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.

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.

Source: NO LINKS ALLOWED

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.

Source: NO LINKS ALLOWED

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.

Source: NO LINKS ALLOWED

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.

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.

Source: NO LINKS ALLOWED

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.

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.

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.

Source: NO LINKS ALLOWED

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 ?

Thankyou

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.

Don't really no what else to say except hello

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??

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

Hey everyone i've just started clinical trials for 2 new meds, one is a tablet and the other one is an injection.

I was wondering if anyone else had started the trials?

I will keep you updated on how trials are going and if its helping my psoriasis.

bye for now.

jasse.

I've added a new link in the green bar for members View My Groups if you click it you will see groups that you are a member of and/or groups you can join.

I had to add extra groups for the new newsletter subscription, see here for more info: Newsletter Subscription

So for now you will only see your default user group Newbie, Novice, Member, or 100 + Member I Just Cant Stop, and the option to choose Newsletter Group which will send you the monthly newsletter.

Hope that explains the reason for the new link. If you have any questions or comments please let me know.

Now we have extra user groups, please let me know if you have any suggestions for other user groups that you think could be of interest to members.

Thanks.

Fred.

I first started showing symptoms of psoriasis about a year ago. The first month was the worst, because it took my doctors about this long to figure out what was going on. I was finally referred to a dermatologist, who instantly diagnosed me with gutate psoriasis. She recommended I try light therapy as well as clobetasol propionate. I tried this, which did make the psoriasis better, but the tanning beds also brought up a lovely fungal infection which gave me white spots all over my arms and back (it sounds gross, but it was just another awkward kind of spots in addition to my psoriasis). Also, I did not want to continue with the tanning beds for too long because my family does have a history of skin cancer. I only did short amounts of time, but still, it makes me nervous. I was treated for the fungal infection, and my dermatologist added Dovonex to my treatment for psoriasis. Now, after about a year of really struggling, I feel I am really learning to manage this.

I take a lot of baths with epson salt, which seems to help some. I also have finally found a lotion that keeps my skin moisturized without irritating my VERY sensitive skin. For anyone who has sensitive skin/skin allergies in addition to psoriasis, I recommend trying St.Ives' Oatmeal and Shea butter lotion. Occasionally I will still use the clobetasol or the dovonex to get a bad patch under control, but I find I really hardly need it with the epson salt baths and st. Ives lotion.

Anyway, I just wanted to share because I feel like I am really learning to live with and manage my psoriasis. I'm glad to know this forum exists, because there have been a lot of times in this past year where I have felt alone with this condition. It is nice to be able to scroll through posts and see that I am not alone, and also to see the different ways other people are managing and treating this. Thank you all for sharing.

Taro Pharmaceutical reported today that it has received approval from the U.S. Food and Drug Administration (“FDA”) for its New Drug Application Topicort® (desoximetasone) Topical Spray, 0.25%.

*Topicort® (desoximetasone) Topical Spray, 0.25% is a corticosteroid indicated for the treatment of plaque psoriasis in patients 18 years of age or older.

Source: NO LINKS ALLOWED

*Topicort is also available in 0.05% Cream, 0.25% Cream, 0.05% Gel, & 0.25% Ointment. It's active ingredient is Desoximetasone a topical corticosteroids.

Someone was asking me more about the User CP so here goes.

As a member of Psoriasis Club you have your own User Control Panel (User CP) where you can make changes to the way your account works. To access it you need to click the link in the green bar above where it says Control Panel top left.

OK now you're in your User CP lets run through what you can do here.

At the top you will see your Usename, Number of posts you have made, Your email address (*don't worry only you can see this), The date you registered, And your primary user group.

Below that you will see your Personal Notepad. You can put in here whatever you want, as no one will be able to see it accept you. Make as many changes as and when you want, but remember to scroll down and hit the "Update Notepad" button. More on personal notepad Personal Notepad]

Next you will see thread subscriptions and your threads, self explanatory really.  

• Menu
  
• User CP Home: Your user control panel.
  
• Messenger More on PMs Private Messages
  
• Compose: From here you can send a private message to another member. (*you need to have made 5 posts to use this)
  
• Inbox: This has private messages you have received from another member.
  
• Sent Items: A list of private messages you have sent.
  
• Drafts: Messages are stored here that you have not sent or finished with.
  
• Trash Can: Private messages you have deleted are stored here untill you empty it.
  
• Your Profile
  
• Edit Profile: Here you can change things that are shown in your profile. Bio, Treatment, Location, Psoriasis Score, Birthday, And after you have made 10 posts you can choose a Custom User Title. More on custom titles User Titles/Ranks
  
• Change Password: Change your password here.
  
• Change Email: You can change your email address here.
  
• Change Avatar: Here you can add a nice little picture to your profile so you look different to everyone else. More on Avatars Avatar / Photo in your profile
  
• Edit Options: This is where you change your options like Emails, Notifications, Time, View, Etc.
  
• Miscellaneous
  
• Group Memberships: Here you will see your default group plus any others that you can join. I recommend the newsletter group which will send you a monthly newsletter. More on the newsletter Newsletter Subscription
  
• Saved Drafts: This is where posts that you have saved as a draft for publishing later are stored.
  
• Favorite Threads: Yes I know it's spelt wrong in English, this is where you can view threads you have made favourite. EDIT: *This has been removed*
  
• Subscribed Threads: Here is a list of all threads that you have subscribed to.
  
• Forum Subscriptions: This is different to the above. Here you can get a notification of new threads posted in your chosen boards. More on subscriptions Notification of new threads and posts
  
• View Profile: This is what your profile will look like to other members.
  

This is a study published in the British Journal of Dermatology from a Dutch web-based survey about treatment satisfaction.

Background:
Various psoriasis treatments are currently available: topical therapy, photo(chemo)therapy, oral agents, and biologicals. Little is known about patients’ satisfaction with these treatment options. Moreover, the few available studies show methodological shortcomings.

Objectives:
The present study aims to answer the following questions: 1a) How satisfied are psoriasis patients with their current treatment?; 1b) Does patients’ satisfaction significantly differ between treatment types when controlling for demographic and clinical factors?; 2a) How important are specific domains of satisfaction to patients?, and 2b) When taking perceived importance into account, which domains merit the most attention in improving quality of care?

Methods:
Members of the two existing Dutch psoriasis patient associations were invited to complete a web-based survey, which included a study-specific satisfaction questionnaire.

Results:
1293 patients completed the survey (response rate 32%). Overall, patients were moderately satisfied with their current treatment. Patients receiving topical treatment were significantly least satisfied; patients receiving biological treatment were significantly most satisfied. Overall, patients rated ‘treatment effectiveness’ as most important, followed by ‘treatment safety’ and ‘doctor-patient communication’. Domains with the highest ‘room for improvement’ scores were: 1) effectiveness of topical therapy, phototherapy and oral agents, but not biological treatment, 2) convenience of topical treatment, and 3) safety of systemic treatments (both oral agents and biological).

Conclusions:
From the patients’ perspective, biological treatment is promising. To further improve the quality of psoriasis care, the effectiveness and convenience of topical therapies, the safety of systemic therapies, and doctors’ communication skills need to be addressed.

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We all know there is a link between psoriasis and depression, and this study set out to see whether patients with early onset psoriasis differ psychologically from patients with late onset.

Background:
Onset of psoriasis may occur at any age. Early negative experiences often influence personality development, and may lead to physical disease, anxiety and depression in adulthood. Knowledge about onset of psoriasis and psychopathology is limited.

Objectives:
To examine whether patients with early onset psoriasis differ psychologically from patients with late onset, regarding personality traits, anxiety and depression.

Methods:
A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires; Swedish universities Scales of Personality (SSP), Spielberger State-Trait Anxiety Inventory (STAI, Form-Y), and Beck Depression Inventory (BDI-II). Psoriasis severity was assessed by the Psoriasis Severity and Area Index (PASI).

Results:
Patients with early onset psoriasis (< age 20) were significantly more anxious and depressed than patients with late onset. In multiple linear regression models, younger age at onset of psoriasis was a significant determinant of higher scores of four personality traits, i.e. SSP-Embitterment, -Trait irritability, -Mistrust and -Verbal trait aggression.

Conclusions:
Our results indicate that early detection of psychological vulnerability when treating children and adolescents with psoriasis seems to be of great importance. Traits of psychological vulnerability and pessimistic personality traits were found to be significantly associated with early onset of psoriasis, but not with disease duration in this study. These traits may be seen as a consequence of psoriasis, and / or as individual traits modulating and impairing clinical course and efforts to cope with psoriasis.

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