Hi,
I just registered here. I have had psoriasis for 10 years and got psoriatic arthritis in my first year. In fact, the psoriasis hit the same month I hit menopause, and the arthritis 4 months later. I had some plaque, but mainly my psoriasis type is guttate.

I did feel that when I lost my periods, I gained this disease. It was like I had a way to release my own toxins until then.

For 4 years I tried to fight off the psoriasis with a naturopath's help. I did see some clearing, but the arthritis was awful and nearly crippling. I had it in most of my large joints, but my fingers and toes was worst.

At that point, I finally went to a teaching college where they had tested the biologics. My new derm got me on Enbrel. The following day, I did not need my naproxen pain pills. Within several weeks I noticed a huge difference in my skin. But 4 months later, the skin problems came back. Luckily, 5 years later, I am still in remission from the arthritis.

In spring of 2013, my specialists decided my skin was so bad that I should be put on methotrexate. But I also have a liver condition, so I wasn't happy about methotrexate. I visited my naturopath and she suggested I try LDN or low dose naltrexone. The other doctors were going to start the methotrexate in the fall, so I felt like I had a few months to try the LDN.

Long story short, I responded very well on LDN. I've had one PASI score of 0 and another of 6...but my skin is actually the same (just different doctors). I have pictures and will gladly share them. I have been 90% clear for more than a year. I take 4 mg naltrexone each night before bed. I had no side effects. This has been the most wonderful experience. I am still on Enbrel.

Oddly, I tried to search here for LDN, and the search feature wants 4 letter phrases or more. I then searched for naltrexone, and couldn't find that either.

I have been on the Inspire Psoriasis Foundation Forum for years, and I have learned to hate it because of advertising and being steered by the foundation with all their impersonal emails. Also, I am appalled by the people who attack folks for trying alternative therapies.

I hope I can share my good news and find a place where people aren't locked into the medical/pharmaceutical field's dictates. As we all know, there is no therapy that works for all of us and we have to advocate for ourselves and be willing to try different paths.

Personally, I believe we all share symptoms, not always the same cause. But I believe that the liver and proper digestion/absorption is the key to healthy skin.

I'm looking forward to meeting folks here.

Dulane

Hey all I'm a newbie to this forum recommended to me just a quick intro
I'm a sufferer of psoriasis and have been for 14 years it's started getting worse was just plaque but now the dermo believe guttate has now started up woop like I did have enough
I'm also a sufferer of psoriatic arthritis and ive suffered with that for around 5 year. Psoriasis doesn't like creams and I've had zero success with anything I've had radiation in my knee for the arthritis (yttrium injection) sadly I'm still suffering after having it twice thanks for reading. Hope to speak to you all soon
Lucky xx

I had never heard of TSW until recently when I accidently stumbled upon a site. Steroids is something that I have always been cautious about when prescribed, but have had them by shots, orally, as an inhaler and in creams and oils so I found the information on topical steroid withdrawal informative.

I'm not putting links or info here as anyone interested can do a search but wanted to share the info for anyone using steroid creams and/or oils such as myself that had never heard of TSW.

This novel study of 104 psoriasis patients asked them to complete a postcard entitled ‘Dear Psoriasis…’ – to collect survey data on their personal models of psoriasis. It suggests patient support and psychological treatment should be made available as part of routine care.

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Background:
People with psoriasis report high levels of undermanaged distress. This is compounded by the problem that some patients find it difficult to discuss their emotions. Distress prevents optimal self-management, which may exacerbate psoriasis flares, thereby creating a vicious cycle.

Objectives:
To offer people with psoriasis a novel way of expressing their personal models of psoriasis in order to gain a better understanding of their experiences of living with the condition.

Methods:
We used a qualitative technique – asking people with psoriasis to complete a postcard entitled ‘Dear Psoriasis…’ – to collect survey data on their personal models of psoriasis.

Results:
One hundred and four returned postcards provided new insights into the extent of and reasons for distress in psoriasis. Seven dominant themes emerged: identity and relationships; battleground; control; emotional consequences; hypervigilance; coping; treatment burden.

Conclusions:
Reports of distress were common, and for many it was long-standing. Some reported low self-esteem and self-denigration bordering on self-loathing, and described being hypervigilant and in a constant battle with their skin. Many people did not expect to have intimate relationships, resulting in reduced social support for patients in the future. This research underscores the need for patient support and psychological treatment to be made available as part of routine care.

Hello new here thankyou for leting me join.

An interesting article that looks in to inner ear damage with psoriatic patients (PsA), the study demonstrates strong evidence for inner ear damage.

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Objective:
Although psoriatic arthritis (PsA) is a common chronic inflammatory rheumatic disease, little is known about audiovestibular impairment in this condition. We aimed to establish whether audiovestibular manifestations were present in patients with PsA.

Methods:
A set of 60 consecutive patients who fulfilled the Moll and Wright criteria for PsA and 60 matched controls were studied. During the period of recruitment, individuals were excluded who had a history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere disease and other vestibular syndromes, infections involving the inner ear, barotrauma, or were in treatment with ototoxic drugs.

Results:
Most patients with PsA were men (63%). The mean age at the time of our study was 52.9 years and the mean age at the onset of symptoms was 33 years. Thirty-six (60%) of the 60 patients showed abnormal hearing loss in the audiogram compared to only 5 (8.3%) of the 60 controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). The audiogram disclosed a bilateral and symmetrical sensorineural hearing loss (SNHL) in PsA with predominant pattern of high frequency SNHL in patients with PsA (46.7%) compared to controls (8.3%, p < 0.001). Patients with PsA exhibited abnormal vestibular tests more commonly than controls. A significantly increased frequency of abnormal computerized dynamic posturography with a predominant vestibular loss pattern was also observed in patients (23.3%) compared to controls (0%, p < 0.001).

Conclusion:
Our current study demonstrates strong evidence for inner ear damage in patients with PsA.

Just wanted to say hello...I am still awaiting my official diagnosis after a biopsy...but sadly will most likely to join the psoriasis club.

My story...

About two months ago I developed a ring-like lesion on my bikini line...I was taking swim lessons with my youngest son and figured I probably picked up ringworm at the pool (I have had it before so I thought I knew what it was for sure!)...so I applied some OTC antifungal cream...to no avail

Kept spreading for 2 weeks so I called my derm and she ordered the hardcore rx type anti fungal cream for me...which I dutifully applied twice daily. 2 weeks later STILL no change and STILL spreading and getting very inflamed and basically growing together into one big rash (sigh).

Went into the derms office for her to look at and she did the whole, suck in her breath through her teeth when she saw it...(you know it's bad when they do that!) but she also was pretty sure it was ringworm so she said to either just keep applying the cream and would take time to go away or take the oral anti-fungal (which my husband and I joking called the death pill because of it's side effects)...I decided I had it with the whole thing and was going to take the oral meds. 3 weeks of it and it was still there!!

Derm said there is no way it could be ringworm if the meds had no effect at all...and by this time it's still spreading (bum crack, hands, wrists...typical!) and she thinks it's most likely psoriasis. She took a biopsy to confirm...still awaiting results. Sad face.

That's my story! The derm gave me a steroid cream to use to see if it helps at all. Its just so strange to get a skin condition in the middle of ones life (im 35)...I have never even had the slightest bit of dry skin ever...never use lotion, nothing! At least my husband is understanding...he has extremely bad eczema...so we are going to make quite the pair!

I love any suggestions from anyone else suffering from it in the same location...especially women! Thanks for listening!!

Kirsten

This study which is ahead of full publication in Arthritis Research and Therapy looked at new psoriatic arthritis patients and suggest that a better understanding is needed as to why they don't stay on first treatments for a long period.

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Introduction:
This study aimed to describe treatment changes (discontinuation, switching, and therapy add-on) following the initiation of a biologic or nonbiologic oral disease-modifying antirheumatic drugs (DMARDs) in psoriatic arthritis (PsA) patients.


Methods:
Adult patients with 2 PsA diagnoses from physician office visits, initiated on a biologic or non-biologic oral DMARD, were selected from the Truven Health Analytics MarketScan Research Database (2005 to 2009). Patients were required to have continuous insurance coverage 6 months prior to and 12 months post index date (first prescription fill date). Treatment discontinuation, treatment switch, and therapy add-on were captured over the 1 year period following the index date. Treatment changes were described separately for patients initiated on nonbiologic and biologic DMARDs.

Results:
A total of 1,698 and 3,263 patients were initiated on an oral nonbiologic DMARD and biologic DMARD respectively. For patients initiated on nonbiologic DMARDs, 69% had 1 therapy change over the 12 month study period (median time 85 days). Among patients who had a therapy change, 83% discontinued, 29% switched therapy (64% switched to a biologic DMARD), and 25% had a therapy add-on (76% added-on with a biologic DMARD). For patients initiated on a biologic DMARD, 46% had 1 therapy change (median time 110 days). Among patients who had a therapy change, 100% discontinued, 25% switched therapy (92% switched to another biologic DMARD), and 7% had a therapy add-on with a nonbiologic DMARD.

Conclusion:
This study suggests that PsA patients newly initiated on a nonbiologic/biologic DMARD do not remain on the index treatment for a long period of time. A better understanding of factors related to these early treatment changes in PsA patients are needed.

LINK REMOVED

Here an article on scientific research and the flaws in it. If this is the status of real scientific research, how shall we weight the results of pharma paid research on their own products then?

Seems life is kind of a roulette...

The market for treatments of psoriatic arthritis therapies will grow nearly 66 percent increasing to $3.7 billion in 2023 do to increased uptake of premium-price biologics and novel therapies that are expected to launch during the 2013 to 2023 forecast period.

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Decision Resources Group finds that the market for psoriatic arthritis (PsA) therapies will grow nearly 66 percent, increasing to $3.7 billion in 2023, owing to the continued uptake of premium-price biologics and novel therapies that are expected to launch during the 2013 to 2023 forecast period. In 2013, five marketed TNF-alpha inhibitors dominated sales in the PsA market with over 90 percent of the $2.3 billion major-market total; adalimumab (AbbVie/Eisai's Humira) was the overall sales leader. Over the next decade, TNF-alpha inhibitors will retain their sales-leading position, but recently launched treatments ustekinumab (Janssen's Stelara) and apremilast (Celgene's Otezla), together with noval therapies—which include the anti-interleukin-17 monoclonal antibodies secukinumab (Novartis), ixekizumab (Eli Lilly), and brodalumab (Amgen/AstraZeneca/Kyowa Hakko Kirin) and the Janus-kinase inhibitor tofacitnib (Pfizer's Xeljanz)—will account for approximately 21 percent of 2023 PsA sales combined in the United States, France, Germany, Italy, Spain, United Kingdom and Japan.

Of the five agents entering the PsA market, tofacitinib (Pfizer's Xeljanz) will experience the most uptake during the forecast period. Tofacitinib and recently launched apremilast feature oral formulations and unique mechanisms of action, thus allowing them to compete for TNF-alpha inhibitor-refractory patients, as well as experience uptake as "stop gaps" for conventional DMARD failures before stepping up to treatment with biologics.

Less-expensive biosimilar versions of several biologics will launch beginning in 2015 and will erode biologics' sales through 2023, with the largest impact on the TNF-alpha inhibitor class.

Interviewed thought leaders report that conventional DMARDs and TNF-alpha inhibitors are the clinical mainstays for mild and moderate-to-severe PsA, respectively, and will face only moderate loss of patient shares to recently launched and incoming novel therapies.

Decision Resources Group Director Bingnan Kang, Ph.D.
"The addition of the TNF-alpha inhibitors to the PsA treatment algorithm represented a significant step forward in the management of this heterogeneous disease. Despite advances in the diagnosis and treatment of PsA, significant opportunity remains for developers of additional disease-modifying agents and agents with a high degree of efficacy against multiple disease manifestations."

"Physicians are keen for results of pivotal clinical trials of emerging PsA therapies. Interviewed thought leaders tell us that should ixekizumab and/or tofacitinib prove to be as or more effective than active comparator arms (versus adalimumab) in their respective Phase III trials, these therapies would experience stronger uptake compared with other novel agents entering the PsA market."

"Biosimilar versions of etanercept, adalimumab and infliximab are expected to launch in most or all of the major markets during the forecast period and to account for approximately 36 percent of TNF-alpha inhibitor sales for PsA in 2023. Our primary research indicates that most rheumatologists will feel comfortable prescribing biosimilars for PsA, based on biosimilars' clinical trial data in RA, thereby reducing biosimilars' barrier to entry in this market."

This article published in The International Journal of Rheumatic Diseases measured changes in the serum levels of adiponectin, resistin and visfatin, and the associations of such changes with the extent of disease activity and insulin resistance in Psoriatic arthritis (PsA) patients.

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Aim:
Psoriatic arthritis (PsA) is an inflammatory form of arthritis typically associated with psoriasis and/or psoriatic nail disease. Adipocytokines were once thought to influence development of (only) insulin resistance and diabetes mellitus. However, it is now clear that adipocytokines play important roles in development of the inflammation associated with either autoimmune or auto-inflammatory disorders. In the present study, we measured changes in the serum levels of adiponectin, resistin and visfatin, and the associations of such changes with the extent of disease activity and insulin resistance in PsA patients.

Material and methods:
A total of 67 subjects (28 with PsA and 39 healthy controls) without hypertension or diabetes mellitus were enrolled. Adiponectin, resistin and visfatin levels, and the extent of insulin resistance (assayed using the homeostasis model [HOMA-IR]), were measured in all subjects. Assessment of PsA disease activity was done with the Disease Activity Index for Psoriatic Arthritis (DAPSA).

Results:
Psoriatic arthritis patients had considerably higher serum levels of adiponectin, resistin and visfatin than did healthy controls (all P < 0.05). In the logistic regression analysis, the following variables may contribute to complex pathogenesis of PsA: adiponectin (P = 0.001, OR = 3.1, 95% CI = 1.6–6.0), resistin (P = 006, OR = 1.8, 95% CI = 1.2–2.9) and visfatin (P = 0.031, OR = 3.9, 95% CI = 1.1–13.9). In contrast, we have not detected any correlation between DAPSA and adipocytokine serum levels (P > 0.05).

Conclusion:
There is no correlation between adipocytokines and disease activity. Although serum adiponectin, resistin and visfatin levels are higher in patients with PsA, pathophysiological significance of the result has to be evaluated with more extensive studies.

I know that we are each going to be different on this as there are different type of psoriasis and different types of treatment represented here on the forum but as someone recently starting treatment, I'm looking each day at signs of improvement. Some days I think things are looking up and other days I don't feel I'm closer to getting clearer. Since treatment takes time and I doubt anyone woke up to say "I'm clear!" I thought I'd ask if anyone wanted to share what they noticed was happening while they were "clearing up". Did you still have bad days when it looked worse, did it just gradually over time keep improving or did it maybe get worse before getting better?

For me, I haven't noticed a huge improvement yet and yes, I know it's still early for me. Less itching (although sometimes I wonder if that's just me being overly hopeful) and my ears almost cleared... but I was on a steroid medpac and I'm guessing it helped with that as they have since gone back to how they were before. My scalp is peeling more than ever I think, but I don't know if that is a good sign or bad. The "redness" still comes and goes, goes as in not away just not as red some days as others.

Also, maybe how long into treatment before you noticed an improvement? (Again, I know that will vary according to treatment, type of p and just individual person)

Dupuytren contracture (DC) is a fibrocontractile disease of the palms where the fingers bend towards the palm and cannot be fully extended, this study looked at the correlation between psoriasis and dupuytren contracture.

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Aim:
To evaluate the prevalence of DC in the full range of clinical psoriasis phenotypes.

Methods:
In total, 98 patients with psoriasis attending our psoriasis clinic were examined for DC, based on predetermined criteria. In addition, 84 patients with DC, obtained from a specialist hand clinic, were assessed using a validated psoriasis questionnaire. We utilized Bayes theorem and bootstrap simulation to calculate the conditional prevalence of DC, then we used the results to compare the prevalence of DC between patients with psoriasis and a nonpsoriasis population.

Results:
The percentage of patients with DC was 19.6% in the psoriasis population and 3.6% in the nonpsoriasis population. Development of DC showed a phenotypic predilection, with 39.1% of patients with predominantly palmoplantar involvement and 38.9% of patients with intertriginous psoriasis developing DC compared with 12.7% of patients with psoriasis who did not have these two phenotypical presentations.

Conclusions:
Our data show a positive correlation between psoriasis and DC. Patients with the palmoplantar phenotype of psoriasis were more likely to develop DC. By understanding this relationship, dermatologists may diagnose DC early in its onset in patients with psoriasis, prompting referral to hand surgeons when appropriate.

This study although small looked at the possibility of NB-UVB (narrow band ultraviolet-B phototherapy) being used after a bio treatment failure.

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Background/Purpose:
Biological therapy has demonstrated a very satisfactory anti-psoriatic effect; however, the loss of response with time has been reported.

Objective:
To evaluate the efficacy of the narrow band ultraviolet-B phototherapy (NB-UVB) as a rescue in patients with moderate to severe psoriasis who have lost efficacy in their biological treatment.

Methods:
A retrospective chart review study was conducted on patients with moderate to severe psoriasis receiving treatment with a biologic, with a good initial response that subsequently had lost efficacy. All the patients received combined treatment with NB-UVB.

Results:
Seventeen patients were included, with a mean age of 44 years. The biologics were: 8 etanercept, 4 adalimumab, 3 ustekinumab, 1 efalizumab, and 1 infliximab. The mean NB-UVB sessions was 25 (7–48 sessions), with a mean accumulated dose of 31.12 J/cm2 (5.2–94.6 J/cm2). Sixteen patients had the following results: 44% PASI 90–100, 31.3% PASI 75–89, and 25% PASI 50–74 response.

Conclusion:
According to this study on clinical practice, it could be considered that the use of NB-UVB along with biological drugs that have lost efficacy in controlling moderate to severe psoriasis in adults could contribute to the recovery of the initial response.

I have had psoriasis since I was 4 years old (yup, not usual...the Dr.s had fun studying me in the sixties). It has been quite a journey going from doctor's office to doctor's office. I used tar and cortizone and anthralin and psoralin and methytrexate and light boxes and sea water. My mother tried every remedy going from shark, seal, whale oil to white turkey meat only to butter from New Zealand to....you get the idea. I drank this kind of drink or that which was supposed to have some healing property. She brought me to this healer and that. The only thing I got from it was the profound feeling that I was defective and not human. Bless her for caring, but the best thing I have found is to simply accept myself with my anomalies.

As I have done so, I have altered my diet and activity. I have gained understanding and compassion for others coping with difficulties. I have also learned to pay attention to my skin as an indicator of the need to balance and improve my life better. It is a great meter for how much stress I am under.

I have found that eating a good diet (including lots of fish - I have gained fishing as a hobby now) helps keep my skin under control. I avoid all stimulants (no chocolate, caffeine, etc.), I avoid nightshades, only fish and nuts for protein (although I have not learned to avoid cheese that well yet), no fried foods, no sugar (I do use raw honey), whole grains only, few or no processed foods. Menopause caused a flareup, but I am getting things back in order by living the healthy eating principles more strictly. I also make sure that I am outside as much as possible being active in the sunshine (I walk 3-5 miles a day). The side effect of a diet like this is lots of energy, and not being able to eat out at fast food restaurants very much.

I am careful to study all that is given to me by anyone now. I have learned that most natural oils help with the lesions but do not remove it. I have also learned that some remedies have a backlash effect, meaning that the psoriasis comes back worse than ever if you do not increase the dosage or usage (some drugs and remedies will do this and will cause any number of side effects from being sick all the time to sending the individual on an emotional rollercoaster in addition to causing birth defects if you are the child-bearing type). Do your own homework and decide about the risks you will take. I am currently trying out a Vitamin D.

I guess that's it for now. Thank you for this forum where no one is trying to sell me anymore snake oil! I am grateful I get to hear and explore some of the more natural ways of living and being healthy with my skin.

Hello!

My name is Elvi and I have psoriasis on my hands, feet, scalp, arms and legs. It is worst on my calves. Currently I am using corticosteroids but I have tried all sorts of horrendous forms of treatment - I wish my skin would normalise!

It started approximately five years ago when my husband and I started divorcing (he ran off with a woman - older unusually!), my daughter also took a job abroad around the same time and I felt totally alone after 27 years of marriage! The stress of this triggered patches on my scalp and hands but it soon spread to my feet, legs and arms. I ignored it for awhile in the stress of trying to find a new house, job etc but eventually I went to see a doctor, who sent me to this lovely dermatologist - she has prescribed me a cocktail of treatments over the last five years and so far nothing clears it completely - corticosteroids work when there is a crisis to get me back to a mild case.

I really would love your suggestions and solutions - I just want to wear dresses again and not feel so shy about it - I am 62 and should not have to feel shy about anything! SO PLEASSSEEE let me know or direct me to other threads with ideas that might help! I would be very appreciative!

This article published in The Journal of the European Academy of Dermatology and Venereology looked at the use of Bio treatments for psoriasis in the over 65s and found no differences in the risk association between young and the elderly.

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Background:
Psoriasis patients over 65 years-old (elderly) constitute a growing group, underrepresented in clinical trials, and likely to be more prone to adverse events.

Objective:
To describe safety of systemic psoriasis therapy in patients over 65 years-old compared to younger patients.

Methods:
Patients registered in Biobadaderm, a Spanish national registry of psoriasis patients treated with systemic therapy, were grouped in elderly (≥ 65 years old) and younger patients. Rates of adverse events were described by severity and type, and the risks compared in both groups, taking into account exposure to classic or biologic drugs, using Cox regression.

Results:
175 (9.8%) of 1793 patients were elderly. Overall risk of adverse events was not higher in elderly (drug group adjusted HR 1.09 (95%CI: 0.93-1.3)). Serious adverse events were more common in elderly (drug group adjusted HR 3.2 (95%CI: 2.0-5.1)). Age adjusted HR of all adverse events was lower for patients exposed to biologics compared to classic drugs in the whole sample (HR 0.7 (95%CI: 0.6-0.7)). Age did not seem to modify the effect of therapy (biologic vs. classic) in the risk of adverse events (likelihood ratio test for interaction, p = 0.12 for all adverse events, p = 0-09 for serious adverse events).

Conclusions:
Serious adverse events are more common in elderly patients, although they may be related to other variants that are associated with this age group and not due to the treatment itself. Use of biologics was associated with lower risk of adverse events in the whole group. We found no differences in this association between young and elderly. These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low.

Hi just made a mistake and another post was posted as me..it repeated the other post... It starts out I'm 37 year old and thought psoriasis was hereditary ... I hope it can be delegated!

Just getting the hang of this new site.

Any way I hope to get this straightened out. Sorry for the mistake.


I hope I haven't caused too much trouble.

Hi, I am the snorkel horse my name is Quest4Cure .
I have psoriasis and psoriatic p. Have a whole mixed bad. The plaque P. I've had since a child, it isn't quite as bad and palmoplanter P. Hand and feet are the worse . Also just this year developed Inverse P. So 4 out of 6 types of P . Sun shine helps this time of year for plaque . I just look like I have white freckles.
Palmoplanter It comes every winter like clock work . Water is my biggest enemy.. For Hands and feet. So sharing ideas and talking with others & sharing what they do to help control their P. Or palmoplantar. Or al types of P. PustularP and plaque P.

Thank goodness Derms have become better at treating this disease and better meds have come along the past few years.

My right hand had surgery last yr for one finger as it turned out it caused what they call the Keobler effect and and caused a flair from surgery causing all my fingers to curl and remain stiff. Has anyone else experienced the Keobler effect ?

I highly recommend a hand spa with wax to keep hands and feet moisturizers during cold dry winters.

Looking foreword to meeting new people and sharing experiences with living with P.
Thanks Quest4Cure

Hi
I've been on fumaderm for a year now and have reduced my dose from 2 tablets OD to 1 tablet once a day. We are trying every other day at the moment but it's starting to come back quite quickly.
Fumaderm has transformed me and my skin. It has had it's side effects but a very small price to pay and all manageable. I'm concerned what the long term implications will be, my dermatologist has said I can only be on it for 2 years and due to a lack of evidence for long term care I'm starting to feel a little anxious at it all returning again.
Has anyone been on it long term? Advise appreciated please
Charlotte x