This study from The Journal of Dermatology suggests male predominance in psoriasis may occur in Japan.

Quote:

---

Psoriasis is thought to be a multifactorial disease triggered by both genetic and environmental factors. The HLA-C locus on chromosome 6p21.33 remains the strongest susceptibility candidate locus in psoriasis.

The strong association between psoriasis and the HLA-Cw6 allele has been well documented in various races. It is known that psoriatic patients with early onset are more likely to be familial and associated with HLA-Cw6. Familial occurrence of Japanese psoriasis is smaller than other populations. Furthermore, males are predominant over females in Japanese psoriasis.

We investigated the relation between HLA-C alleles and age of onset, and in each gender for Japanese psoriasis, and discuss male predominance in the incidence of psoriasis in Japan. Four hundred forty six unrelated Japanese patients with psoriasis vulgaris and 557 sex- and age-matched unrelated Japanese healthy controls were investigated by genotyping.

We confirmed the association between early-onset type of psoriasis with HLA-C*06:02 allele in Japanese. In addition, we detected the association between the late-onset type of psoriasis and the HLA-C*12:02 allele in Japanese. No significant differences in allele frequency were observed between females and males.

Our results suggest that there is no genetic factor effect on male predominance in Japanese. In contract, the effect of environmental risk factors on the onset of Japanese psoriatic patients is stronger in males than in females. As a result, male predominant in psoriasis may occur in Japan.

This study in The Journal of Dermatology showed that biologic therapy ameliorates clinical symptoms and controls the immune response in patients with psoriasis.

Quote:

---

Therapy with monoclonal antibodies to tumor necrosis factor (TNF)-α and the interleukin (IL)-12/23 p40 subunit has significantly improved the clinical outcome of patients with psoriasis. These antibodies inhibit the effects of the target cytokines and thus the major concern during their use is the induction of excessive immunosuppression.

Recent studies evaluating the long-term efficacy and safety of biologic therapy in psoriasis have shown no significant appearance of serious adverse effects including infections and malignancies. However, the immunological consequence and the mechanism by which the blockade of a single cytokine by biologics can successfully control the activity of psoriasis remain unclear.

In the current study, we investigated the effect of biologic therapy on cytokine production of various lymphocytes and on the activity of monocytes and neutrophils in psoriatic patients. Neutrophils, monocytes and T cells were purified from heparinized peripheral venous blood by Ficoll density gradient centrifugation, and γ-interferon, TNF-α and IL-17 production from lymphocytes was measured by flow cytometer. The activation maker of neutrophils and the activated subsets of monocytes were also analyzed.

Biologic therapy induced no significant changes in the cytokine production by lymphocytes from the skin and gut-homing T cells. However, neutrophil activity and the ratio of activated monocyte population increased in severely psoriatic patients were normalized in psoriatic patients receiving biologic therapy.

The present study showed that biologic therapy ameliorates clinical symptoms and controls the immune response in patients with psoriasis.

This is a retrospective, single-centre study assessing all patients commenced on FAEs between October 2003 and July 2012.

Quote:

---

Background:
Fumaric acid esters (FAEs) have been used for over 30 years in the management of psoriasis.

Objectives:
To determine drug survival of FAEs in patients with psoriasis, treatment-limiting adverse drug events and the range of effective drug doses.

Methods:
A retrospective, single-centre study assessing all patients commenced on FAEs between October 2003 and July 2012. Demographic data, length of treatment, reasons for discontinuation of FAEs, side-effects and range of doses were recorded.

Results:
Two hundred and forty-nine patients [160 (64%) male] were included. The mean age at which FAEs were commenced was 44·5 years (range 17–82 years). The mean length of treatment was 28 months (range 1 week to 106 months). In patients who were commenced on FAEs ≥ 4 years before inclusion in this study, the 4-year drug survival was 60% (64/107). FAEs were discontinued in 146/249 patients (59%); this was due to lack of efficacy in 59/146 (40%) and gastrointestinal upset in 39/146 (27%). A very low dose of FAEs (< 240 mg daily) was successful in maintaining control of psoriasis in 26 (10%) patients. The mean treatment duration of these patients was 64 months (range 32–106 months).

Conclusions:
Fumaric acid esters have a 4-year drug survival rate of 60%, which compares favourably with reported 4-year survival rates of 40% for etanercept and adalimumab and 70% for infliximab. Longer drug survival is more likely in the significant subgroup of patients in whom a very low dose of FAEs is sufficient to control disease. The reasons for this are unclear.

Not one for me as I'm a professional couch potato, but some may find this piece interesting.

Quote:

---

Background:
Psoriasis is a common chronic multifactorial disease which can result in restrictions to social and recreational activities. Psoriasis subjects are at high risk to develop metabolic and cardiovascular diseases. Physical activity, a vital component in prevention and management of these diseases, is reported to be potentially associated in a negative way with psoriasis.

Objective:
To investigate the relationship between psoriasis and physical activity.

Materials and methods:
Anamnestic and physical examination as well as a specific doctor-administered questionnaire was performed to a group of 416 consecutive sportive subjects and 489 sex and age-matched controls. Moreover, similar investigations were executed on 400 consecutive psoriatic patients without psoriatic arthritis.

Results:
Psoriasis was significantly more common in controls respect to sportive group (n = 27, 5.4% vs. n = 7, 1.7%, P < 0.01) whereas a positive familial history of psoriasis was observed in similar percentages in both groups (n = 51, 10.2% vs. n = 40, 9.6%). The number of subjects performing sports activities was significantly lower in psoriasis group compared to controls (n = 44, 11% vs. n = 106, 21.3%; P < 0.001). Of these psoriatic patients, 35/44 referred that sporting activities showed a positive influence on the natural course of their disease, whereas the remaining 11 patients did not highlight positive or negative influences on their illness. Interestingly, 23.75% of psoriatic patients (n = 95) related that they had regularly carried out sporting activities before the onset of the dermatosis referring that psoriasis represented a huge obstacle to continue practicing physical activities.

Conclusion:
Our survey showed that regular physical activity may lower the risk of psoriasis and have a beneficial effect on the natural course of the disease, positively influencing not only the severity as well as the incidence of metabolic comorbidities, but also, through possible epigenomic, metabolic, anti-inflammatory and psycho-emotional effects, the onset of the dermatosis. However, larger birth cohort studies are needed to confirm these results.

Could be interesting for consulting a dermatologist,so copy under here.

Quote:

---

How to use teledermatology for psoriasis
Not everyone with psoriasis lives near a dermatologist. Sometimes work or family responsibilities can get in the way of maintaining regular appointments.
That's one place where the power of technology can help.
Teledermatology, the practice of consulting with a dermatologist online, continues to expand and is especially important for those with chronic conditions like psoriasis that require ongoing treatment, said Dr. April Armstrong, vice chair of clinical research and director of the psoriasis program at the University of Colorado School of Medicine in Denver.
How does teledermatology work?
There are two main ways that people can use teledermatology, said Armstrong – either by sharing photos (a practice called "store-and-forward") or "live interactive," which is more like a virtual appointment.
"In our practice, we've done both, and I find that most patients prefer live interactive," she said. "They can really talk with the doctor, and the doctor can pick up on non-verbal clues. If a patient has a question, they can ask right then."
To make the most of a teledermatology appointment, Armstrong also offers the following tips:
You must have Internet access and a camera.
If using "store-and-forward," be sure to send the best possible images. In some cases, a primary care physician may even work with you in their office to help you get the best photos.
Write down questions ahead of time.
Be open to technology. Telemedicine providers have to abide by the same legal privacy regulations as a doctor in an office.
How do I find a teledermatologist?
In 2012, there were 38 teledermatology offices in the U.S., according to the U.S. Teledermatology Survey. The trend is growing.
If you are interested in using teledermatology, but do not work with a dermatologist who uses this service, ask for a referral from your primary care provider, Armstrong said. The insurance reimbursement varies for teledermatology from state to state. Be sure both you and your provider’s office check with your state’s reimbursement policies.
There are also online sites where users can send photos to a board-certified dermatologist, such as AccessDerm. Armstrong cautions that if using an online site, visitors should check out the doctors' profiles to be sure they are working with a qualified provider.
In a paper published in March of 2014 in the Journal of the American Medical Association Dermatology, Dr. Carrie Kovarik writes that the Affordable Care Act could mean an increase in people using teledermatology appointments.
Already, patients often have to wait a month for dermatology appointments, writes Kovarik, associate professor of dermatology at the Hospital of the University of Pennsylvania and assistant professor of medicine. She goes on to explain that within the next two years, as more people receive access to health insurance, providers could be flooded with a whole new group of patients.

ok i know i'm supposed to say oh it's so easy to ditch the caffeine, sugar, alcohol and gluten but I am about ready to kill for some sugar right now - or a martini, or both.

Just. Say. NO.

Saw my Derm today. He wanted to do light box but copayments are cost prohibitive for me. He prescribed Soriatane and wants to see me in a month. Told me to continue with Topicals.
Just wondering if anyone here has tried this treatment and had success ?
Oh and the Derm had no comment when I asked him if he felt diet played a role in repairing immune system. But he doesn't make any $ if this clears up with improved diet ;-)

He confirmed I have a severe case of plaque and guttate psoriasis. I left his office content w his diagnosis and more determined than ever to completely eliminate all sugar, gluten, caffeine and alcohol for 90 days.

You are what you eat and toxins are permeating my intestinal wall and being absorbed by my blood (cropping up on my skin) instead of being eliminated by my body.

Just my opinion.

My nails have been really bad at times.
Crippling in fact..and very ugly.
For the past four years have eaten kiwi fruit and raw broccoli
Every day......seems to work wonders.

Any opinions on this......or other amazing fruit out there ?

Hello .my name is mark.north London.
I've had psoriasis for 25 years..
Would be good to talk to people who understand.

I know Fumaderm has the side effect of hot flushes - but im boiling and feel very itch ( like prickly heat ) is this normal????

Hi all. I had a very bad week full of bad flares. Friday night I simply couldn't take it any more. the plaques on my stomach and back were as thick as pancakes. My scalp and face were not. My next Dr appt is not until end of sept. I went to the ER and they put me on a 14 day taper of prednisone, some hydroxizine for the itch and naprosyn (prescription nsaid) for the back pain at L4-L5 which had come on suddenly and gotten worse over the last 5 days (i was questioning psoriatic arthritis). I was in a panic. Not knowing if I had now come down with shingles in addition to psoriasis ??? I didn't know what was going on but it was bad. My torso was on fire. Inflammed, itchy and very painful. My blood work was normal accept for being anemic which I find odd given the amount of healthy eating i have been doing last several weeks, in addition to supplments. My back xray showed no significant findings.

I had huge relief from the prednisone after 1st dose. pancake thick plaques were completely flat and redness is 90 percent gone after 3 doses and my skin is practically clear. I know prednisone is not a long term treatment but i am thankful to have short term relielf.

Best of all, I am able to get in to see a new (and hopefully) better dermatologist on Tuesday instead of waiting until September. The ER doc called on my behalf and insisted they squeeze me in. So, while I am not ready to give up on the hope that this can be brought under control through diet alone, I also realize that I can no longer suffer while I wait for my leaky gut to repair itself. I'm a bit depressed but in so much relief that I'm willing to go on methotrexate or whatever the dr. deems appropriate at this point given topical steroids did nothing for me.

and how has your weekend been, all?

I feel like I'm losing my mind. My arms, legs, face don't itch at all. My scalp, which used to be the worst, barely itches. My back itches a lot and my stomach - holy hockeysticks - It's driving me crazy. I am taking antihistamines to try and quiet the itch down but they don't seem to do much. I don't understand why some body parts that have plaques don't itch and others itch like crazy. No lotion or cream seems to keep my skin moist and every one of them burns when applied to my stomach.

This affliction is new to me so I'm still trying to understand the ins and outs. Bear with me!! I honestly don't even know for sure if I was correctly diagnosed. My dermatologist looked only at my elbow, not any other body part, didn't take a biopsy, didn't ask me any questions at all. I was in and out of his office in 5 mins after saying I think I might have psoriasis (after waiting months for an appointment). He threw 3 prescription creams at me and a few weeks later when I insisted he see me again because my scalp was on fire and the lesions on my body had tripled in size and in number, he threw a few more different steroid prescriptions at me and referred me to another dermatologist that I'm waiting months to get to see.

I don't know how people deal with this affliction without jumping out the window. I'm about ready to. Even if I wanted to go back to using the steroid topicals I would have to practically cover my entire torso and upper arms. Doesn't seem like a real good idea to have my body absorbing that much steroid.

What do you folks think????

Does anyone have any ideas on how to put lotion, etc on the places I can't reach in the middle of my back? I live alone

hi my name is Jessica and I have a friend that has severe psoriasis all over his body and we got onto the subject of me cooking for him and he told me to look up psoriasis diet so I did, I have a few friends that have it only a little so I started looking into what it is and what I can cook for him and what is beneficial to aid in not causing flare ups, I don't look at him as he expects me to or thinks im going to I don't judge by looks as I have weight issues and have had all my life and get judged for my looks with tattooes and lots of piercings. but I think if I can get more insight from people that have had to deal with ridicule and being shunned I can honestly be not just a friend but maybe more and find out what I can do to ease his symptoms. so any info or suggestions will greatly be appreciated

Hi folks,
new to this site but was wondering if anyone else has experienced my problem?

I have been on Stelara now for 18 months and it's a brilliant drug, I've gone from 75% body coverage to ZERO!!!
However, over the last 6 months, I have had 2 teeth snap, and, I've always had extremely strong teeth, also, 2 crowns that had been in place for 10 years or so, came lose as the roots developed cracks!
has anyone else experienced teeth problems whilst using this drug?

Here is a piece of news that may be the answer to finally differentiate between psoriasis and eczema, this could have a huge impact on early treatment for both patients.

Quote:

---

In many patients it is not easy to differentiate between the chronic inflammatory skin diseases psoriasis and eczema. Researchers at the Helmholtz Zentrum München and the Technical University of Munich (TUM) have now developed a procedure based on a skin analysis that enables an exact diagnosis to be made.

In some patients, the chronic inflammatory skin diseases psoriasis and eczema are similar in appearance. Up to now, dermatologists have therefore had to base their decision on which treatment should be selected on their own experience and an examination of tissue samples. A team of researchers at the Helmholtz Zentrum München and the Technical University of Munich (TUM) have now analyzed the molecular processes that occur in both diseases and discovered crucial differences. This has enabled them for the first time to gain a detailed understanding of the ways in which the respective disease process occurs. Building on this knowledge, the scientists, led by Dr. Stefanie Eyerich and Prof. Dr. Kilian Eyerich as well as Prof. Dr. Fabian Theis, have developed a diagnostic procedure which in practice enables psoriasis and eczema to be reliably differentiated from one another on the basis of only two genes.

“Both diseases have a highly complex appearance, which often varies widely from one patient to another,” says Dr. Stefanie Eyerich, who heads the Specific Immunology working group at the Institute of Allergy Research (IAF) at the Helmholtz Zentrum München. “This has led previous attempts to compare their molecular signature to fail.” In this study, the researchers identified 24 patients who were suffering simultaneously from psoriasis and eczema and in each analyzed at the molecular level the characteristic differences they demonstrated between psoriasis and eczema compared to clinically unremarkable skin.

“We were thus able to drastically reduce random genetic or environmental influences and gain a detailed picture of the development of these two diseases,” explains Prof. Fabian Theis of the Institute of Computational Biology (ICB) at the Helmholtz Zentrum München.

In recent years, many new specific treatments have been developed for psoriasis and eczema. However, in each case, these are only effective for one or other of the two diseases. And they are very expensive: one such treatment generally costs several tens of thousands of euros per year, per patient. The ability to make an exact diagnosis therefore has a considerable economic impact.

If it cannot be clearly determined on presentation which of the two diseases is involved, the newly developed diagnostic tool will help to differentiate them. It involves a test which compares samples of diseased and healthy skin and is concluded within one day. The researchers have now filed a patent application for it.

The procedure, moreover, marks the first step towards the introduction of personalized medicine also for chronic inflammatory skin diseases. “Whereas this is practiced increasingly in oncology, for example in the form of mutation analyses and the subsequent decision in favor of the best individual treatment option, it is not common in the case of inflammatory skin diseases,” says Kilian Eyerich of the Clinic and Polyclinic for Dermatology at the Technical University of Munich.

The researchers plan to purse this path with a view to characterizing even more precisely the molecular processes involved in inflammatory skin diseases and combining them with clinical information, such as the choice of certain treatments. In this way, their goal is to determine the best possible treatment option for each individual patient.

This is an early view before publication and it looks at the Clinical factors affecting quality of the response to Stelara (ustekinumab) for psoriasis.

Quote:

---

Ustekinumab has demonstrated efficacy for psoriasis. However, it is known that approximately 30% of patients have shown insufficient response.

The aim of the current study is to clarify the specific clinical factors that could be associated with response to ustekinumab treatment. We reviewed the medical records of all patients who were treated with ustekinumab. The Psoriasis Area and Severity Index (PASI) score was calculated, and the efficacy was evaluated at week 0 and week 16. The relationship between clinical efficacy and the patients’ background was investigated. The patients, who showed a <74% reduction in the PASI score, were classified as insufficient-responders. A total of 74 patients (average 60.3 years old, male to female ratio 54:20) were examined retrospectively. Eighteen patients were identified as insufficient-responders.

Each of the factors, body weight (BW) over 80 kg, body mass index (BMI) over 25, or smoking habit over 20 cigarettes/day showed a higher proportion of insufficient-responders compared with responders, although the difference was not statistically significant. Patients with previous exposure to biologics showed a significantly lower response to the treatment. Furthermore, a statistical difference was identified between patients with none of these factors and patients with some of these factors.

Our data suggest that some factors, such as high BW, high BMI, a smoking habit over 20 cigarettes/day, or exposure previous treatment with biologics are likely to affect the quality of the response to ustekinumab. Therefore, these factors need to be taken into account when ustekinumab is administrated.

i've gpt moderate psoriasis on body, severe on scalp.i have been drinking way too much past several months and believe this is the trigger. started the clean gut cleanse, giving up all caffeine, sugar processed foods - following it strictly. a week into this find that I have a bad rash on my stomach and back. could this be due to the supplements dr. junger recommends? I'm taking all of them. or perhaps it is the hemp powder in the shakes? help. i don't know what to do. i don't want to go back on topical steroids.

will this rash go away? any suggestions on what to eliminate, if anything and still stay on clean gut?

hi my name is Andrea i have had psoriasis for 40 yrs.its really bad at the moment i am thinking of having stelare can anyone give me some help pls help