Well, I went for my follow up appointment today, and was put onto Acitretin (Neotigason).
I have been put on a daily dose of 30mg, and I have to go for blood tests in 3 weeks, ready for my next appointment in 4 weeks.
I have taken my first dose today and will monitor my progress for the next few months to see what sort of progress I achieve.
Will keep you updated as I go.

Let's see how this works eh !!!!

So you've often heard and probably wondered is it true that alcohol is bad for psoriatic arthritis! Personally I have never noticed any difference, and when I was in hospital for a week they gave me Red Wine with my dinner.

This is a study from researchers at the Leiden University Medical Centre in The Netherlands. Make your own mind up Cheers.

Quote:

---

Objectives:
There are conflicting reports concerning the association between alcohol consumption and RA. We performed a case–control study to investigate the association of alcohol consumption with RA as well as with other forms of arthritis. To assess whether alcohol consumption affects long-term disease outcome, we also investigated its association with radiographic progression and sustained drug-free remission in RA.

Methods:
Patients with arthritis and various diagnoses including RA, OA, ReA, SpA and Psoriatic Arthritis (PsA) were compared with 5868 controls from the general population. The association of disease with alcohol consumption was analysed by logistic regression analysis.

Results:
Alcohol consumption was inversely associated with not only RA [odds ratio (OR) 0.28, 95% CI 0.23, 0.35] but also OA (OR 0.31, 95% CI 0.16, 0.62) and other forms of arthritis (OR 0.34, 95% CI 0.24, 0.48). A higher degree of systemic inflammation, reflected by the ESR and CRP level, was associated with a smaller proportion of patients consuming alcohol. There was no dose–response relationship between the amount of alcohol consumed and the presence of arthritis. The extent of joint destruction and the rate of sustained drug-free remission were not affected by alcohol consumption.

Conclusion:
Arthritis patients report less alcohol consumption than controls, regardless of the type of arthritis. This suggests that alcohol may either protect against different kinds of arthritis or that the inverse association between alcohol and arthritis may be secondary to disease development, with arthritis patients being less inclined to consume alcohol due to their decreased general well-being.

Hello I'm 45 year old living with Psoriasis and as of now i don't take any medications. It starts two years ago, now its already spreading on my whole body.

Below is translated with Google Translate and checked on correctness.
It shows a recent investigation in the Netherlands in which it is clear that MTX is useless when trying to beat PsA. But that doctors keep on prescribing.
The article can be read (in Dutch) at LINK REMOVED

MTX senseless with Arthritis Psoriasis
A double-blind randomized studies has shown no evidence that six months of treatment with methotrexate (MTX) is effective against synovitis in psoriatic arthritis (PsA). The researchers wonder whether MTX in PsA is effectively a DMARD.

The doctor who prescribes MTX in PsA, does something what many of his colleagues do too. He is even encouraged to do so by the guidelines, while the effectiveness of this treatment has not been conclusively proven. Nevertheless the NICE guidelines advise to try MTX  before considering - well proven effective in PsA - TNF-alpha inhibitors.

British researchers therefore decided to put to test, which was not done before, the effect of MTX in PsA a randomized clinical trial (Rheumatology. 2012, 51 (8) :1368-77). The 221 participants had active PsA and were randomized to 15 mg MTX weekly or placebo. The primary outcome were the Psoriatic Arthritis Response Criteria (PsARC). Secondary outcome measures were the scores of ACR20 and DAS-28, and the seperate items in them.

44 participants, about equally divided between the two groups could not be involved in the follow-up, 26 participants discontinued treatment (14 in the MTX group). After six months no significant effect on PsARC (OR 1.77), nor on the ACR20 or DAS28 score (OR 2.00 respectively. 1,70) showed. Nor has there been significant positive effects of MTX on the number of tender and swollen joints, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), evaluation of health (HAQ score) and pain perception.

Although there was a trend towards improvement in MTX use, but none of the indices referred to this effect reached statistical significance. The only positive effects of MTX were an improvement of both the doctor and patient global scores and skin scores. The safety was as expected.

The authors conclude that the results do not indicate any improvement of synovitis in PsA by treatment with MTX. They recommended to practitionars that patients should be used with effective conventional means as leflunomide and biologicals.

---------
Additonal remarks from me... Biologicals can be very dangerous as part of the immune system is inhibited.

Instead, it is found that psorinovo (DMF) used with psoriatic arthritis (PsA) in 9 of the 10 cases gives disappearance and brings much less risk, if the recommended dose is not exceeded. This is demonstrated by including research in 2008 of dr. L. Kunst.

---------
Name            Type          dose                                      price/year
Remicade      infliximab    5 mg/kg 1 x per 2 months      € 19.352.-
Humira          adalimumab  1 x per week 40 mg                € 32.480.-
Enbrel            etanercept    2 x per week 50 mg              € 28.260.-
Psorinovo      DMF            6 x day 120 mg                      € 1.200,-

Fred im not getting an email for new threds in help me or intros

Hello all

I have never had any sort of skin problem. However over the past few months I have had 'something' develop on my scalp. It started as clustered clumps of 'dandruff' on my scalp, but nothing to bad. I went to see GP who give me some coconut coal stuff, she said it was caused by stress. Then a few months later, I developed quite bad dry skin behind my ears, of which became infected and started weeping. Then my head became significantly worse, it become very very sore and cracked. It feels like it is burning and the skin is very tight. I can easily simply scratch my head and my nails will be full of 'clumps' of white / yellow stuff. Sometimes my scalp also weeps to the point that it soaks my hair at the back. I have looked at it when it has been oozing and it seems to be a greenish liquid seeping. Its becoming increasingly sore and I am still not sure what it is. My dr gave me some steriod cream for behind my ears, and antibiotics but nothing else for my hair. The coal stuff I got earlier this year does not work and actually hurts very much because I am putting it on sore cracked skin. Does this sound like psoriasis?

Thanks all

Hi im new to this site, I suffer from guttate psoriasis. Im currently covered in it, the only place thats not effected so far is my face. I itch all over, I cant sleep, its driving me crazy ! I dont need help I just need to moan about it ! Fed up

Please move if I've put this in the wrong section.

As you may or may not know, after my recent relapse, I've lost quite a few layers of skin from my feet. Luckily I now have my meds and will be away on holiday in a few weeks.

The problem now is........shoes!

My feet are still uber sensitive (as are my ankles from all that tippy toeing around) and still get a bit hot. It will take a while for the skin to toughen up again. I need to find some shoes that basically feel like slippers or perhaps try some memory foam insoles?

Just wondered if anyone had anyone suggestions or personal recommendations.

I've been on Humara. My plaque P is gone. I have some of the glut P which I didn't have before but only about 6 or 10. Finger nails are back to normal. PA seems to be much better. Under carriage is clear. Scalp is doing great which is good news because the cover over it is disappearing rapidly. I hope it doesn't quit working.

This article published in Journal of the American Academy of Dermatology suggests that psoriasis patients are at a significant risk of parkinsonism.

Quote:

---

Objective:
We sought to investigate the risk for parkinsonism during a 5-year follow-up period after a diagnosis of psoriasis using a population-based data set in Taiwan.

Methods:
We identified 4885 patients with psoriasis for the study cohort and randomly selected 24,425 patients as a control cohort. Each subject was individually followed up for a 5-year period to identify those who subsequently developed parkinsonism.

Results:
Stratified Cox proportional hazards regression showed that the adjusted hazard ratio for parkinsonism during the 5-year follow-up period for patients with psoriasis was 1.74 (95% confidence interval 1.35-2.20) that of control patients. Furthermore, the adjusted hazard ratios for parkinsonism within the 5-year follow-up period after the index date for subjects with psoriasis were similar between both sexes (1.78 and 1.66 for men and women, respectively).

Limitation:
Our data set did not provide detailed information on the severity of psoriasis, or individual factors such as cigarette smoking, alcohol consumption, body mass index, and dietary patterns.

Conclusion:
Patients with psoriasis were found to be at a significant risk of parkinsonism during a 5-year follow-up.

Source: NO LINKS ALLOWED

Hi i'm new to the psoriasis club. Started to develop a rash about a week and a half ago, which started on the palm of my hands and then gradually spread to most other areas of my body. i thought it was excema to begin with as I have suffered with excema on and off for years.

But after making an appointment to see the doctor today he told me that it was guttate psoriasis.

He has given me Dermol cream to apply, oilatum for the bath and antibiotics, I have to take the antibiotics 2 tablets at a time 4 times a day, 8 tablets in total. this seems a lot of tablets, just wanted to know if anyone else who was first diagnosed was given this many tablets to take a day. They are penicillin.

Thank you

xx

I'm new to this site, just wanted to say hello. I was diagnosed today with guttate psoriasis caused through having a throat infection. looking forward to posting on the site xx

Hi everyone
I stumbled onto this site whilst googling Apremilast. Spent some time browsing through and it looked like a friendly and informative place.

I am staying in the East and was trained in the West (UK) so I have the opportunity to treat my psoriasis with both Eastern and Western medicines.

During my 40 years of living with psoriasis, I have tried ayurvedic medicines, traditional Chinese therapies ( imbalance in the Ying and Yang) and even gone to Thailand to drink snake bile.

I have smeared myself with all sorts of creams ( steroids, Daivonex, moisturizers, herbal products). UV light therapy only helped for a short time.

I tried a course of cyclosporine... I suffered every known side effect and it did not help my skin a single bit.

So far I have avoided anti-TNF medication and the only thing that controls my skin is Methotrexate which I have been taking every 2 - 3 weeks for the past 30 years.

I am considering trying apremilast but it is still not available here. So I am still struggling to live with my itchy, scaly and often painful skin and hoping some day someone will find a cure.

Hi.

I'm plonky and I have P.

Sorry for the long, detailed post.

After reading the new study by Kantar Health below, I thought the subject would make a good poll for Psoriasis Club.

• This poll is available to guests
  
• Members are welcome to post on this thread.
  
• Physician = A person qualified to practice medicine.
  
• Please don't mention any physician's by name if posting on this thread. (I will remove them)
  
• You cant change your vote, but should your view change please let me know and I will edit it for you.
  
• Usernames are not shown in the results.
  

Quote:

---

Four in 10 psoriasis patients—including 25 percent of moderate to severe patients—currently are not under the care of a physician for their condition, according to new research conducted by Kantar Health, a leading global healthcare consulting firm.

Results from a survey conducted among psoriasis patients in the U.S. show that while most patients who do see a physician for their psoriasis are satisfied with the medical care they receive, about one-third have stopped seeing a physician because of their dissatisfaction with their psoriasis treatment or progress. As disease severity increases, these patients are more likely to have changed physicians multiple times.

Patients who are dissatisfied with the care they receive cited their physicians’ inability to provide effective treatment as the primary reason for their dissatisfaction. Only four out of 10 claim to have a satisfactory level of clearing of their psoriasis plaques, with those using prescription treatments being the most satisfied with clearing but still falling short of their expectations. Furthermore, some patients also mentioned their physician had a lack of attention, emotional support or empathy as contributing to their dissatisfaction.

“Physician advice is far and away the greatest influence on how psoriasis is treated,” said Rose Lorenzo, director of research at Kantar Health. “However, a relatively large number of moderate to severe patients are declining to see a doctor about their disease, and those who are being treated are much more likely to be dissatisfied with their physicians. It’s important for physicians to set more realistic expectations on the level of psoriasis clearance they are likely to experience to help close the gap between expectations and treatment satisfaction.”

Caroline I'm not sure if you have seen or posted about this on here, but I'm sure you will find it interesting.

Quote:

---

Background: 
Fumaric acid esters (FAE) are used as an effective and safe oral treatment for plaque psoriasis in adult patients, but little is known about their efficacy and safety in children with psoriasis.

Objectives: 
To assess the effectiveness and safety of FAE in the treatment of paediatric psoriasis.

Methods: 
This is a retrospective analysis of 14 paediatric patients with psoriasis (age < 18 years) treated with FAE between 2004 and 2012 at several Dutch university and regional clinics. Patients were identified through databases or registries.

Results: 
The median age at the start of FAE treatment was 15 years (range 8–17 years). The median duration of FAE treatment was 10 months (range 1–80 months), and the median maintenance dosage per day was 360 mg dimethylfumarate (range 240–600 mg). Five patients (36%) achieved a complete clearance of their psoriasis, one patient (7%) had a good improvement, three patients (21%) had a partial response and five patients (36%) were nonresponders. FAE treatment was well tolerated, but two patients (14%) discontinued FAE, one with severe diarrhoea and one with flushes. Five patients (36%) had transient, slightly abnormal laboratory values of liver-function tests or leucocytes that did not necessitate FAE dosage reduction or treatment discontinuation. No serious adverse events occurred.

Conclusions: 
In this retrospective case series FAE seemed to be an effective and safe treatment for children with psoriasis. FAE may be an attractive therapeutic alternative to the currently used systemic immunosuppressive agents for paediatric patients with psoriasis. Further studies are needed to evaluate the suitability of FAE in paediatric psoriasis.

Here's an interesting article that was published in the British Journal of Dermatology asking the question "Is the prevalence of psoriasis increasing?"

I found the results interesting as it shows that people are self reporting psoriasis to their GPs, and could be more aware about psoriasis than ever before. Lets hope Psoriasis Club is playing it's part in helping that result.

Quote:

---

Background:
There is indication of an increasing prevalence of psoriasis in some western populations. However, the results are not conclusive.

Objectives:
To analyse trends in the prevalence of psoriasis over the past 30 years, separating age, birth cohort and time period effects.

Methods:
Five population-based surveys in North Norway, the Tromsø Studies 2–6, collected between 1979 and 2008, were studied. Participants aged 20–79 years with self-reported psoriasis data in at least one of the surveys were included, yielding a total of 69 539 observations from 33 387 unique individuals born between 1915 and 1977. Trends in psoriasis prevalence were examined using cross-sectional, time lag and longitudinal designs of graphical plots. Observed trends were further evaluated in generalized linear-regression models.

Results:
The self-reported lifetime prevalence of psoriasis increased from 4·8% in 1979–1980 to 11·4% in 2007–2008. Graphical plots showed an increasing prevalence of psoriasis with each consecutive survey in all examined age groups and birth cohorts, leaving time period effects as the explanation for the increase. The odds for psoriasis in the cohort were 2·5 times higher in 2007–2008 than in 1979–1980 (adjusted odds ratio 2·49, 95% confidence interval 2·08–2·99). The prevalence of persons reporting a doctor’s diagnosis of psoriasis was 9·9% in the last survey. In subgroups of the study population, psoriasis was associated with higher body mass index, lower physical activity during work and leisure time, lower educational level and smoking.

Conclusions:
Our findings indicate an increasing prevalence of self-reported psoriasis. This could represent a true increase in prevalence, possibly due to changes in lifestyle and environmental factors, or an increased awareness of the disease.

Background: 
In the pathogenesis of psoriasis, proinflammatory T cells are strongly involved in the inflammatory process, where regulatory T-cell (Treg) function is impaired.

Objectives: 
As effective Treg function is associated with a numerical balance between Treg and effector T cells, we wondered whether Treg/T-helper cell ratios may be associated with certain stages of the inflammatory process. We opted for the margin zone model as a dynamic approach.

Methods: 
From nine patients with chronic plaque psoriasis, 3-mm punch biopsies were obtained from the centre and margin of the lesion, perilesional skin and distant uninvolved skin. Skin biopsies of 10 healthy volunteers were included as a control. Samples were analysed using immunohistochemistry and immunofluorescence.

Results: 
In the transition from symptomless to lesional skin, a significant increase of CD3+, CD4+ and Foxp3+ cells was found. In seven of nine patients the ratio of Treg (Foxp3+) vs. CD4+ T cells was higher in the distant uninvolved skin than in the perilesional and lesional skin. Interestingly, the Foxp3/CD4 ratio in the distant uninvolved skin was even higher than in the skin of healthy controls. Notably, we found that most of the interleukin (IL)-17 expression was not related to CD4+ cells, but to mast cells.

Conclusions: 
The relatively high Foxp3/CD4 ratio in symptomless skin of patients with psoriasis suggests an active immune controlling mechanism distant from the psoriatic plaque. In the margin and centre of the plaque the ratio appears skewed towards effector cells associated with inflammation. IL-17, an important driver of the psoriatic process, is mostly related to mast cells, and only sporadically to T cells.

Source: NO LINKS ALLOWED

Summary Background: 
In 2007 the International Psoriasis Council proposed that palmoplantar pustulosis (PPP) should be considered a separate condition from psoriasis, despite the presence of certain phenotypes common in both diseases.

Objectives: 
To describe and compare demographic and clinical characteristics among patients with PPP and palmoplantar plaque psoriasis.

Methods: 
This was a retrospective case series study from 2005 to 2010. The following data were obtained: age, sex, family history, smoking habits, nail involvement, joint involvement, disease duration, lesion morphology (plaque or pustular), histological diagnosis, comorbidities, and Physician’s Global Assessment (PGA) score for extrapalmoplantar lesions. The sample size calculation indicated that 80 patients, 40 patients for each group (palmoplantar plaque psoriasis and PPP) were needed to see clinically relevant differences between groups.

Results: 
Ninety patients were selected, 51 with palmoplantar plaque psoriasis and 39 with PPP. No statistically significant differences were registered between patients affected by PPP and palmoplantar plaque psoriasis as regards age at onset of the disease (48 vs. 44 years; P = 0·4), disease duration (6 vs. 10 years; P = 0·1), family history of psoriasis (28% vs. 33%; P = 0·7), concomitant arthritis (26% vs. 25%; P = 1·0), or smoking habits (54% vs. 41%; P = 0·2). We observed a female predominance (P = 0·01) and a lesser frequency of nail involvement (P = 0·03) in patients affected by PPP.

Conclusions: 
Our data suggest a close relationship between PPP and psoriasis. The existing data concerning epidemiology, clinical presentation, genetics, histopathology and pathogenesis do not permit a clear distinction between these two entities, which seem to coincide in many aspects. PPP appears to have a marked predilection among female smokers.

Source: NO LINKS ALLOWED

Hi all,

As suggested by Fred I have started my very first thread on a forum! Eeeek!

After 2 doses of MTX and a horrible reaction I got my first dose of Stelara last Thursday - the injection was a doddle and my nurse was lovely!

Its too early to now anythign really but so far no nasty side effects and I think theres a change, my right arm was a favourite picking spot and would be an area that the psoriasis came back daily, but i noticed yesterday that the skin I picked hasnt come back thick enough to pick since before the weekend.

Sorry - that description sounds terrible but not sure how else to explain what I mean. I did take some pictures on the day of the injections so hope that helps me monitor how it goes. I think my comfort eating has decreased but thats maybe cos my wine intake has increased due to work being utter pants!

Fingers crossed peeps!