I am curious to know if I try some drugs (biologics etc.) for PsA and Ps and I stop them will I get a rebound flairup like I used to when I used topical steroid creams?

I have sworn off Cortisone forever and the way Dermatologists prescribe it by the tube after tube ad nauseum....I must have 8 tubes of this skin thinner and regret the way I have used way too much over the years. My wife who is a clinical Pharmacist warned me that skin damage would be the end result, but that's all they gave me by the bucket full. I now have been using the new non-Cortisonal," Tazarotene" cream at $75.00 US for 30 gram small tube, The gel of the same is over $700.00 US per tube thanks to Big Pharm. The Flesh on my elbow and knee is so thin it bleeds at will, leaving behind an angry red mess that seems to be the end of normal skin ever coming back. Thank You For This Forum and You Folks and my everlasting Rants, Best Regards...........

Johnson & Johnson release long-term data showing skin clearance, joint symptom relief, and safety of Tremfya (guselkumab)

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Johnson & Johnson today announced long-term data from the Phase 3 DISCOVER-2a study showing that the skin clearance, joint symptom relief, and safety of TREMFYA® (guselkumab) previously demonstrated through 24 weeks and one year (Week 52) in adults with active psoriatic arthritis (PsA) continued through two years (Week 112). These findings also confirmed that the robust efficacy TREMFYA demonstrated in patients at Week 24 on physical function, physical aspects of health-related quality of life, and resolution of enthesitis and dactylitis was also seen through Week 100. In addition, the extent of radiographic progression was studied through two years. These data will be presented virtually in abstract, poster, and video form during the Innovations in Dermatology: Virtual Spring Conference, March 16–20, 2021.1,2 TREMFYA is the first and only IL-23 inhibitor therapy approved in the U.S. to treat both adults with active PsA and adults with moderate to severe plaque psoriasis (PsO).

“PsA can be a chronically painful and debilitating disease, and many PsA patients are still searching for enduring relief of their symptoms,” said Philip J. Mease,e M.D., of the Swedish Medical Center/Providence St. Joseph Health and the University of Washington in Seattle, Washington and presenting author. “These data, which show that the observed benefits of TREMFYA in PsA continue through two years, represent positive news for physicians and patients alike.” 

Results showed that at Week 100:

Complete Skin Clearance: In patients who had clinically meaningful skin involvement at baseline, 59 percent of those receiving TREMFYA every four weeks and 53 percent of those receiving TREMFYA every eight weeks achieved complete skin clearance (Psoriasis Area Severity Index [PASI] 100; utilizing non-responder imputation [NRI], with this method of analysis, subjects with missing data are assumed to be non-responders).

Joint Symptom Improvement: Among randomized patients, 76 percent of those receiving TREMFYA and 74 percent of those receiving TREMFYA achieved at least 20 percent improvement in the American College of Rheumatology (ACR 20) response criteria (utilizing NRI).

Radiographic Progression: At Week 24, TREMFYA demonstrated statistically significant inhibition of radiographic progression of joint structural damage (p=0.011) (as measured by PsA-modified van der Heijde-Sharp [vdH-S scores]). TREMFYA afforded numerically, but not statistically significant, less radiographic progression (p=0.072) compared with placebo. From Week 52-100, low rates of radiographic progression of joint damage were observed in patients receiving TREMFYA (0.75) and TREMFYA (0.46), which were both further numerically reduced from the results observed during Weeks 0-52 (1.06, 0.99,). In the group of patients who crossed over from placebo to TREMFYA at Week 24, mean changes in vdH-S scores were 1.12 from Week 0-24 while receiving placebo, and 0.34 from Week 24-52 and 0.13 from Week 52-100 while receiving TREMFYA, indicating that further numerical improvements were also made through Year Two in this group.

Durability: Robust joint and skin response rates and mean improvements from baseline in outcome measures were maintained through two years, and approximately 90 percent of patients randomized to TREMFYA continued treatment with TREMFYA through Week 100.

Safety: No new safety signals were observed in the safety analysis conducted through Week 112. TREMFYA safety in patients with active PsA through two years was comparable to safety at six months and one year and generally consistent with TREMFYA safety in patients with moderate to severe plaque PsO.

In addition, results showed 56 percent of TREMFYA patients and 55 percent of TREMFYA patients achieved at least 50 percent improvement in ACR score (utilizing NRI). Among patients who had clinically meaningful PsO at baseline, 62 percent of TREMFYA 4 week patients and 55 percent of TREMFYA 8 week patients achieved complete skin clearance as measured by the Investigator Global Assessment (IGA) score of 0 (utilizing NRI).

My question is about inverse psoriasis, I have had for 4 years. I have read about numerous help for this, from powders to ointments. what is the point here, Keep area dry or moist ? Thank you

In a discussion in Which of these treatments have you used for psoriasis ?, we bumped into the coal tar business.
And well, I was wondering: “Why does coal tar work for psoriasis?”
What does it exactly do?
What is the specific ingredient that does the work.
Dave already said in RE: Which of these treatments have you used for psoriasis ?, that it works, seems to work. Fred is doubting that it does much.
Perhaps there are more who have experienced coal tar?

I did some searching already but even the “official” site tell about coal tar that is a good treatment, but nowhere there is an explanation of why it works. There is even a suspected drawback in that it can cause cancer (I am not surprised by that, tar contains PAC’s Polycyclic Aromatic Hydrocarbons which are known for that).

Of all other treatments, corticosteroids, systemics, light, biologicals, we know what it exactly does. But coal tar ?? I (seems to) works.

Who can enlighten this subject ?

This study compared fumaric acid esters with placebo in young patients aged 10–17 years with moderate‐to‐severe plaque psoriasis.

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Background:
Apart from biologics, no systemic drugs are approved in Europe for children with moderate‐to‐severe psoriasis. Retrospective observational studies have shown promising results for fumaric acid esters (FAE) in this setting.

Objectives:
To show superiority of FAE over placebo in terms of treatment response after 20 weeks in children and adolescents aged 10–17 years.

Methods:
In a multicentre, randomized, double‐blind, placebo‐controlled phase IIIb study, patients aged 10–17 years with moderate‐to‐severe plaque psoriasis requiring systemic therapy were randomized 2 : 1 to receive FAE (n = 91) or placebo (n = 43) over 20 weeks, followed by an open‐label FAE treatment phase. The coprimary endpoints were ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) and Physician’s Global Assessment (PGA) score of 0 or 1 (clear or almost clear) at week 20. The study was registered with EudraCT number 2012‐000035‐82.

Results:
At week 20, 55% [95% confidence interval (CI) 0·44–0·65] of FAE‐treated patients achieved a PASI 75 response vs. 19% (95% CI 0·08–0·33) in the placebo group (absolute difference 36%, 95% CI 0·20–0·53; P < 0·001). In total, 42% (95% CI 0·32–0·53) in the FAE group vs. 7% (95% CI 0·01–0·19) in the placebo group achieved a PGA score of 0 or 1 at week 20 (absolute difference 35%, 95% CI 0·21–0·49; P < 0·001). During the double‐blind period, drug‐related adverse events occurred more frequently in patients receiving FAE compared with placebo (76% vs. 47%). Gastrointestinal disorders were the most common adverse events.

Conclusions:
FAE administered over a period of 20 weeks demonstrated a better response than placebo; the difference was statistically significant and clinically meaningful. Application up to 40 weeks was generally well tolerated. However, further studies are required.

Which of these treatments have you used for psoriasis ?

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Hi, 
I’m sandy. I’ve been dealing with psoriasis since I was 12. I cried about it because I didn’t know what was wrong with me . I got it on my scalp and my parents never had it . I then had a terrible out break on my entire body. It made me feel so ugly and ashamed . I didn’t want anyone to look at me . I got treated and after a few years Enbrel stopped working for me. I got sick with Covid and my psoriasis had the worst reaction ever and I’m in the worst skin episode I’ve ever had . My entire body and face is covered . I recently broke up with my boyfriend because I didn’t want him to see my face or body. I’m 23 years old and I feel so ashamed of myself... I joined this page because I want to be around more people who are suffering with this. 

We are in this together guys .
Xoxo

This study looked at the significance of chronic pruritus for intrapersonal burden and interpersonal experiences of stigmatization and sexuality in patients with psoriasis.

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Background:
60–90 % of patients with psoriasis suffer from pruritus and 65 % report itching as one of the most burdensome symptoms, raising significant quality of life (QoL) impairments. However, pruritus is not only an intrapersonal symptom but also a psychosocial interactive phenomenon and little is known about the effects of itching on interpersonal experiences.

Objectives:
This study aimed to compare the disease burden and patient needs between patients with none/mild vs. moderate/severe pruritus, and to examine the impact of disease parameters and intrapersonal burden on perceived stigmatization and sexual relationships.

Methods:
This cross‐sectional study included German patients aged ≥ 18 years with psoriasis vulgaris. Disease severity was assessed with PASI (Psoriasis Area and Severity Index); patients reported on intensity of pruritus, skin‐generic and pruritus‐specific QoL, patient needs and benefits, anxiety and depression symptoms, dysmorphic concerns, perceived stigmatization and sexual dysfunction.

Results:
107 patients with psoriasis participated (mean age = 46.3 ± 14.6 years; 52.3 % male): 64 with none/mild pruritus (NRS ≤ 3) and 43 with moderate/severe pruritus (NRS ≥ 4). Patients with moderate/severe pruritus reported more QoL impairments, depression and anxiety symptoms and dysmorphic concerns, but less treatment benefits, than those with none/mild pruritus. The patient needs most frequently rated as “very/quite important“ were: “be healed of all skin defects“ (88.8 %), and “be free of itching“ (87.0 %), with no differences between the groups. Younger age, disease severity, frequency of scratching behaviors, dysmorphic concerns and treatment benefits were positively associated with stigmatization experiences; disease severity, sleeping problems and skin‐generic QoL impairments were positively associated with sexual dysfunction.

Conclusions:
Pruritus induces significant burden in patients with psoriasis. Along with disease severity, intrapersonal burden has a great impact on social and dyadic relationships. Treatment choices that are effective in reducing pruritus should be prioritized in patient‐centered healthcare.

Hi
Just wanted to share what I did to cure my psoriasis.
The doctor said no cure.
so I decided to find ways to cure myself.
1. I have observed that its like superficial wounds
2. Scented soap makes it worst like its refreshed and angry.

Base On this observation.
I concluded to treat it as a wound.

Cure process:
1. Acquire Guava leaves (I know most of you have no access to this leaves.) It grows in Tropic countries.
Guava leaves is used to treat wounds here in our country.
2. Acquire Cheep papaya soap not scented sold in the streets in my country. (may not be available in your country.)

1* Boil the Guava leaves till the water is like a tea may be boiled multiple time (not for drinking)
when taking a bath use the water from guava leaves to rinse papaya soap. (should be used as final rinsing)
Do This till you see results.. may take weeks, months, never years.

I know how hard it is to deal with this stuff everyday as a teenager.
I was even bullied. saying I would kill my self if I was in your situation.

Try it worked for me. Might work for you too.

Hello to all! Very happy to find this page since I am new to this diagnosis!  Background story: I am a full time RN who just got done battling a rare form of ovarian cancer, diagnosed in 2015.  My attention, of course, was on the cancer and subsequent surgeries, not the achy joints and mild itchy, flaky scalp! Fast forward to April 2019, after a final surgery (hysterectomy) and surgically induced menopause, I was finding myself with an extremely itchy scalp.  My dermatologist, whom I see yearly for full body checks, believed it was cause by the menopause.  Several prescription shampoos later, it not only persisted but became worse when COVID hit us full force in March of 2020!  My dermatologist group then looked into my achy joints and sore feet history further, put two and two together and bam! psoriatic arthritis!   So now I am at the end of week 4 of Otezla and I am feeling like the main side effects (nausea, diarrhea, tiredness/depression and headaches) might be decreasing for the most part. The headaches are terrible some days but I am thinking they may also be related to my daily use of N95, surgical mask and goggles required during my entire 12 hour shift on a cardiac/neuro unit.    The doctor said I also may experience weight loss (I wish!), I have noticed a weight gain!     So I am not sure if I am simply experiencing the perfect storm of menopause, work stress and psoriatic arthritis....or are these all side effects of this med?  Have any of you tried this med and if so, what side effects did you experience?  
*side note* I thankfully no longer have to vacuum my car out daily due to all of the flakes coming off of my scalp!  I will take a win wherever I can at this point!
I am thankful for finding this group and am looking forward to some good conversations!

Nancy

How well do you feel your family support you with psoriasis ?

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Hi, been fighting since 1980, tried it all. After 2 shots of Taltz it went away, . I was covered 60 % of my body. The shot is painful, but only for 1 min. Well worth it. 

The objective of this study was to illustrate a statistical conversion method that was developed to derive absolute PASI values from available clinical trial data on relative PASI improvements.

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Background:
In practice, the goal of treatment for patients with psoriasis is to achieve almost clear or clear skin and maintain disease control, regardless of baseline disease severity. However, identifying absolute Psoriasis Area and Severity Index (PASI) values for new treatment goals is challenging, as most clinical trials report relative PASI 50, 75, 90 or 100 improvements but rarely absolute PASI values achieved.

Objective:
Our objective was to illustrate a statistical conversion method that was developed to derive absolute PASI values from available clinical trial data on relative PASI improvements. The results of network meta‐analyses (NMAs) based on these derived data were then compared with those of NMAs based on the corresponding relative PASI improvement data for selected biologics for moderate‐to‐severe psoriasis.

Methods:
The PASI statistical conversion method was applied to relative PASI improvement data for 11 biologic treatment regimens and placebo at 12 weeks using data from 50 published studies. The respective proportions of patients reaching absolute PASI values ≤1, 2, 3 or 5 were then calculated. Frequentist NMAs (Rücker method) were subsequently used to compare efficacy results across relative and absolute PASI data.

Results:
The ranking of included treatment regimens for patients achieving absolute PASI 0 to 8 was aligned with results for relative PASI scores (from 100 to 60) at end of induction therapy. Across the range of PASI scores considered, the most effective treatment regimens based on both absolute and relative PASI NMAs were brodalumab 210 mg every 2 weeks and ixekizumab 80 mg every 2 weeks, followed by guselkumab 100 mg every 8 weeks and risankizumab 150 mg every 12 weeks.

Conclusion:
Data generated using this mathematical model will be useful to inform ongoing scientific discussions on treatment goals in the absence of primary absolute PASI data for all available treatments for moderate‐to‐severe plaque psoriasis.

Phase 3 results of efficacy and safety of two Cosentyx (secukinumab) dosing regimens low dose (LD) and high dose (HD) in children with severe chronic plaque psoriasis over one year.

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Background:
Secukinumab has demonstrated sustained long‐term efficacy with a favourable safety profile in various psoriatic disease manifestations in adults.

Objectives:
Here, the efficacy and safety of two secukinumab dosing regimens [low dose (LD) and high dose (HD)] in paediatric patients with severe chronic plaque psoriasis over one year are reported.

Methods:
In this multicentre, double‐blind study (NCT02471144), patients aged 6 to <18 years with severe chronic plaque psoriasis were stratified and randomized by weight (<25 kg, 25 to <50 kg, ≥50 kg) and age (6 to <12 years, 12 to <18 years) to receive low‐dose (LD: 75/75/150 mg) or high‐dose (HD: 75/150/300 mg) subcutaneous secukinumab or placebo or etanercept 0.8 mg/kg (up to a max of 50 mg).

Results:
Overall, 162 patients were randomized to receive secukinumab LD (n = 40) or HD (n = 40), etanercept (n = 41) or placebo (n = 41). The co‐primary objectives of the study were met with both secukinumab doses (LD and HD) showing superior efficacy compared to placebo (P < 0.0001) with respect to PASI 75 response (80.0%, 77.5% vs. 14.6%) and IGA mod 2011, 0 or 1 response (70%, 60% vs. 4.9%) at Week 12. Both secukinumab doses were superior to placebo (P < 0.0001) with respect to PASI 90 response at Week 12 (72.5%, 67.5% vs. 2.4%). The efficacy of both doses was sustained to Week 52 with secukinumab achieving higher responses vs. etanercept (PASI 75/90/100: LD, 87.5%/75.0%/40.0% and HD, 87.5%/80.0%/47.5.% vs. etanercept, 68.3%/51.2%/22.0% and IGA 0 or 1: LD, 72.5% and HD, 75.0% vs. etanercept, 56.1%). The safety profile of secukinumab was consistent with the adult Phase 3 studies, with no new safety signals identified.

Conclusions:
Both doses of secukinumab demonstrated high and sustained efficacy up to Week 52 with a favourable safety profile in paediatric patients with severe chronic plaque psoriasis.

This phase 3 study investigate the long‐term safety, efficacy, and maintenance of response with halobetasol propionate (HP) and the retinoid tazarotene (TAZ)  lotion.

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Background:
The topical corticosteroid halobetasol propionate (HP) and the retinoid tazarotene (TAZ) are effective in psoriasis treatment. To mitigate adverse cutaneous reactions observed with monotherapy, a fixed‐combination HP 0.01%/TAZ 0.045% lotion has been developed for the treatment of plaque psoriasis in adults.

Objectives:
To investigate the long‐term safety, efficacy, and maintenance of response with HP/TAZ lotion.

Methods:
This was a 1‐year, multicenter, open‐label study in 555 adults with psoriasis (Investigator’s Global Assessment [IGA] score of 3 [“moderate”] or 4 [“severe”] and body surface area [BSA] of 3‐12% at baseline). HP/TAZ was administered once daily for 8 weeks and then intermittently as needed in 4‐week intervals for up to 1 year based on achievement of treatment success (IGA score of 0 [“clear”] or 1 [“almost clear”]). Maximum continuous exposure was 24 weeks.

Results:
Of 550 participants with post‐baseline safety data, 318 (57.8%) achieved treatment success during the study. Of those, 54.4% achieved treatment success within the first 8 weeks; retreatment was not required for >4 weeks in over half (55.3%), and 6.6% did not require any retreatment. Among participants enrolled for the full 52 weeks, 77.5% maintained BSA ≤5% on treatment. There were marked improvements in severity of itching, dryness, and burning/stinging over the study course. The most common treatment‐related adverse events were application site reactions of dermatitis, pruritus, pain, and irritation.

Conclusions:
Fixed‐combination HP/TAZ lotion provided maintained efficacy with a favorable tolerability and safety profile, supporting its use for the long‐term treatment and management of moderate‐to‐severe plaque psoriasis.

This phase three study compared Skyrizi (risankizumab) with Fumaderm (fumaric acid esters)

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Background:
In a phase 3 clinical study, patients from Germany with moderate to severe psoriasis who were naïve to systemic treatment and received risankizumab had greater and more rapid disease improvements compared with those who received fumaric acid esters (FAEs).

Objective:
To evaluate patient‐reported outcomes (PROs) in patients treated with risankizumab compared with FAEs.

Methods:
Adult patients were randomized 1:1 to receive either risankizumab 150 mg subcutaneous injections at Weeks 0, 4, and 16 or FAEs (Fumaderm®) provided according to the prescribing label. PRO secondary endpoints assessed were Psoriasis Symptom Scale (PSS), Dermatology Life Quality Index (DLQI), 36‐Item Short Form Health Survey, version 2 (SF‐36v2), Patient Benefit Index (PBI), Hospital Anxiety and Depression Scale (HADS), Patient Global Assessment (PtGA), and European Quality of Life 5 Dimensions 5 Level (EQ‐5D‐5L). PROs were assessed at Weeks 0, 16, and 24.

Results:
Sixty patients each were randomized to receive risankizumab or FAEs. A significant PSS improvement was observed with risankizumab versus FAEs at Weeks 16 and 24 for total and psoriasis‐associated redness, itching, and burning scores (P<0.001). DLQI scores were significantly lower (reflecting better health‐related quality of life) with risankizumab versus FAEs, with least squares (LS) mean differences of −7.4 and −7.6 at Weeks 16 and 24, respectively (both P<0.001). Patients randomized to risankizumab also had larger improvements in SF‐36 Physical and Mental Component Summary scores, HADS anxiety and depression scores, PtGA, and EQ‐5D‐5L index and visual analog scale scores (all P≤0.002) at Weeks 16 and 24 compared with FAEs. PBI was significantly higher, indicating greater benefit, with risankizumab versus FAEs, with an LS mean difference of 1.1 and 1.3 at Weeks 16 and 24, respectively (both P<0.001).

Conclusions:
Risankizumab provides significant benefits over FAEs in improving PROs across several dimensions in patients with moderate to severe psoriasis.

Sun Pharma announces initiation of Phase 2 Clinical Trial of SCD-044 in Patients with Moderate to Severe Plaque Psoriasis.

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Sun Pharmaceutical today announced that it has initiated Phase 2 clinical trial for SCD-044 (a novel,orally bioavailable sphingosine-1-phosphate(S1P) receptor 1 agonist) in patients with moderate to severe plaque psoriasis.

The Phase 2 study is a randomized, double-blind, placebo-controlled study to assess the efficacy and safety of SCD-044 in the treatment of moderate to severe plaque psoriasis.The study will enrol approximately 240 subjects and topline results are expected in 2022.

SCD-044 is a novel orally bioavailable S1P receptor 1 agonist for the treatment of inflammatory diseases such as atopic dermatitis and psoriasis. S1P receptor 1 agonists are promising for the treatment  of  autoimmune  inflammatory  diseases  as  they  cause  diminished  migration  of lymphocytes out of lymphatic tissue.

This results in a decrease of circulating lymphocytes, thereby reducing inflammation. A Phase 1 study of SCD-044 has been completed in healthy volunteers. This study established clinical  proof-of-concept  for  SCD-044in  terms  of  its safety  and pharmacodynamic  effects. Lymphocyte  count  reduction, a  surrogate  marker  of  efficacy forS1P receptor 1 agonists, was observed at all dose levels evaluated.

Skyrizi (risankizumab) Phase 3 Results Demonstrate Improvements in Disease Activity Across Joint and Skin Symptoms Among Psoriatic Arthritis Patients.

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AbbVie today announced positive top-line results from two Phase 3 studies in adults with active psoriatic arthritis, KEEPsAKE-1 and KEEPsAKE-2, showing that significantly more patients treated with risankizumab (150 mg) achieved the primary endpoint of ACR20 response at week 24 versus placebo. In KEEPsAKE-1 and KEEPsAKE-2, 57 and 51 percent of patients receiving risankizumab achieved ACR20 response at week 24, respectively, versus 34 and 27 percent receiving placebo (p<0.001).

Results of ranked secondary endpoints showed significant improvements in skin clearance (as measured by at least a 90 percent improvement in Psoriasis Area Severity Index [PASI 90]), physical function (as measured by the Health Assessment Questionnaire Disability Index [HAQ-DI]) and minimal disease activity (MDA) at week 24. These two Phase 3 studies evaluated risankizumab in adult patients with active psoriatic arthritis, and included patients who had responded inadequately or were intolerant to biologic therapy and/or non-biologic disease-modifying anti-rheumatic drugs (DMARDs).

"We are encouraged by these positive results showing the potential of risankizumab in psoriatic arthritis," said Michael Severino, M.D., vice chairman and president, AbbVie. "These results underscore our commitment to research that can provide health care practitioners with important treatment options for patients with psoriatic disease."

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