomes under stringent conditions, capturing incompletely the heterogeneity of patient populations and treatment complexities encountered in real-world practice.

Objectives:
To compare the effectiveness of anti-interleukin (IL)-17A biologics relative to other approved biologics in patients with moderate-to-severe psoriasis.

Methods:
The Psoriasis Study of Health Outcomes (PSoHO) is an ongoing 3-year observational cohort study in adults with chronic moderate-to-severe plaque psoriasis initiating or switching to a new biologic. Primary study endpoint is proportion of patients achieving 90% improvement in Psoriasis Area and Severity Index (PASI 90) and/or static Physician Global Assessment (sPGA) 0/1 at Week 12 (W12) in the anti-IL-17A cohort (ixekizumab [IXE], secukinumab) versus all other approved biologics. Secondary outcomes include proportion of patients who achieve PASI 75/90/100, absolute PASI scores ≤5, ≤2 and ≤1, Dermatology Life Quality Index (DLQI) score of 0/1 at W12 between the two cohorts and among the individual biologics. Comparative effectiveness analyses were conducted using Frequentist Model Averaging (FMA), a novel causal inference machine learning approach. Missing data for binary outcomes were imputed as non-response.

Results:
Patient profiles in the anti-IL-17A cohort and other biologics cohort were similar, with more frequent comorbid psoriatic arthritis and less frequent exposure to conventional treatments in the patients receiving anti-IL17A biologics. At W12, 71.4% of patients who received an anti-IL-17A biologic achieved PASI 90 and/or sPGA 0/1 compared to 58.6% of patients who received other biologics (odds ratios [OR], 1.9; 95% confidence intervals [CI], [1.6, 2.4]). Similar findings were observed for secondary outcomes.

Conclusions:
These results reflect the high efficacy and early onset of skin clearance of IL-17A inhibitors observed in randomized clinical trials and confirm the effectiveness of anti-IL17A biologics in the real-world setting.

A comprehensive, tri-national, cross-sectional analysis of characteristics and impact of pruritus in psoriasis.

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Background:
Pruritus is prevalent in psoriasis but still many features of pruritus, its response to therapy and its burden in psoriasis remain to be better characterized.

Objective:
To investigate characteristics and burden of pruritus in an international cohort of patients with psoriasis.

Methods:
This cross-sectional study included a total of 634 patients and 246 controls from Germany, Poland and Russia. Physicians examined and interviewed participants, recording clinical characteristics, such as severity, therapy and localization of psoriatic lesions. Participants filled out self-reported questionnaires including questions on pruritus severity and impact, characteristics, and response to therapy, and quality of life (QoL). Localization patterns of pruritus and skin lesions were visualized using body heat maps.

Results:
Most patients (82%) experienced pruritus throughout their disease, and 75% had current pruritus. The majority of patients (64%) perceived pure pruritus, and those who reported additional painful and/or burning sensations (36%) reported overall stronger pruritus. The scalp was the most frequently reported localization of pruritus, even in the absence of skin lesions. Body surface area (BSA) of pruritus was not linked to pruritus intensity, but to BSA of psoriatic lesions (rho = 0.278; P < 0.001). One third of patients (31%) reported impaired sex-life, and 4% had suicidal ideations due to pruritus. In up to one third of patients, psoriasis therapies had little or no effect on pruritus. The only therapeutic option offered to some of these patients were antihistamines, which appeared to be effective in most cases.

Conclusion:
Pruritus is highly prevalent in psoriasis and is linked to a significant burden. Current psoriasis therapies are frequently insufficient to control pruritus. Managing psoriasis should include the assessment and control of itch. Efficient antipruritic therapies should be developed and be made available for patients with psoriasis.