My name is Sarah. I was diagnosis with plaque psoriasis in 1991 when I was 12 years old.

Genentech Inc. is facing the first trial of patients’ claims that its withdrawn Raptiva psoriasis drug spawned fatal infections in some users.

Officials of Genentech, a unit of Basel, Switzerland-based drugmaker Roche, are readying for a Jan. 30 jury trial in state court in California over allegations that Raptiva caused Stephen Johnson’s death. The 46-year-old Louisiana businessman took the drug to treat a skin condition. Genentech withdrew the medication from the market almost three years ago after it was linked to fatal brain infections.

“Psoriasis isn’t life-threatening and his wasn’t even that horrible,” Mark Lanier, a lawyer for Johnson’s family, said in an interview. “This drug was never about the patients. This drug was about the money.”

Genentech, based in South San Francisco, California, began withdrawing Raptiva from U.S. and European markets in April 2009 after three psoriasis patients were diagnosed with progressive multifocal leukoencephalopathy, or PML, a rare, incurable brain infection. The month before the withdrawal, Roche completed a $46.8 billion buyout of the biotech company.

Nadine O’Campo, a Genentech spokeswoman, declined to comment on the upcoming Raptiva trial. “Given this litigation is ongoing, we are not commenting,” she said in an e-mailed statement.

Psoriasis is a disease that leaves sufferers dealing with red, itchy skin lesions, lawyers for Johnson’s family said in court filings. Johnson had taken the drug for almost five years before his death in January 2009, the filings show.

Damages Sought
Genentech officials estimated in 2009 about 2,000 U.S. patients were taking the drug when the company began pulling it from shelves. The medication, which generated $108 million in sales in 2008, had been used by an estimated 46,000 patients worldwide. The psoriasis treatment was approved for sale by the U.S. Food and Drug Administration in 2003.

Johnson’s case is the first of about 100 Raptiva suits that have been consolidated before Judge Steven Brick in state court in Oakland, California. Lanier said there are other cases in federal and state courts in Texas and Massachusetts.

The family is seeking $15 million in compensatory damages over Johnson’s death along with “several hundred million dollars” in punitive damages, Lanier said.

Weakened Immune System
Johnson’s wife contends the businessman, who owned a medical-supply store in a suburb of New Orleans, was healthy when he started taking Raptiva to treat his psoriasis and the drug weakened his immune system to the point that he developed a fatal infection.

Doctors at an emergency room in Kenner, Louisiana, noted that Johnson’s death was likely caused by “overwhelming sepsis complicated by the fact that patient was relatively immunosuppressed from his Raptiva,” according to a Jan. 5 court filing.

Lanier and other lawyers for former Raptiva patients contend in the cases that Genentech officials downplayed the medication’s health risks and failed to alert regulators about a patient’s death in 2004 from the same kind of infection that claimed Johnson’s life five years later.

To boost the drug’s prospects, Genentech officials hired an FDA regulator who was responsible for with monitoring Raptiva’s development and discussed “paying the official up to $30,000 to buyout out his contract,” Susanne Scovern, another lawyer representing Johnson’s family, said in a court filing.

The former FDA official, Dr. William Schwieterman (CHTP), later left Genentech and now serves as a consultant to biotech and pharmaceutical makers, Scovern said in an interview.

The biotech company also failed to disclose an internal 2007 analysis that found Raptiva users were five times as likely to get types of pneumonia infections as the general population, Scovern said in the filing.

The case is Johnson v. Genentech Inc., RG 10-494957, California Superior Court, Alameda County (Oakland).

Source: bloomberg.com

Introduction.  Psoriasis is associated with systemic metabolic and cardiovascular disorders, both of which share risk factors with erectile dysfunction (ED). However, few studies have investigated the association between ED and psoriasis.

Aim.  This study set out to estimate the association between ED and having previously been diagnosed with psoriasis by using a population-based dataset with a case-control design.

Methods.  This study used administrative claim data from the Taiwan National Health Insurance program. We identified 4,606 patients with ED as the study group and randomly selected 13,818 patients as the comparison group. Conditional logistic regression was used to examine the association between ED and having previously received a diagnosis of psoriasis.

Results.  Of the sampled patients, 136 (0.7%) had been diagnosed with psoriasis before the index date: 77 (1.7% of the cases) were from the study group and 59 (0.4% of controls) were from the control group. Conditional logistic regression analysis revealed that after adjusting for the patient's monthly income, geographic location, hypertension, diabetes, hyperlipidemia, coronary heart disease, obesity, and alcohol abuse/alcohol dependence syndrome status, patients with ED were more likely to have been diagnosed with psoriasis before the index date than controls (odds ratio = 3.85; 95% confidence interval = 2.72–5.44).

Conclusion. This study revealed an association between ED and prior psoriasis even after adjusting for potential confounding factors. The results of this study highlight a need for clinicians dealing with psoriasis patients to be alert to the possible development of ED.

Source: onlinelibrary.wiley.com

Patients with psoriasis may have an increased risk of cardiovascular disease and myocardial infarction. American Journal of Cardiology

The aim of this study was to investigate whether psoriasis is associated with an increased prevalence of coronary artery disease (CAD) independent of established cardiovascular risk factors in patients undergoing coronary angiography.
A retrospective cohort analysis was performed by linking records of all patients undergoing coronary angiography from 2004 through 2009 with dermatology medical records.

From an overall cohort of 9,473 patients, we identified 204 patients (2.2%) with psoriasis before coronary angiography. Patients with psoriasis had higher body mass index (31.3 ± 8.1 vs 29.3 ± 7.1 kg/m2, p <0.001) but the prevalence of other risk factors was similar. Median duration of psoriasis before cardiac catheterization was 8 years (interquartile range 2 to 24). Patients with psoriasis were more likely to have CAD (84.3% vs 75.7%, p = 0.005) at coronary angiography.

After adjusting for established cardiovascular risk factors, psoriasis was independently associated with presence of angiographically confirmed CAD (adjusted odds ratio 1.8, 95% confidence interval 1.2 to 2.8, p = 0.006). In patients with psoriasis, duration of psoriasis >8 years was also independently associated with angiographically confirmed CAD after adjusting for established cardiovascular risk factors (adjusted odds ratio 3.5, 95% confidence interval 1.3 to 9.6, p = 0.02).

In conclusion, patients with psoriasis and especially those with psoriasis for >8 years have a higher prevalence of CAD than patients without psoriasis undergoing coronary angiography.

Source: ajconline.org

Asia's premier biotechnology Company, Biocon today announced positive results from its Double Blind, Placebo Controlled, Phase 3, TREAT-PLAQ Study with Itolizumab in chronic plaque psoriasis. Itolizumab, the first humanized anti CD-6 monoclonal antibody, successfully met the pre-specified primary endpoint of significant improvement in PASI-75 (Psoriasis Area and Severity Index) score after 12 weeks of treatment in patients with moderate to severe psoriasis compared to placebo. It also met multiple secondary endpoints after 12 and 28 weeks of treatment.

This 52 week study conducted in India, had a 12 week placebo controlled phase, 16 week consolidation and 24 week randomized withdrawal phase. It enrolled over 200 patients across placebo and two active treatment regimens. In this 28 week interim analysis, both treatment regimens were statistically significantly better than placebo with the fixed dose regimen of 1.6 mg/kg every two weeks for 12 weeks followed by 1.6 mg/kg every 4 weeks for 16 weeks demonstrating response rate of 36% (p<0.0043)at Week 12 and 46% at Week 28. The response rates for patients with PASI> 20 at baseline was 43% and 54% at Week 12 and 28 respectively. The molecule also exhibited an excellent safety and tolerability profile with very low rates of infection (~10%) in active treatment arms suggesting a favorable risk benefit profile compared to currently available biologic treatments. Biocon plans on presenting the safety and efficacy data from the entire 52 week study at an upcoming scientific meeting.

Expressing her excitement at the outcome of the study Ms. Kiran Mazumdar-Shaw, Chairman & Managing Director, Biocon said, "Itolizumab represents a significant advancement in the treatment of psoriasis and potentially other autoimmune diseases with an excellent risk-benefit profile. This could possibly become the first novel biologic developed and approved from India and is an important milestone for Biocon in its pursuit of affordable innovation. We look forward to taking this molecule to the market across multiple indications with a global partner to ensure that affordable innovation reaches patients worldwide in a timely manner."

"We strongly believe in this molecule and are pleased with the results from the TREAT-PLAQ study. The low opportunistic infection rate despite the study being conducted in India validates the preclinical findings and along with novel mechanism of action opens new treatment paradigms for treatment of psoriasis and other autoimmune diseases. We are looking forward to accelerating clinical development in other autoimmune conditions like MS (Multiple Sclerosis) and RA (Rheumatoid Arthritis)," said Abhijit Barve, M.D., Ph.D., President R&D, Biocon.

Source: marketwatch.com

Results from a systematic review and meta-analysis indicate that psoriasis is a risk factor for diabetes.

Several previous studies have shown an association between psoriasis and diabetes, but others have not.

"The reasons for this difference are not quite clear but probably due to poor design, inadequate size, the severity of psoriasis, and consequent lack of power," write Juan Cheng (Beijing 302 Hospital, China) and colleagues.

To clarify the issue, Cheng and team analyzed data from 22 published studies performed in the USA (n=4), Europe (n=12), and Asia (n=6), including a total of 3,307,516 participants.

To be included, studies had to have a comparison control group, present original data, and have incidence of diabetes associated with psoriasis as an outcome.

The team calculated that patients with psoriasis had a significant 42% increased risk for developing diabetes overall compared with those without the condition. In total, psoriasis significantly increased the risk for diabetes in 15 of the 22 studies.

The Newcastle-Ottawa Scale was used to assess study quality, but removal of four "lower quality" studies did not significantly influence the overall result.

Geographic location seemed to affect the association to some degree, with a stronger link observed in the Asian compared with the European and American studies.

Cheng et al note that due to the observational nature of the original studies, potential confounding cannot be excluded as a possible cause of the association. Confounding factors could include smoking, obesity, and presence of the metabolic syndrome, all of which have previously been shown to increase the risk for developing diabetes.

"More research, both epidemiological and mechanistic, is needed to further clarify the association between psoriasis and risk of diabetes,"

Source: medwire-news.md

LEO Pharma A/S, a global pharmaceutical company specializing in dermatology, has entered into a multi-million dollar collaboration with the US biotech company Virobay Inc. to develop an oral treatment for psoriasis.

The pharmaceutical company LEO Pharma A/S has signed an in-licensing deal with the US biotech company Virobay Inc. to develop an oral treatment for psoriasis. The in-licensing deal concerns an innovative compound which has the potential to be the first on the market with its specific mode of action. The deal involves an upfront payment to Virobay of USD 7m, followed by milestone payments totaling up to USD 300m and tiered royalties.

The compound is currently being tested in preclinical studies. Phase I studies will be launched in Q4 2012, and testing on psoriasis patients is planned for Q1 2013. A limited number of oral psoriasis treatments are already on the market, but they have potential drawbacks in terms of adverse effects and a need for monitoring. A safe and convenient oral treatment thus addresses a significant unmet patient need.

"Virobay's expertise with this compound is outstanding internationally. Combined with LEO Pharma's expertise in dermatology and drug development, we are the perfect match to develop this innovative compound further. Together with Virobay, we pursue new scientific findings and not least, strive to develop a safe, effective and convenient oral treatment," comments Kim Kjøller, Senior Vice President, Global Development, LEO Pharma.

For Virobay, the deal represents a valuable opportunity for the small drug discovery company to work with an industry heavyweight.

"Collaborating with LEO Pharma makes it possible for us to conduct testing in a clinical program with world-leading dermatologists. The compound's possible indications cover a range of dermatological diseases and co-morbidities. However, first and foremost we hope to develop a safe oral treatment for the 125 million or so people worldwide who suffer from psoriasis," states Robert Booth, founder and CEO of Virobay.

More deals are expected in the future

The scientific collaboration with Virobay is the latest milestone in LEO Pharma's ambitious global growth strategy. More acquisitions and in-licensing deals are expected in the future as well as investments in internal drug discovery.

"We are actively seeking out new opportunities to expand our pipeline. Virobay's compound is a strong asset which will drive our innovation forward. The next steps take place in the laboratories where our researchers will work hard together to achieve new innovative solutions to dermatologic diseases," adds Kim Kjøller.

Source: marketwatch.com

Financing will be used to advance Avexxin's lead compound against psoriasis. Proof-of-Concept trial in man is expected to commence late 2012.

Avexxin AS, a company focusing on the development of novel small molecule therapeutics for patients suffering from chronic inflammatory conditions, announces the second closure of a financing A round with existing shareholders enabling the company to take its lead compound against psoriasis through early clinical development.

Besides psoriasis, the company has pre-clinical development programs against other chronic inflammatory conditions.

The company has an active partnering strategy on its compounds.

Avexxin builds its novel therapeutic approach on a deeper understanding of the intracellular mechanisms of chronic inflammatory diseases. Avexxin new small molecule compounds target a novel intervention point, the group IVα phospholipase A2 (GIVαPLA2) enzyme, which regulates cytokine induced activation of the proinflammatory transcription factor nuclear factor-κB (NF-κB).

Mikael Oerum, CEO of Avexxin: "We are pleased that Sarsia Seed and Leiv Eiriksson Invest provides further support for the company to advance its lead compound against psoriasis. We believe that a clinical trial aimed at obtaining Proof-of-Concept in man can start in the second part of 2012."

Farzad Abdi-Dezfuli, PhD, Partner at Sarsia Seed: "We believe the strategy of using potent and selective PLA2 inhibitors against inflammatory disease to be highly promising, and look forward to the entry soon of the company's lead compound into clinical development."

Ensemble Therapeutics, a biotechnology company developing EnsemblinsTM, a novel class of small molecule therapeutics with the power of biologics, announced today that the company has identified a series of unique small molecule antagonists of Interleukin-17, a pro-inflammatory cytokine implicated in multiple inflammatory and autoimmune diseases such as psoriasis, rheumatoid arthritis, Crohn’s and intestinal bowel disease. The Ensemblins represent first-in-class small molecule antagonists of this important, clinically validated protein-protein-interaction target that has proven impervious to traditional small molecule pharmaceutical approaches and has only been addressed to date with protein therapeutics. A small orally active inhibitor of IL-17 would have significant advantages over the current class of clinical stage anti-IL-17 antibody products.

“To our knowledge, no other small molecule antagonists of IL-17 exist in spite of the active efforts of a number of major pharmaceutical companies to find such compounds.” said Dr. Michael D. Taylor, CEO of Ensemble Therapeutics. “The discovery of a series of small molecule macrocycles that exhibit single-digit nanomolar potency, and are selective and druggable with excellent potential for oral administration is a compelling example of the power of Ensemble’s drug discovery platform against a most challenging and valuable target.”

The company expects this rapidly advancing program to produce an orally active development candidate by the end of 2012.
The IL-17 program reflects, in part, Ensemble’s increasing focus on the key therapeutic areas of oncology and immuno-inflammatory diseases for its internal macrocycle drug discovery and development efforts.

Source:ensembletx.com

Nail Psoriasis

Many people who have psoriasis also experience changes in their fingernails or toenails. There are several treatments that can help.

By Krisha McCoy, MS
Medically reviewed by Kevin O. Hwang, MD, MPH

Nail psoriasis is the term for the changes in your fingernails and toenails that occur as a result of having psoriasis. Up to half of all people who have psoriasis will have nail psoriasis as well. Whileit's not a life-threatening condition, nail psoriasis can affect your quality of life, since it may cause you discomfort and affect your self-esteem, and it may also put you at greater risk of developing psoriatic arthritis. Although it cannot be cured, nail psoriasis can be helped with treatment.

How Psoriasis Affects the Nails

Nail psoriasis occurs because psoriasis affects the process of nail formation. People who have nail psoriasis usually have psoriasis on other parts of their body, such as the skin and joints. Rarely does someone have only psoriasis of the nails.

Symptoms of nail psoriasis vary but may include:
Discoloration of the nail to yellow-brown
Pitting (holes) in the surface of the nails
Horizontal lines across the nails
White patches on the nails
Thickening of the nails
Nails that separate from the nail bed

Nail Psoriasis Treatment Options

Your treatment will depend on the type of nail psoriasis you have and how severe it is. If you have psoriasis that affects other parts of your body, the treatments your doctor recommends to alleviate those symptoms may also help your nail psoriasis. Other options for nail psoriasis include:
Topical treatments. These medications are applied to the nails: Dovonex (calcipotriene), a form of synthetic vitamin D3 that can slow cell growth
High-potency corticosteroids, anti-inflammatory medications that can be applied to the nails temporarily
Cordran (flurandrenolide), a steroid medication that is in the form of a tape that can be applied to the nails
5-fluroruracil cream, a topical treatment that often helps with nail pitting
Tazorac (tazarotene), a topical medication that can slow cell growth

Corticosteroid injections. In some cases, having steroid medications injected into your nail bed or matrix can temporarily improve nail psoriasis symptoms.
Phototherapy. A type of phototherapy known as PUVA (psoralen and ultraviolet light A) uses UVA light plus a light-sensitizing medication called psoralen. When your skin or nails are sensitized to UVA rays, excessive cell production can be slowed. PUVA for nail psoriasis may involve taking psoralen orally or painting it onto the nails before UVA treatment.
Cosmetic nail repair. Sometimes surgery or the application of a urea compound is necessary to remove deformed nails. In cases where nails are excessively thick and long, they can be filed down. If nails are discolored or otherwise cosmetically deformed, the deformity can be covered up with nail polish or artificial nails. And pitted nails can be buffed and polished.

Keeping Nails With Psoriasis in Good Shape

In addition to following your doctor's recommendations involving treatment for nail psoriasis, there are other ways to take care of your nails:
Keep your nails trimmed as short as possible.
Wear gloves when you're working with your hands.
Wear shoes with plenty of room in them.
Avoid scrubbing or scraping underneath your nails.
Use gentle nail-cleaning tools.
Soak your nails in tar bath oil mixed with water, then apply nail moisturizer.
If your nails are intact, consider using a nail hardener to improve their appearance.

Taking good care of your nails can minimize the effects of psoriasis-associated nail changes

Background:  Most publications to date on comorbidities associated with psoriasis have focused on cardiovascular and metabolic diseases. Few comprehensive investigations of medical comorbidities in a cohort of patients with psoriasis appear in the literature.

Objectives:  To examine the prevalence of comorbidities in adult patients with psoriasis, including a comparison of comorbid prevalence vs. that in controls without psoriasis, in a nationally representative dataset in Taiwan.

Methods:  There were 1685 adult patients with psoriasis in the study group and 5055 randomly selected subjects in the comparison group. We used conditional logistic regression analyses to examine the risk of 29 comorbidities for these two groups after adjusting for monthly income, geographical region of residence and the level of urbanization of each patient’s community of residence.

Results:  After adjusting for several potential confounders, patients with psoriasis had higher odds of comorbid congestive heart failure [odds ratio (OR) 1·63], ischaemic heart disease (OR 1·51), renal failure (OR 1·45), uncomplicated diabetes (OR 1·37), liver diseases (OR 1·34), hepatitis B or C (OR 1·34), complicated diabetes (OR 1·32), hyperlipidaemia (OR 1·28), hypertension (OR 1·24) and peptic ulcer (OR 1·22) than did patients without psoriasis. However, patients with mild psoriasis had higher odds of comorbidity only with uncomplicated diabetes (OR 1·55), asthma (OR 1·30), liver diseases (OR 1·30) and peptic ulcer (OR 1·26) than patients without psoriasis.

Conclusions:  We conclude that psoriasis is associated with a variety of medical comorbidities including cardiovascular diseases, metabolic diseases, renal failure, liver diseases, viral hepatitis B or C, asthma and peptic ulcers.

Source: onlinelibrary.wiley.com

Emerging data support the practice of switching biologic agents after an initial biologic therapy fails in psoriasis, and even the possibility of rotating back to a biologic that didn’t work previously, according to Dr. Francisco Kerdel, director of the dermatology inpatient service at the University of Miami Hospital.

In one recent series of 747 psoriasis patients on biologics, the 4-year drug response was in the range of 40% for etanercept or adalimumab and 70% for infliximab "Thus, there is a logical need for ‘switching’ biologic therapy," he noted at the SDEF Las Vegas Dermatology Seminar.

The reasons for treatment failure are not known. Antibody production has been suspected of playing a role, but the presence of antibodies seldom correlates with clinical response, he said.

In a 16-week, open-label trial, a Physician Global Assessment (PGA) rating of "clear" or "minimal" was achieved in 52% of 152 patients who had chronic plaque psoriasis and were switched to adalimumab following suboptimal responses to etanercept, methotrexate, or phototherapy.

In the PSUNRISE study (a prospective, multicenter, open-label study of infliximab treatment in 215 patients with plaque psoriasis who had had a prior inadequate response to etanercept), a PGA score of 0 (clear) or 1 was achieved by week 10 in 65% of the 179 completers, and 60% remained at PGA 0-1 in weeks 14-26. These data have been submitted for publication, according to Dr. Kerdel, who was one of the study authors.

Good to excellent responses were achieved with ustekinumab at doses of either 45 mg or 90 mg, depending on body weight, in 9 of 11 psoriasis patients who had experienced treatment failures on multiple biologics, including infliximab (11 patients), etanercept (10), efalizumab (9), adalimumab (7), and golimumab (3).

There is even some evidence that patients can return with success to a biologic therapy that they had previously failed.

Dr. Kerdel and his associates have conducted an open-label study of etanercept re-treatment in 20 patients with moderate to severe psoriasis (defined as a PGA score of 3 or greater) who had had prior therapy with etanercept for a minimum of 6 months but had discontinued it because of loss of efficacy. The 10 men and 10 women had an average age of 49 years, with an average of 3.5 years between stopping and restarting etanercept. Five patients withdrew and were classified as treatment failures, regardless of the reason for withdrawal.

The proportion of responders (defined as those achieving a PGA score of 0 or 1) was 5 of 20 (25%) at week 8, and 8 of 20 (40%) at week 12. Body weight appeared to play a role. Among the 14 patients who had a PGA score of 2 or less at week 12, the average weight was 198.4 pounds, compared with 217.6 pounds for the 6 who did not have that response.

Source: skinandallergynews.com

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I am starting fumaderm in the new year after trying all the creams, light treatment, methodrexine, cyclosporin, etc and having no luck! I found the side effects of the oral medication horrendous, and am hoping for better luck with this treatment!

Has anybody any helpful tips for a newbie?

Karo Bio AB (publ) has entered into a research collaboration agreement with Pfizer Inc., to discover and develop novel small molecule RORgamma modulators for the treatment of autoimmune diseases.

Under the agreement, Pfizer will provide full funding for the research costs and have the exclusive right to market any products that may be developed as a result of the collaboration. Karo Bio may receive up to USD $217 million in upfront and milestone payments in addition to potential royalty fees.

The nuclear hormone receptor RORgamma is a novel attractive target for the treatment of autoimmune diseases like rheumatoid arthritis, multiple sclerosis and psoriasis. RORgamma directly controls the production and secretion of the cytokine IL-17, a major contributor to inflammation. The receptor’s key role in driving disease pathology has been implicated through clinical studies using monoclonal antibodies that neutralize IL-17 activity.

Karo Bio has developed a proprietary RORgamma drug discovery program and has discovered novel, potent, and specific RORgamma modulators.

“We are delighted to collaborate on RORgamma with Pfizer and with the agreement in total. This partnership secures a pole position within this new and rapidly evolving area of autoimmune diseases. It also confirms the commercial value of Karo Bio’s leading position in the nuclear receptor drug development field”, says Per Bengtsson, CEO of Karo Bio.

“The central role of RORgt in Th17 cell differentiation coupled with the increasing clinical validation for the importance of IL-17 and other Th17-derived cytokines in autoimmune diseases, makes RORgt a compelling target,” says Jose-Carlos Gutierrez-Ramos, senior vice president, Biotherapeutics, Worldwide Research and Development, Pfizer. “Combining KaroBio’s deep expertise in nuclear hormone receptors with the world-class chemistry and cytokine immunology expertise of Pfizer has the potential to accelerate our drug discovery effort in this competitive area.” 

Source: karobio.com

Switching to adalimumab (Humira) in psoriasis patients who are not responding adequately to etanercept (Enbrel) is significantly more cost effective than escalating the etanercept dose, an analysis has shown.

During the first 6 months following the decision to either switch or escalate, 372 etanercept (Enbrel) dose escalators incurred an adjusted average of $2,451 more in incremental total health care costs than the $12,943 average in 728 patients who instead switched to adalimumab (Humira), Dr. Kim A. Papp reported at the annual congress of the European Academy of Dermatology and Venereology.

Switching to adalimumab in psoriasis patients who are not responding adequately to etanercept is significantly more cost effective than escalating the etanercept dose, an analysis has shown.

During the first 6 months following the decision to either switch or escalate, 372 etaner cept (Enbrel) dose escalators incurred an adjusted average of $2,451 more in incremental total health care costs than the $12,943 average in 728 patients who instead switched to adalimumab (Humira), Dr. Kim A. Papp reported at the annual congress of the European Academy of Dermatology and Venereology.

Source: skinandallergynews.com

I just got the bill for my next Stelara injection; I pay USD75 (about 57 euro), my insurance pays $11,292 (€8,648).

Now my employer has filed for chapter 11 bankruptcy, not only is my pension in jeopardy, who knows what the medical plan will look like next year.........

Psoriasis patients with nail disease have a greater magnitude of underlying systemic subclinical enthesopathy than those with normal nails according to new research.

Objective:
Enthesopathy is a major feature of psoriatic arthritis (PsA), which is supported by imaging studies. Given that nail disease often predates PsA and that the nail is directly anchored to entheses, the authors asked whether nail involvement in psoriasis equates with a systemic enthesopathy.

Methods:
Forty-six patients with psoriasis (31 with nail disease) and 21 matched healthy controls (HC) were recruited. 804 entheses of upper and lower limbs were scanned by an ultrasonographer blinded to clinical details.

Results:
Psoriasis patients had higher enthesitis scores than HC (median (range) 21 (0–65) vs 11 (3–39), p=0.005). Enthesopathy scores were higher in patients with nail disease (23 (0–65)) than in patients without nail disease (15 (5–26), p=0.02) and HC (11 (3–39), p=0.003). Inflammation scores of patients with nail disease (13 (0–34)) were higher than patients without nail disease (8 (2–15), p=0.02) and HC (5 (0–19), p<0.001). Modified nail psoriasis severity index scores were correlated to both inflammation (r2=0.45, p=0.005) and chronicity scores (r2=0.35, p=0.04). No link between the psoriasis area and severity index and enthesitis was evident.

Conclusion:
The link between nail disease and contemporaneous subclinical enthesopathy offers a novel anatomical basis for the predictive value of nail psoriasis for PsA evolution.

Source: ard.bmj.com

Background:
The reason psoriasis favours extensor skin is unknown. We hypothesized that psoriasis may involve extensor skin preferentially because of differences in the number or type of dermal dendritic cells (dDCs) between flexural and extensor skin.

Objective:
We sought to compare dDC type and distribution in normal-appearing flexural and extensor skin, psoriasis, and nummular dermatitis (ND).

Methods:
Using immunohistochemical markers, the number, distribution, and type of Langerhans cells, myeloid dendritic cells (DCs), and plasmacytoid DCs was compared in normal-appearing skin, psoriasis, and ND.

Results:
Significant differences in dDC density were not identified between flexural and extensor skin, although extensor skin contained fewer CD11a+ and CD11c+ cells. Compared with normal-appearing skin, cells expressing CD11a, CD11c, CD123, CD303, and CD207 were increased in psoriasis. ND lesions showed similar increases. No significant difference between psoriasis and ND was evident with the exception of decreased S100A6+ cells in psoriasis.

Limitations:
We did not study seasonal variation in DC density or assess nonlesional skin from patients with psoriasis.

Conclusions:
The data did not support the hypothesis that psoriasis favors extensor skin because of differences in DC localization. However, dDCs were significantly increased in psoriasis by comparison with normal-appearing skin, supporting existing evidence that they are involved in the overall pathogenesis of psoriasis.

Well firstly I don't think I spelt the name right lol

anyways...


some time ago (about 7yrs ago) pretty much most of my psoriasis cleared.
At that point in my life, I left my perents home, I started drinking alcohol most nights, I was stuck in a tiny room with my ex smoking LOTS of weed and his mates also, I was smoking fags like no tomorrow, I didn't give a second thought as to what I was eating and I can assure you apart from the odd orange juice it was all pretty much junk and sugar!!!

I left him...moved back home and yup psoriasis came back...

I moved out of home 2 years ago, at that point I stoppped my methotrexate and BAM my worst flare ever, wearing clothes (if I managed to dress myself) were painful :(

so I started cyclosprin, was on that for a year I stopped it in october and in septemember I started eating better and have also given up smoking for 2 months my lower lefs are just psoriasis, never had so much. My only saving grace is that it isn't thick at all!

Also I had P when I was 4yrs old and when in my teens just had it on my elbows.........I only ever ate sweets, like a whole bag of haribo for breakfast most days!!!! and my folks smoked all the time inside.

so if pagano is right surely I should be clearing now and should of had psoriasis worse than I do now in the times of my life that my lifestyle and diet were so bad!!!


My other issue is that the 7 yrs ago.....I had my 2nd lot of UVB previous and my psoriasis was comming back bad I was trying all sorts, I called the derm for an appointment and they said they would call me back Weeks had gone by with no call, so I just thought F'em they not helping. I still had loads of emotional stuff and was always thinking of killing myself.
but about a year or 2 after that point it started to clear by itself!!
Part of me can't help but feel maybe I should just grin and bare what my skin throws at me and not have UVB or any meds and see what happens!!


just thought I would share some of what I've been through!!

(also the whole nightshade thing.....I no thats it's all related to the deadly night shade etc....BUT if you think about it, if you ate an uncooked kidney bean that can make you really ill but cooked it's fine!!)