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Psoriasis Club is a friendly on-line Forum where people with psoriasis or psoriatic arthritis
can get together and share information, get the latest news, or just chill out with others who understand. It is totally
self funded and we don't rely on drug manufacturers or donations. We are proactive against Spammers,
Trolls, And Cyberbulying and offer a safe friendly atmosphere for our members.
So Who Joins Psoriasis Club?
We have members who have had psoriasis for years and some that are newly diagnosed. Family and friends of those with psoriasis
are also made welcome. You will find some using prescribed treatments and some using the natural approach. There are people who
join but keep a low profile, there are people who just like to help others, and there are some who just like
to escape in the Off Topic Section.
Joining Couldn't Be Easier: If you are a genuine person who would like to meet others who understand,
just hit the Register button and follow the instructions.
Members get more boards and privileges that are not available to guests.
OK So What Is Psoriasis?
Psoriasis is a chronic, autoimmune disease that appears on the skin. It
occurs when the immune system sends out faulty signals that speed up the
growth cycle of skin cells. Psoriasis is not contagious. It commonly
causes red, scaly patches to appear on the skin, although some patients
have no dermatological symptoms. The scaly patches commonly caused by
psoriasis, called psoriatic plaques, are areas of inflammation and
excessive skin production. Skin rapidly accumulates at these sites which
gives it a silvery-white appearance. Plaques frequently occur on the
skin of the elbows and knees, but can affect any area including the
scalp, palms of hands and soles of feet, and genitals. In contrast to
eczema, psoriasis is more likely to be found on the outer side of the
joint.
The disorder is a chronic recurring condition that varies in severity
from minor localized patches to complete body coverage. Fingernails and
toenails are frequently affected (psoriatic nail dystrophy) and can be
seen as an isolated symptom. Psoriasis can also cause inflammation of
the joints, which is known as (psoriatic arthritis). Ten to fifteen
percent of people with psoriasis have psoriatic arthritis.
The cause of psoriasis is not fully understood, but it is believed to
have a genetic component and local psoriatic changes can be triggered by
an injury to the skin known as Koebner phenomenon. Various
environmental factors have been suggested as aggravating to psoriasis
including stress, withdrawal of systemic corticosteroid, excessive
alcohol consumption, and smoking but few have shown statistical
significance. There are many treatments available, but because of its
chronic recurrent nature psoriasis is a challenge to treat. You can find more information
Here!
Got It, So What's The Cure?
Wait Let me stop you there! I'm sorry but there is no cure. There are things that can help you
cope with it but for a cure, you will not find one.
You will always be looking for one, and that is part of the problem with psoriasis There are people who know you will be
desperate to find a cure, and they will tell you exactly what you want to hear in order to get your money. If there is a
cure then a genuine person who has ever suffered with psoriasis would give you the information for free. Most so called cures
are nothing more than a diet and lifestyle change or a very expensive moisturiser. Check out the threads in
Natural Treatments first and save your money.
Great so now what? It's not all bad news, come and join others at Psoriasis Club and talk about it. The best help is from accepting it and talking
with others who understand what you're going through. ask questions read through the threads on here and start claiming
your life back. You should also get yourself an appointment with a dermatologist who will help you find something that can
help you cope with it. What works for some may not work for others
Posted by: Fred - Fri-03-05-2013, 09:30 AM
- No Replies
Many people weigh themselves and track what they eat, but neurobiology professor Russell Poldrack studies himself in an in-depth way no one has done before in his quest to learn how a healthy brain functions daily.
His study consists of a weekly blood sample and two MRI scans per week paired with mood questionnaires, according to Poldrack. Poldrack said he also completes daily surveys measuring aspects such as sleep quality, diet and what happened that day. Poldrack said he began data collection in September 2012 and plans to publish his results in the fall.
Poldrack said he tracks the fluctuations of his psoriasis and has found that on days he recorded it being worse, the genes related to psoriasis are expressed more.
“Even though this is really preliminary, it starts to show us the kinds of stuff that we might be able to find,” Poldrack said. “The question is if we had enough data could we relate this back to brain function, too.”
There is no research on how brains change over a period of weeks and months, and because some disorders, including depression, fluctuate over this period, people with these disorders could get scanned regularly to measure which treatments work, Poldrack said.
One of Poldrack’s colleagues, Tom Schonberg, said that his research receives some criticism. “His colleagues try to plant the seeds of doubt and criticism all the time because when it’s out there scientifically, when he reaches the stage of trying to publish this, he’ll get criticism from all directions,” Schonberg said.
Poldrack said although it will be challenging to find people willing to participate, he wants to do the study on a large set of people. Poldrack said he may not have the funds to analyze a year’s worth of blood samples, which show how gene levels relate to what is happening in the body, because it costs $700 to analyze a week’s worth of blood.
“If we could find the money … then we could go back and do it,” Poldrack said. “It would be a really unique data set. I don’t know of any other data sets of a person who collected blood at the same time every week for such a long period of time.”
Posted by: Fred - Wed-01-05-2013, 15:19 PM
- No Replies
Attorney General Eric T. Schneiderman announced today that New York along with 35 other states reached an $11 million settlement with the drug manufacturer Amgen, Inc. The agreement resolves claims that the company inflated pricing data for six of its prescription drugs in a way that caused New York and the other settling states’ Medicaid programs to overpay for those drugs.
“There are no excuses for ripping off New York State taxpayers and defrauding our Medicaid programs,” Attorney General Schneidermansaid.“At a time when state budgets are already strained, I am committed to going after any company that rips off our taxpayers-no matter how big they are.With this settlement the message we are sending is clear: Biotechnology giants are not above the law and my office will continue to ensure that those who cheat the system are held accountable.”
The drug pricing data at issue in this settlement concerns the “Average Wholesale Price” (AWP) and “Wholesale Acquisition Cost” (WAC), benchmarks used by most states’ Medicaid programs, including New York, to set pharmacy reimbursement rates for pharmaceuticals dispensed to state Medicaid beneficiaries.New York and the 35 other states alleged that Amgen reported inflated AWP and WAC pricing data, thereby creating an artificially inflated “spread” between the price at which Medicaid providers dispensed the named drugs and the price at which the states reimbursed providers for the drugs. After creating the inflated spread, Amgen marketed that spread to Medicaid providers in order to boost Amgen’s sales of Aranesp, Enbrel, Epogen, Neulasta, Neupogen, and Sensipar.
This settlement was part of a larger investigation into allegations of illegal marketing practices, which included promoting the drugs for unapproved uses, and illegal kickbacks schemes by Amgen. The investigation resulted in a misdemeanor guilty plea in federal court by Amgen for introducing a misbranded drug into interstate commerce. The company has now paid a total of more than $647 million in damages related to the investigations, with New York’s Medicaid program recovering over $19.2 million of the money.
New York’s recovery pursuant to this national, multi-state settlement is $3.3 million.
In this instance, as in the previous settlements, New York lead a national team made up of state attorneys and analysts from California, Illinois, Indiana and North Carolina and worked through the National Association of Medicaid Fraud Control Units.
The New York team was headed up by Jay Speers, Counsel to the New York MFCU; Carolyn Ellis, Special Assistant Attorney General; Michael LaCasse, Chief Auditor for MFCU’s Civil Enforcement Division; Meghan Collins, Associate Special Auditor Investigator; Matthew Tandle, Senior Special Auditor Investigator; Karin Flynn, Associate Special Auditor Investigator; Colin Ware, Special Auditor Investigator and Nicholas Furnari, Computer Programmer Analyst. The team was supervised by Deputy Attorney General Monica Hickey-Martin, Director of the Medicaid Fraud Control Unit, and Executive Deputy Attorney General for Criminal Justice Kelly Donovan.
Posted by: Fred - Tue-30-04-2013, 19:52 PM
- No Replies
Ipsos Healthcare, the global healthcare division of Ipsos, has announced the launch of Ipsos Healthcare SEES (Syndicated Expert Ethnographic Studies). The disease-specific studies will bring to life the day-to-day challenges of living with a chronic disease.
Beginning with Psoriatic Arthritis (SEES PsA), the studies will reveal the patient perspective in 3 core areas: quality of life (lifestyle, coping mechanisms); medication (regimen, tolerance, compliance); and pathway to diagnosis (HCP interaction, time lapse). Initially available in the UK, France, Italy, Spain and the US, they will be delivered in collaboration between the disease experts from Ipsos Healthcare’s Global Therapy Monitors teams, and the anthropologically-trained researchers from Ipsos’ Ethnography Centre of Excellence.
Ipsos Healthcare SEES brings together the patient perspective offered by ethnography with the Global Therapy Monitors’ quantitative view of the market and physician perceptions; in doing so, it can help pharmaceutical and biotech companies identify wider patient-level and market opportunities. Subscribers will gain ongoing understanding through access to a searchable database of patient video footage, in addition to customised reports.
Commented Rhoda Schmuecking, President of Global Therapy Monitors, Ipsos Healthcare:
“Living with a chronic disease means constantly adapting to all aspects of life. Ipsos Healthcare SEES can help us to understand patients’ needs and motivations for seeking treatment, their true compliance versus stated levels, and the involvement of patients in their treatment decisions. This understanding can guide every articulation of a pharmaceutical or biotech company’s product value, from doctor detailing and conference material to employee education and patient support.”
Added Victoria Guyatt, Deputy Head of Ethnography, Ipsos UU:
“Ultimately, ethnography has the power to change the way the pharma / biotech industry views patients, putting them at the centre of decision-making.”
Source: NO LINKS ALLOWED
*Ipsos is a global independent market research company ranking third worldwide among research firms. They specialize in six areas: advertising research; marketing research; media, content and technology research; loyalty, quality and customer relationship management research; opinion polls and social research; and survey management, data collection and delivery.
Posted by: Fred - Mon-29-04-2013, 22:14 PM
- No Replies
This study published in The British Journal of Dermatology suggests clinicians should avoid intermittent treatment with Infliximab (Remicade) for psoriasis.
Background:
Continuous maintenance therapy with infliximab 5 mg/kg every 8 weeks is effective for moderate-to-severe plaque-type psoriasis.
Objective:
This study evaluated efficacy and safety of continuous versus intermittent infliximab maintenance therapy.
Methods:
RESTORE2 was a long-term extension of RESTORE1. At baseline of RESTORE2, eligible patients who had received infliximab for 26 weeks and achieved Psoriasis Area and Severity Index (PASI) 75 in RESTORE1 were re-randomised 1:1 to continuous therapy (infliximab 5 mg/kg every 8 weeks) or intermittent therapy (no infliximab until >50% loss of PASI improvement). Safety and efficacy assessments occurred throughout the study.
Results:
222 patients were randomised to receive continuous therapy; 219 to intermittent therapy. Numerically more serious infusion-related reactions occurred with intermittent therapy (8/219 patients, 4%) than continuous therapy (1/222 patients, <1%), leading the sponsor to terminate the study. Mean duration of exposure to infliximab was 40.12 weeks (SD = 27.55,) with a mean of 5.8 infusions (range, 0–16) for continuous therapy and 22.78 weeks (SD = 22.98) with a mean of 3.4 infusions (range, 0–16) for intermittent therapy. Although no formal efficacy analyses were conducted, continuous therapy led to numerically greater PASI 75 at week 52 in the continuous group (81/101, 80%) than in the intermittent group (39/83, 47%); several other efficacy measures demonstrated similar patterns.
Conclusions:
For patients with moderate-to-severe plaque-type psoriasis, continuous therapy with infliximab may be more effective than intermittent therapy. The incidence of serious infusion-related reactions in the intermittent group suggests that clinicians should avoid intermittent therapy in this population.
Posted by: Fred - Mon-29-04-2013, 19:29 PM
- No Replies
Do you, or have you used Oat Baths to help with psoriasis? If so ********** would like to hear from you for their new ground-breaking programme exploring the world of alternative medicine, health and beauty.
They are looking for people who are using an unusual homemade remedy for health and beauty purposes. Across the nation, people are taking health and beauty matters into their own hands. More and more people are treating themselves at home, using all sorts of regular household products in unexpected ways to try and treat ailments or boost their wellbeing.
They are particularly interested in talking with psoriasis patients who use or have used oat baths as a successful treatment for psoriasis.
If you do use this treatment and would like to chat further, you can talk to ************
Please mention Psoriasis Club, and feel free to post on this thread how you got on.
EDIT by Fred: I have been going through some of these types of threads and although they promise to come back and talk to us about the program, they never do. So they obviously want free traffic from this website to theirs, and from now on I will not allow any posts for recruitment to TV programs.
I have also removed any mentions or links to the relevant program, as Psoriasis Club is not here to promote a TV production company.
I'm about to start taking ciclosporine for moderate/severe guttate psoriasis. Recreational drugs (in moderation) have never had too bad effects on my psoriasis. I'm really worried that certain ones might have an interaction with ciclosporine, and I cant find any information anywhere. I'm about to finish my degree and really dont want to have to worry about what I'm putting into my body for just two weeks, so I was wondering if anyone on here could help.
Sorry if I've offended anyone.
Posted by: Fred - Fri-26-04-2013, 13:33 PM
- No Replies
Background:
Chronic plaque psoriasis is frequently associated with metabolic disorders including obesity. Antitumour necrosis factor α treatments can induce body-weight increase in patients with psoriasis. Information on the effect of ustekinumab (Stelara) on body weight is not available.
Objectives:
To investigate whether therapy with ustekinumab (Stelara) is associated with changes in body mass index (BMI) in patients with chronic plaque psoriasis.
Methods:
A prospective, multicentre study comparing the changes in BMI in two closed cohorts of patients with psoriasis during 7-month treatment with ustekinumab (Stelara) (n = 79) or infliximab (Remicade) (n = 83).
Results:
Patients treated for 7 months with infliximab (Remicade) showed a significant (P < 0·001) increase in mean BMI (2·1 ± 4·5%) and body weight (2·5 ± 3·3 kg) compared with patients treated with ustekinumab (Stelara) (0·1 ± 3·3%; 0·6 ± 1·1 kg). Some 45% of patients treated with infliximab (Remicade) had a BMI increase > 2%, compared with only 11% of those receiving ustekinumab (Stelara) (P = 0·01). In the multivariate analysis, all other clinical parameters predicted the BMI increase, except for the use of infliximab (Remicade). At month 7, 96% of patients treated with infliximab (Remicade) and 82% of patients treated with ustekinumab (Stelara) achieved at least a 50% improvement from their baseline psoriasis area and severity index (PASI 50), and 69% of the infliximab (Remicade) group compared with 58% of the ustekinumab (Stelara) group achieved at least PASI 75. There was no difference in the proportion of PASI 50 and PASI 75 responders between the two groups.
Conclusions:
In contrast to infliximab (Remicade), ustekinumab (Stelara) does not increase BMI in patients with chronic plaque psoriasis. This difference could be taken into account in the selection of biologics when treating patients with psoriasis.
Source: NO LINKS ALLOWED
Damn and I thought I could blame Stelara for my weight increase.
Posted by: Fred - Fri-26-04-2013, 13:23 PM
- No Replies
Background:
Nail psoriasis is common in patients with psoriasis and can seriously affect their quality of life. Current treatments are limited and there is no standard course of therapy.
Objectives:
To assess the efficacy and safety of etanercept (Enbrel) on nail psoriasis in patients with moderate-to-severe psoriasis.
Methods:
Patients with moderate-to-severe plaque psoriasis, who had previously failed at least one form of systemic therapy for nail psoriasis, were randomized to receive open-label Enbrel 50 mg twice weekly (BIW) for 12 weeks followed by once weekly (QW) for 12 weeks (BIW/QW group) or Enbrel 50 mg QW for 24 weeks (QW/QW group). The primary endpoint was the mean improvement in the Nail Psoriasis Severity Index (NAPSI; score range 0–8) over 24 weeks in the target fingernail with the most severe abnormalities.
Results:
Seventy-two patients received one or more doses of Enbrel (38 BIW/QW; 34 QW/QW) and 69 patients were included in the modified intent-to-treat population. At baseline, mean (standard error) target fingernail NAPSI score was 6·0 (0·3) in the BIW/QW group and 5·8 (0·3) in the QW/QW group. At week 24, mean target fingernail NAPSI score had decreased significantly by −4·3 [95% confidence interval (CI) −4·9 to −3·7; P < 0·0001] in the BIW/QW group and by −4·4 (95% CI −5·0 to −3·7; P < 0·0001) in the QW/QW group. Improvement in NAPSI showed significant correlation with Psoriasis Area and Severity Index improvement. Enbrel was well tolerated with no unexpected safety findings.
Conclusions:
Both Enbrel regimens were effective at treating nail psoriasis in this patient population.
Posted by: Fred - Fri-26-04-2013, 13:14 PM
- No Replies
Before starting an anti-TNF treatment for psoriasis patients should always have a TB test. This study compared the different tests available, (TST) tuberculin skin test, (QFR) QuantiFERON®-TB Gold In-Tube, and (TSTB) T-SPOT.TB.
Background:
Targeted biological therapies have transformed the treatment of chronic inflammatory disease. However, reactivation of latent tuberculosis infection (LTBI) is a significant risk with the use of antitumour necrosis factor (anti-TNF)-α therapy and screening is mandatory prior to treatment. The tuberculin skin test (TST) may be difficult to interpret in patients with inflammatory disease or receiving immunosuppressive therapies.
Objectives:
The aim of this study was to evaluate and compare the QuantiFERON®-TB Gold In-Tube (QFR) and T-SPOT.TB (TSTB) interferon-γ-release assays (IGRA) against the TST in a cohort of patients commencing anti-TNF-α therapies for chronic inflammatory disease.
Methods:
A prospective cross-sectional study was undertaken at a London tertiary referral centre. Demographic data collected included TB risk factors. TST, QFR and TSTB were performed in all patients.
Results:
Seventy patients with chronic plaque psoriasis were included in the study. Agreement between QFR and TSTB, excluding indeterminate results, was 89% (κ = 0·567), between QFR and TST 85% (κ = 0·313) and 81% (κ = 0·244) between TSTB and TST. There was no significant association with concomitant immunosuppression and either TST or IGRA results. Seven patients received chemoprophylaxis for LTBI diagnosed after clinical risk assessment together with positive TST and/or IGRA. Three patients had positive results in all three tests.
Conclusions:
While there was moderate overall agreement between QFR and TSTB and fair correlation between TST, QFR and TSTB, there were a number of discordant results, suggesting that a three-pronged approach using TST, QFR and TSTB may be of additional benefit.
Posted by: Fred - Fri-26-04-2013, 12:59 PM
- No Replies
Background:
Ustekinumab (Stelara) is a fully human anti-p40 monoclonal antibody which neutralizes interleukin (IL)-12 and IL-23, thereby interfering with T-helper (Th)1/Th17 pathways and keratinocyte activation, and is highly effective in the treatment of psoriasis. During ustekinumab treatment, some of our patients noticed reduced koebnerization of noninvolved skin and less new plaque formation.
Objectives:
To determine whether ustekinumab improves psoriasis-related gene expression and tape-strip responses in noninvolved skin.
Methods:
Before and 4 weeks after ustekinumab treatment, noninvolved skin was tape-stripped. After 5 h, biopsies were taken from untouched and tape-stripped skin. The mRNA expression of psoriasis-related markers such as NGF, GATA3 and IL-22RA1, and several antimicrobial peptides (AMP) was quantified. Leucocyte counts and a broad range of inflammatory serum proteins were analysed to gain insight into the systemic alterations.
Results:
Four weeks following a single ustekinumab injection, NGF showed a significant decrease, whereas GATA3 and IL-22RA1 expression increased, indicative of reduced responsiveness to epidermal triggering. This was accompanied by an increase of the inflammation-related serum proteins GPNMB, MST1 and TRADD. The baseline and tape-strip-induced mRNA expression of the AMP human β-defensin-2 (hBD-2), S100A7 and LL-37 remained unaltered. Clinically, after 4 weeks, eight out of 11 patients showed a 50% psoriasis area and severity index (PASI) improvement, which was accompanied by a significant reduction in serum hBD-2 levels. No changes were noted in total leucocytes, C-reactive protein and erythrocyte sedimentation rate.
Conclusions:
These findings indicate that ustekinumab reduces psoriasis-related gene expression in noninvolved psoriatic skin, making it more resistant to exogenous triggering, without disturbing its antimicrobial response. In parallel, ustekinumab modulates important circulating inflammation-related proteins.
Posted by: Fred - Fri-26-04-2013, 12:51 PM
- No Replies
Background:
Psoriasis is a chronic, inflammatory skin condition associated with a high frequency of cardiovascular events. Modifications of plasma lipids, and an increase in the levels of biochemical markers of inflammation and lipid peroxidation have been reported in subjects with psoriasis, suggesting a relationship between psoriasis, inflammation and oxidative damage.
Objectives:
To investigate whether modulation of inflammatory activity by tumour necrosis factor-α inhibitors in patients with psoriasis is associated with modification of lipid profiles, oxidative stress and paraoxonase (PON)1 activity.
Methods:
The levels of plasma lipids and lipoprotein(a), and the levels of the markers of inflammation and lipid peroxidation were evaluated in subjects with psoriasis (n = 23) before and after 24 weeks of treatment with etanercept (Enbrel). In the same subjects plasma total antioxidant capacity and the activity of PON1, an antioxidant and anti-inflammatory enzyme associated with the high-density lipoproteins (HDLs), were investigated.
Results:
The results showed that clinical improvement in patients with psoriasis treated with etanercept (Enbrel) is associated with a reduction in the levels of inflammatory markers [C-reactive protein (CRP)] and lipid peroxidation, and also with increased antioxidant capacity in the serum of patients with psoriasis. These modifications are associated with a significant increase in the activity of PON1. A significant increase in the PON1/CRP ratio has also been observed in patients with psoriasis after treatment. The significant inverse correlation between CRP and PON1 activity suggests a relationship between PON1 activity and inflammation.
Conclusions:
Treatment with etanercept (Enbrel)is associated with a reduction in lipid peroxidation and an improvement in HDL antioxidant and anti-inflammatory properties.
Source: NO LINKS ALLOWED
* Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage and can cause disruptions in normal mechanisms of cellular signalling.
Posted by: Fred - Fri-26-04-2013, 12:36 PM
- No Replies
The majority of people with psoriasis have localized disease, where topical therapy forms the cornerstone of treatment. We set out to summarize evidence on the relative efficacy, safety and tolerability of different topical treatments used in plaque psoriasis.
We undertook a systematic review and meta-analyses of randomized trial data of U.K.-licensed topical therapies.
The primary outcome was clear or nearly clear status stratified for trunk and limbs; and scalp.
Network meta-analyses allowed ranking of treatment efficacy. In total, 48 studies were available for trunk and limb psoriasis, and 17 for scalp psoriasis (22 028 patients in total); the majority included people with at least moderate severity psoriasis.
Strategies containing potent corticosteroids (alone or in combination with a vitamin D analogue) or very potent corticosteroids dominated the treatment hierarchy at both sites (trunk and limbs, scalp); coal tar and retinoids were no better than placebo.
No significant differences in achievement of clear or nearly clear status were observed between twice- and once-daily application of the same intervention or between any of the following: combined vitamin D analogue and potent corticosteroid (applied separately or in a single product), very potent corticosteroids, or potent corticosteroids (applied twice daily).
Investigator and patient assessment of response differed significantly for some interventions (response rates to very potent corticosteroids: 78% and 39%, respectively). No significant differences were noted for tolerability or steroid atrophy, but data were limited.
In conclusion, corticosteroids are highly effective in psoriasis when used continuously for up to 8 weeks and intermittently for up to 52 weeks. Coal tar and retinoids are of limited benefit.
Posted by: Fred - Thu-25-04-2013, 12:04 PM
- Replies (3)
There has recently been three letters published in The New England Journal Of Medicine about the use of fumarates which is used to treat psoriasis. Letters 1 & 2 by GPs are reports on 2 patients diagnosed with progressive multifocal leukoencephalopathy (PML) as a result of using fumarates, letter 3 is a Manufacturer's Response to these letters.
*PML (progressive multifocal leukoencephalopathy) is a rare and usually fatal viral disease characterized by progressive damage or inflammation of the white matter of the brain.
Quote:Letter #1 by Ummehan Ermis, Joachim Weis, M.D. Jörg B. Schulz, M.D. Rheinisch–Westfälische Technische Hochschule Aachen, Aachen, Germany.
Fumaric acid is considered effective and safe in the treatment of psoriasis vulgaris and is licensed for this use in Germany. We diagnosed progressive multifocal leukoencephalopathy (PML) in a 74-year-old man who had received monotherapy for psoriasis with oral fumaric acid for 3 years (2007 through 2010) in doses of up to 120 mg of dimethyl fumarate and 95 mg of monoethyl fumarate, each taken two times a day. The patient had had psoriasis for more than 5 years and had been treated topically with glucocorticoids (January through May 2005) and orally with acitretin (maximum dose of 50 mg once daily, May 2005 through June 2006) and methotrexate (maximum dose of 22.5 mg once weekly, July 2006 through July 2007). In July 2010, progressive sensory aphasia developed. Magnetic resonance imaging (MRI) of the brain and positive results on polymerase-chain reaction (PCR) assays for the JC virus in the cerebrospinal fluid (CSF) (90 copies per milliliter) and brain tissue (88,800,000 copies per microgram of DNA) led to the diagnosis of PML.
A differential blood count revealed grade 3 lymphocytopenia, retrospective analysis revealed that the lymphocytopenia had reached grade 3 status within 1 year after the initiation of treatment with fumaric acid. Although it was the manufacturer's recommendation to discontinue treatment with fumaric acid in patients with severe lymphocytopenia, treatment was continued in this patient until the diagnosis of PML was made 2 years later.
Before implicating fumaric acid–associated lymphocytopenia as the probable cause of immunodeficiency, we ruled out other causes of immunodeficiency and cancer. Flow-cytometric immunophenotyping of peripheral blood and bone marrow aspirate did not reveal any myelodysplastic syndrome. Tests for markers of paraneoplastic tumors were negative, and computed tomographic scans of the chest, abdomen, and pelvis were normal. PCR assays of the CSF for neurotropic viruses were negative, as were the results of HIV testing. At the time of diagnosis, the only other medication the patient was taking was tamsulosin, for the treatment of prostate hyperplasia.
When PML was diagnosed in August 2010, fumaric acid was discontinued and treatment with mefloquine and mirtazapine was started. Within 5 weeks, an immune reconstitution inflammatory syndrome (IRIS) developed, manifested by clinical worsening and detected in areas of enhancement on MRI of the brain after the administration of gadolinium Methylprednisolone was administered at a dose of 500 mg per day for 5 days.
In January 2011, MRI studies revealed regression of T2-weighted hyperintensities, with almost complete absence of gadolinium enhancement. The patient's condition had improved despite the persistence of a marked sensory aphasia syndrome. PCR assays for the JC virus in the CSF and plasma were now negative.
Fumarate, unlike other immune-based therapies that may cause PML (e.g., rituximab, natalizumab, efalizumab, and infliximab), does not belong to the monoclonal antibody family. Although this patient may have been at higher risk for PML for other reasons, long-term treatment with fumarate was probably an important factor in its development, given the unrevealing evaluation for other causes of immune deficiency, the induction of an IRIS with 5 weeks after the withdrawal of fumarate, and the patient's clinical improvement and survival after a follow-up of more than 2 years. Similar to treatment with natalizumab,3 long-term treatment with fumaric acid and prior treatment with other immunosuppressants may have increased this patient's risk of PML.
Letter #2 by Bob W. van Oosten, M.D., Ph.D, Joep Killestein, M.D., Ph.D, Frederik Barkhof, M.D., Ph.D, Chris H. Polman, M.D., Ph.D, Mike P. Wattjes, M.D. VU University Medical Center, Amsterdam, the Netherlands.
Preparations containing various mixtures of fumaric acid esters are prescribed for psoriasis in several countries, in many cases for off-label use, and are regarded as safe. One such preparation is enteric-coated, slow-release Psorinovo (compounding pharmacy, Mierlo-Hout), in which the active agent is dimethyl fumarate and in which copper gluconate was used as an additive until 2010.
On November 5, 2012, a 42-year-old woman who reported having progressive right-sided hemiparesis since May consulted us for a second opinion. She had been given a diagnosis of possible multiple sclerosis in September and at that time received 3000 mg of intravenous methylprednisolone over 3 days, without effect. Her medical history was notable for psoriasis, for which she had been taking 420 mg of Psorinovo per day since 2007, supplemented by 1000 mg of calcium ascorbate per day and EPA-1000 fish oil capsules (EPA denotes the omega-3 fatty acid eicosapentaenoic acid).
Sequential magnetic resonance imaging (MRI) scans of the brain showed small, deep white-matter lesions and one large progressive lesion, which was suggestive of progressive multifocal encephalopathy (PML), as described in a study of imaging findings in relation to PML resulting from treatment with monoclonal antibodies. Hematologic studies revealed lymphopenia, with a count of 200 lymphocytes per cubic millimeter (normal range, 600 to 2900). We realized in retrospect that the lymphopenia had developed after the initiation of treatment with Psorinovo. The patient was seronegative for HIV, but a semiquantitative, real-time polymerase-chain-reaction (PCR) assay of a specimen of the cerebrospinal fluid was positive for the JC virus.
We made a diagnosis of PML, stopped treatment with Psorinovo on November 7, and then started treatment for PML with mefloquine and mirtazapine.
Initially, the hemiparesis remained progressive, even though the lymphopenia began to abate. On December 7, we noticed signs of an immune reconstitution inflammatory syndrome (IRIS) on MRI, with indications becoming more evident on December 13. We initiated treatment with intravenous methylprednisolone. Her clinical condition stabilized in early January 2013, and we observed the first signs of recovery on January 31.
We believe that treatment with Psorinovo contributed to the development of PML in our patient. First, lymphopenia developed during treatment with Psorinovo and is a well known side effect. Second, our patient had used no immunosuppressive medication before the onset of PML, and she was seronegative for HIV. Finally, the occurrence of IRIS after the discontinuation of Psorinovo argues in favour of a causal link.
We think this case report is of special relevance since preparations of fumaric acid esters, including dimethyl fumarate, are emerging drugs that may have a broader range of therapeutic indications in the near future.
Letter #3 by Marianne T. Sweetser, M.D., Ph.D, Katherine T. Dawson, M.D, Carmen Bozic, M.D. Biogen Idec, Cambridge, MA
In the letters from Ermis et al. and van Oosten et al. published in this issue of the Journal, progressive multifocal leukoencephalopathy (PML) is reported in two patients with psoriasis who were being treated with Fumaderm (Biogen Idec) or a compounded version of fumaric acid esters (FAEs) referred to as Psorinovo (compounding pharmacy, Mierlo-Hout). Compounded FAEs and other compounded products are not approved by regulatory authorities and may be associated with risks. Fumaderm, an approved, fixed-combination product, contains four active ingredients: dimethyl fumarate and three monoethyl hydrogen fumarates (calcium, magnesium, and zinc salts). The compounded product Psorinovo contains dimethyl fumarate and may also contain other ingredients, such as copper monoethyl fumaric acid. In the two case reports, both patients had severe lymphopenia for prolonged periods — 2 and 5 years, respectively — before receiving a diagnosis of PML.
There are two additional reports of PML in patients with psoriasis who were treated with Fumaderm and had significant confounding factors for PML. In one patient with a history of sarcoidosis that was treated with methotrexate and steroids, PML was diagnosed after 1 month of exposure to Fumaderm. The other patient had been treated with efalizumab and received a diagnosis of cancer. Efalizumab was stopped, and the patient subsequently began treatment with Fumaderm for psoriasis. Sarcoidosis, cancer, and efalizumab are known risk factors for PML. Overall, there have been a total of four reports of PML in patients with psoriasis who were treated with fumarates — three with Fumaderm and one with compounded FAEs.
Fumaderm is an oral medication that is widely prescribed for the systemic treatment of moderate-to-severe plaque psoriasis. Its safety profile has been assessed in 19 years of postmarketing surveillance and physician experience, since its approval in Germany. Its efficacy and safety have been comprehensively reviewed, and the results of a large retrospective study of long-term therapy with Fumaderm have been published. Although decreased levels of lymphocytes are commonly observed in patients receiving Fumaderm, severe lymphopenia occurs in 3% of patients, and it is likely that prolonged and severe lymphopenia occurs even less frequently. Compounded FAEs have been used for psoriasis, but they are unregulated, and the exact composition, quality, and safety of these compounds, and the number of patients who have been exposed to them, are unknown.
On the basis of more than 180,000 patient-years of experience with Fumaderm, reports of PML are rare. In the two patients reported by Ermis et al. and van Oosten et al., Fumaderm or compounded FAEs may have contributed to the development of severe and prolonged lymphopenia. Severe lymphopenia is a risk factor for PML6 and can be mitigated through the periodic monitoring of lymphocytes.
In BG-12 (Biogen Idec), a product recently approved in the United States for the treatment of relapsing forms of multiple sclerosis, the only active ingredient is dimethyl fumarate. In the clinical program for BG-12, more than 2600 patients with multiple sclerosis have been treated for periods of up to 4 years or more, with a median follow-up of approximately 2 years. BG-12 is associated with a reduction in mean lymphocyte counts of approximately 30% from baseline. Among patients treated with BG-12 to date, there has been no evidence of an increased risk of serious or opportunistic infections, and no reports of PML.
Overall, fumarates are distinct products with different active ingredients, metabolites, and formulations, and they are used in different populations with varying coexisting conditions. These factors may lead to important differences in the safety profiles among the various products.
All these letters were found in The New England Journal Of Medicine [web]https://www.nejm.org[/web]
Basically, this semester has been a bust. I've had Psoriasis pretty bad the whole time. I could care less if I blow off any other girl on hanging out, which usually turns into sex, because I don't have any interest in them. This girl though, I can not blow off. She wants to hang out TOMORROW and she's already mentioned us getting together. I can't just tell this gorgeous girl I have a bunch of psoriasis all over and that's why I cant have sex or even chill, but that is the only thing holding me back. I'm so stuck. If I blow her off, I will most definitely miss my opportunity not only just to hook up, but to actually just hang out with this chick. So I guess I'm going to figure it out tomorrow the hard way. I just needed to tell someone who understands... wish me luck.
Posted by: Fred - Tue-23-04-2013, 11:39 AM
- No Replies
Human Leukocyte Antigens B (HLA-B) is a human gene that provides instructions for making a protein that plays a critical role in the immune system.
Background:
Up to now, there is no consensus conclusion about the association between psoriasis and HLA-B.
Objectives:
To clarify the association between psoriasis and HLA-B.
Methods:
Articles were selected, following the predefined criteria, from the case-control studies on the association between psoriasis and HLA-B that were published from January 1, 1972 to November 11, 2012 and were included in pub med and ISI Web of Knowledge databases.
Results:
Thirty-seven eligible articles covering 16,206 participants (14,644 Caucasian and 1,562 Asian) were included. Altogether sixty HLA-B alleles were reported, among which twenty-six were susceptible, twenty-four were protective, and ten were un-associated. For unspecific psoriasis (UPs), there were three strongly susceptible alleles (OR ≥ 3.0) in Caucasian and four in Asian, with HLA-B*57 and HLA-B*13 common to both races; there were four strongly protective (OR ≤ 0.3) alleles in Caucasian and seven in Asian, with HLA-B*07 common to both. For psoriasis vulgaris (PsV), nine alleles were strongly susceptible in Caucasian and five were in Asian, with HLA-Bw*37 and HLA-B*57 in both; three alleles were strongly protective in Caucasian, and one in Asian, with none in common. Psoriatic arthritis (PsA) and psoriasis guttate (PsG) cases were reported only in Caucasian, with eight and seven strongly susceptible alleles in each, as well as two and three strongly protective alleles in each. Analyses of onset age showed praecox patients with family history were significantly more susceptible to HLA-B*13 and HLA-B*57 alleles than tardive ones.
Conclusions:
A significant association was identified between psoriasis and fifty HLA-B alleles. The association varied in terms of different races, clinical types and onset ages of psoriasis.
Posted by: KLBolton - Tue-23-04-2013, 10:26 AM
- Replies (4)
Hi,
I suffer from psoriasis on chest and stomach, my back and in my hair. I no I should consider myself lucky as I do not have it as bad as some people and I am mostly able to cover it up. However it's currently got worse all over I use to just have spots which are now joining to small patches and is beginning to scar.
I have a few things i hope to find advice on and any advice is very much welcome and appreciated:
1) the flakes of dry skin I often pick off is this the right or wrong thing to do, could this be why it's scaring?
2) any advice to remove or treat the scars
3) I was advices to use Johnsons shampoo and head and shoulders between my medicated shampoo, are there any other unmediated shampoos I can use
4) I currently use dovobet on my chest and back it does clear it but it comes back the next day and the doctor tells me there is no other ointment as I've tried everything, are there other creams ?
Posted by: KLBolton - Tue-23-04-2013, 09:30 AM
- Replies (3)
Hello everybody, I just found the forum and look forward to getting to no some new people. I live in England, Cheshire. I have recently turned 18 and have had psoriasis a short time of 5 years. I don't no anyone who has psoriasis so don't really have anyone to talk to, I have a boyfriend but I don't think he understands psoriasis although he tries, so I thought I'd try something new.
Posted by: acaseas - Sun-21-04-2013, 08:51 AM
- Replies (5)
hi i started having Psoriasis last year on my scalp only...i asked my neighbor about this for my mother told me we have common disease....my neighbor look on my scalp to see if its alike with her and yes were both the same...she told me about dermobate a clobetsol cream to help lessen this dandruff like on my scalp....but unfortunately this doesnt work and it got worst...this past 2 months i have on my body this itchy scaly on my skin....i went to a dermatolgy ang she recomended me to use mineral oil before bathing tar shampoo during a bath and betnovate scalp solution after bath and continue clobetasol cream on my skin...but this doesnt work....i want a help to relieve this...im not comfortable with this...also i am a breastfeeder mom is it ok to breastfeed my 2 yr old son??
Posted by: Gquik - Fri-19-04-2013, 01:07 AM
- Replies (4)
hello to all, found the forum this evening.i have psoriasis since i was 6yo, iam 30 now.been trying so many things,at the moment i am covered pretty much but i hope to be clean soon.i am from croatia, europe,in my country there are lot of people with psoriasis and arthritis. sad but true.keep the faith all you out there
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How many people have Psoriasis?
In 2012 there were approximately 36.5 million prevalent cases of psoriasis, and by 2022, GlobalData epidemiologists forecast that this figure will reach approximately 40.93 million.
The condition affects individuals of both sexes and all ethnicities and ages, although there is a higher prevalence of psoriasis in the colder, northern regions of the world.
The prevalence of psoriasis in the central region of Italy is 2.8 times greater than the prevalence in southern Italy.
Caucasians have a higher prevalence of psoriasis compared with African-Americans, but African-Americans in the US tend to suffer from a more severe form of the disease.