Hello everyone. I have been diagnosed recently with Pamoplanter p. Prescribed Acitretin and also waiting on apt for uv treatment. Prior to this using topical steroids and oral steroids for really bad episodes. Only 4-days on acitretin tabs and am hopeful they will, along with uv, work.

Protopic as far as I know is not prescribed for psoriasis but I thought this may be of interest to some as it gets 15 thread results in a search on the forum.

A leading French medical journal Prescrire has said that Protopic has disproportionally undesirable effects that include skin cancer and Lymphoma, also termed lymphatic cancer and are warning people to avoid it.

Hi All! My name is Fred and I suffer from Psoriasis. 

I've had it for about 6 years now and it has been getting progressively worse and worse. I'm a 49 year old male. Have been seeing a good dermatologist PA for years. His office practice sucks but he's one of the most caring and helpful people I've had the pleasure of meeting. 

My condition is unique from what my derm tells me. Rather than having it in one spot I have it in many many spots all over my body. Small red spots on my thighs, arms, belly, and oh boy my back. The worst was my head. LARGE flakes always coming from there. They were typically raised and very scaly. I flaked all of the time. They were also itchy. Often scratched myself to bleed. No fun.

Anyway, I tried Stelara last year. Took it in April. Two shots to start. Started to see results in about 2 months. I was pleased! Then, I got a single shot to follow up and a short time later I noticed that my plaque was back. Each shot after did nothing to help really. At $19,000 a shot through my insurance I was clearly disappointed. I took my last Stelara shot on December 7th 2017.

My derm had been working to get me approved for Taltz. I just took my first two doses of Taltz on January 12th. One in the arm and one in my belly. It hurts like hell (I guess I'm a wimp) going in. You need to really press that button to make it work and to me it goes in slow. That last click takes a while. 

The good news though is things have been GREAT. I am seeing TREMENDOUS effect from it. My head is smooth as is behind my ears. No flaking from the scalp. All of my patches are reduced or nearly gone! I can't believe how fast. 

Today though, about a week and a half after the two starters I developed a raised red rash around the injection sites. They are somewhat itchy and painful to the touch. Some googling around lead me here and it appears that this is somewhat common. My derm told me to watch it and see if it spreads beyond what I see now. Also asked me to watch for any other symptoms like nausea, fever, and fatigue. Said he might want me to go get some blood work just to be safe.

Anyway, I am due to take my next single shot Friday the 26th. He told me to do it in the fatty portion of my leg and to avoid the other two areas. More than willing to share my results down the road if there is interest.

Thanks for reading!

Update: 1/28/2018

Just as an update for anyone who might be interested. The swelling and rash has gone down on my arm and on my belly were my first two injections went on the 12th. Last Friday I gave my injection in the fatty part of my thigh. This time I did let the medicine sit out for approximately 45 minutes before I administered. Unfortunately this time it would appear that the pain and swelling came within hours of the injection and is in fact still there. The central part of the raised area is nearly purple and hot to the touch. I’m taking Benadryl per recommendation of my derm and also Advil to try to reduce the pain. Honestly, I’m currently contemplating whether this is all worth it.

Hi, I'm a new member. I am 55 years old and my first outbreak of psoriasis was when I went to university at 18. Since then I have had the usual range of treatments but always stuck to topical remedies and one course of uvb. To date I have been lucky as my psoriasis has never itched too much and I had learned to live with it. Apart from applying diprobase 2 time a day I did little else. Last summer it disappeared completely and I thought that I had got rid of it! Unfortunately it came back with a vengeance in october and vaseline was the only way I could moisturise it sufficiently. I resorted to vaseline at the end of the year and it started to clear up. Around this time I developed some very itchy bumps on my shoulders and back. There are not very many but they itch like crazy. I have applied betnovate to calm them down a little and have an appointment with a dermatologist in a couple of weeks. I think that the vaseline may be responsible as it can cause heat rash type symptoms but the itchy bumps have been there almost a month now. has anybody else experienced something like this?? Thanks.

hello out there to all my new ichy friends

This study looked at 10 years of real-world data on the effectiveness of biological treatments for psoriasis.

Quote:

---

Background:
Few studies have analysed the long-term effects of biological treatment in psoriasis. PsoReg, the Swedish national register for systemic psoriasis treatment, started in 2006 and now includes 10 years of real-world data on the effectiveness of biological treatment.

Objectives:
To analyse the long-term real-world outcome data of patients who are biologically naïve with moderate-to-severe psoriasis after switching to biological treatment.

Methods:
An observational study of patients who are biologically naïve with at least one registration of outcome before switching to biological treatment while included in PsoReg and at least one follow-up visit. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI) and EuroQol-5D (EQ-5D) values were analysed at 3–5 months, 6–11 months and at least once after ≥ 1 year, up to 9 years after the switch to biological treatment.

Results:
In total, 583 patients fulfilled the inclusion criteria. Of these, 399, 395 and 373 patients had observed outcome data beyond 1 year on the PASI, DLQI and EQ-5D, respectively, and 164, 168 and 152, respectively, were observed in at least three time periods after the switch. Significant (P < 0·01) improvement in PASI, DLQI and EQ-5D scores was observed 3–5 months after the switch and sustained under the whole observation period. The mean PASI, DLQI and EQ-5D changed from 13·5 ± 9·1, 9·0 ± 8·1 and 0·74 ± 0·22, respectively, before the switch, to 4·0 ± 3·5, 3·7 ± 4·7 and 0·79 ± 0·21, respectively, 1–5 years after the switch.

Conclusions:
Biological treatment, as used in clinical practice, shows a stable long-term effectiveness in all the measured dimensions, PASI, DLQI and EQ-5D.

This study tried to evaluate the safety of psoriasis biological treatments in conception and/or pregnancy.

Quote:

---

Background:
Biological therapies are effective treatments for psoriasis and are often prescribed to women of child-bearing age.

Objectives:
To evaluate the safety of biological therapy in conception and/or pregnancy.

Methods:
We performed a systematic review of pub med, Medline, Embase and Cochrane databases for multivariate-adjusted studies of women exposed to biologics relevant to the treatment of psoriasis during conception and/or pregnancy.

Results:
We identified four population-based cohort studies involving 1300 women exposed to tumour necrosis factor (TNF)-α inhibitors (TNFi) 3 months prior to or during the first 3 months of pregnancy. These studies showed a trend towards drug-specific harm with TNFi exposure in women with different inflammatory diseases, with an increased risk of congenital malformations [three studies; odds ratio (OR) range 1·32–1·64] and preterm birth (one study; OR 1·69, 95% confidence interval 1·10–2·60). This trend did not reach statistical significance in all studies; study heterogeneity, variation across comparator cohorts, inadequate adjustment for important confounding variables such as co-therapy, and an absence of a common constellation of malformations means there is uncertainty about the causal role of TNFi. No studies specifically addressed the effect of TNFi exposure in psoriasis during conception and/or pregnancy, or of interleukin (IL)-17 and IL-12/23 antagonists in any indication.

Conclusions:
When counselling women these findings must be balanced against the potential impact of untreated severe psoriasis on conception and/or pregnancy and maternal wellbeing; ongoing pharmacovigilance via registries remains essential to address this evidence gap.

This study investigated the risk of cancer in patients with psoriasis treated with biological therapy.

Quote:

---

Background:
Biological therapies are highly effective in psoriasis, but have profound effects on innate and adaptive immune pathways that may negatively impact on cancer immunosurveillance mechanisms.

Objectives:
To investigate the risk of cancer in patients with psoriasis treated with biological therapy.

Methods:
We searched Medline, Embase, and the Cochrane Library (up to August 2016) for randomized controlled trials, prospective cohort studies and systematic reviews that reported cancer incidence in people exposed to biological therapy for psoriasis compared with a control population.

Results:
Eight prospective cohort studies met our inclusion criteria. All the evidence reviewed related to tumour necrosis factor inhibitors (TNFi) with the exception of one study on ustekinumab. An increased risk of nonmelanoma skin cancer (NMSC), particularly squamous cell carcinoma, was reported with TNFi compared with both a general United States population and a rheumatoid arthritis population treated with TNFi. No evidence for increased risk of cancers (reported as all cancers, lymphoma, melanoma, prostate, colorectal and breast cancer) other than NMSC was identified.

Conclusions:
There were important limitations to the studies identified including choice of comparator arms, inadequate adjustment for confounding factors and failure to account for latency periods of cancer. There remains a need for ongoing pharmacovigilance in relation to cancer risk and biological therapy; the NMSC signal requires further investigation to determine the risk specifically attributable to biological therapy using prospectively collected data with adjustment for known NMSC risk factors.

Hello
I am new to The forum. 
A week and a half ago I started Fumaderm. Early days i know.
I moved to 2, 30mg tablets on Tuesday. I took them at night and woke up the next day bright red. It didn't last long and I was my normal colour by 1. 
I let the doc know and they called me in for a look but I was back to nirmal. 
They could not explain this. They said maybe it was flushing and told me to take the tabs at separate times.
Nothing happened Thursday
Today I took a tablet at 630. I had my dinner at 830. At 945 my skin went insane. I felt hot and sore and mad itchy. When I looked i had once again turned pink from head to toe
I was just wondering if anyone else has experienced flushing like this. It is still going at the moment and i am on fire.
The doctor seemed to think flushing was only face and chest... Anyone else has whole body redness??
Thanks in advance
Cheers ☺

I thought it would be interesting to have a poll asking what people thought is the worst part of the body to have psoriasis. I don't think it's worth making the poll multi choice as we will probably tick all the boxes, so I have made it single answer.

Obviously anywhere to have psoriasis is a bad thing, but if you had to pick one what is the worst part of the body for you to have psoriasis ?

The poll is open to members and guests with no closing date.

Members are also welcome to post in this thread if they wish.

This study looked at the economic burden of psoriasis in German patients.

Quote:

---

Background:
Though psoriasis poses a substantial chronic socio-economic burden, few studies have addressed the economic impact in Germany.

Objectives:
The objective was to evaluate the annual costs of psoriasis in Germany from the societal perspective.

Methods:
A cross-sectional study was performed in randomly selected German dermatology practices and clinics in 2013/2014 using standardized questionnaires of illness-related costs. Costs were grouped by perspective and category as well as analysed by sex and age. Group differences were tested by non-parametric tests.

Results:
Complete data were obtained from 1158 patients in 132 centres. Annual average costs for patients with psoriasis: total costs € 5543 ± € 8044, systemic treatment costs (paid by the statutory health insurances [SHI]) € 3733 ± € 7322, out-of-pocket costs € 224 ± € 406, total SHI costs € 4940 ± € 7533, direct costs € 5164 ± € 7581 and indirect costs € 379 ± € 2087. Significant higher costs in male and significant lower costs in 65+-year-old patients were found.

Conclusions:
Psoriasis induces a considerable economic burden. Between 2003 and 2014, costs have markedly shifted from hospital, out-of-pocket and indirect costs towards systemic drug costs.

This study suggest that smartphone overuse could speed up the possible development of psoriatic arthritis.

Quote:

---

Background:
Distal interphalangeal (DIP) arthritis is a frequent form of psoriatic arthritis being often linked to nail psoriasis. Modern society is characterized by overuse of smartphones. Indeed, literature has recently focalized on research into smartphone addiction and health-related problems.

Objectives:
As smartphone addiction is able to determine overuse and repeated movements of DIP joints and nails, the aim of this study was to evaluate the impact of smartphone use on hand joints of young psoriatic patients.

Methods:
An observational study involving four different groups such as non-smartphone-addicted (SA) psoriatic patients, SA psoriatic patients, non-SA controls and SA controls was performed. Each subject underwent an ultrasound examination of both hands by three independent and blinded to group assignment radiologists. A specific score was used to evaluate the inflammatory state of the analysed joints.

Results:
The total ultrasound score was statistically significantly higher in SA controls respect to non-SA controls (3.4 vs. 1.4; P < 0.05) as well as in SA psoriasis patients compared to non-SA psoriatic subjects (15.2 vs. 6.7; P < 0.01). Higher mean of ultrasound score was found for left hand in controls (both SA or not) and for right hand in psoriatic subjects (both SA or not), however without reaching statistical significance.

Conclusions:
Smartphone overuse was found to be linked with higher signs of inflammation of musculoskeletal structures of hands joints in both psoriasis and controls through ultrasound examination. Therefore, smartphone overuse may be a factor which facilitate or speed up the possible development of psoriatic arthritis.

This study looked at the impact of Taltz (ixekizumab) on facial psoriasis and related quality of life measures in moderate-to-severe psoriasis patients.

Quote:

---

Background:
Facial psoriasis was reported in 17–68% of patients with psoriasis and shown to have a negative impact on patients’ personal and health-related quality of life (HRQoL).

Objectives:
To explore the association of facial psoriasis with patients’ HRQoL and to assess the relationship between ixekizumab (IXE) and improvement in facial psoriasis and changes in HRQoL.

Methods:
This work reports the combined results of two phase III multicentre, randomized, double-blind, placebo-controlled, active-comparator trials in patients with moderate-to-severe psoriasis. Patients received placebo, etanercept (ETN; 50 mg twice weekly) or IXE [80 mg every 4 weeks (Q4W) or every 2 weeks (Q2W)] for up to 12 weeks following an initial 160-mg dose. HRQoL parameters were analysed based on facial psoriasis status at baseline using analysis of covariance models. Improvement was assessed as percentage of patients with no facial psoriasis.

Results:
The combined database included 1133 patients with facial psoriasis and 1437 without. Patients treated with IXE whose facial psoriasis cleared had improved Dermatology Life Quality Index 0.1 responses (P < 0.01) compared with patients with facial psoriasis at Week 12. At Week 12, clearance of facial psoriasis compared with the presence of facial psoriasis was independently associated with significantly better improvement in Psoriasis Skin Appearance Bothersomeness scores in the IXE Q2W treatment group (P < 0.01). At Week 12, facial clearance and overall Psoriasis Area Severity Index (PASI) improvement were observed in significant numbers of patients treated with IXE compared with ETN and placebo. Facial psoriasis clearance at Week 12 in patients treated with IXE or ETN was positively associated with PASI75 and PASI90 achievement.

Conclusion:
Facial psoriasis had a larger negative impact on HRQoL than no facial psoriasis. Facial psoriasis clearance was associated with improved HRQoL. Significantly more IXE-treated patients had rapid facial clearance vs. ETN and PBO, which led to better clinical outcomes.

I got the call today that I will able to get Stelara. I'll get a call soon to set up the appointment. For some reason they will not let me self inject and said it would be done in the doctor's office, however, due to insurance (more on that later in another thread so as not to take this one off topic) it will be done at the hospital. The dermatologist will still do the follow ups and be the one primarily taking care of things.

I'm excited and a teeny bit nervous ( but not of the injection.) So, I'll be joining the Stelara Bandwagon soon and I'll post injection dates with reactions to them and progress made (or not) in this thread.

hi 
i just want to share my exp with  Exemptia Adalimumab mad in india

i am on first month now with exemptia since humira is cost 1900 usd  7000 aed
tell i got exemptia
i am now in exemptia with almost 50% recovery and its only 1 month and half 
if u cannot go for humira ask your doc about the exemptia  cost 245 usd 900 aed  i think u can find it in dubai  not sure
but for me its workeing  like a charm
ask your doc about it and i hope its worked for you

Hi

I'm not quite sure how I go about deleting an account on this forum?  Anybody know how it can be done?

Cheers

Kit

This multinational dermatologist and psoriasis patient study looked at the burden of psoriasis.

Quote:

---

Background:
Psoriasis is a chronic, immune-mediated disease, characterised by symptoms that include itching and skin pain and is often associated with comorbidities. Patients have a substantial detriment to quality of life (QoL) and work productivity with associated cost burden.

Objective:
To investigate the incremental burden of comorbidities, itch, and affected body areas among systemic eligible patients with psoriasis, using a multinational survey of dermatologists and their psoriasis patients.

Methods:
Multinational data from the Growth from Knowledge (GfK) Disease Atlas global real-world evidence programme were used. Eligible patients were identified as those who were currently having or had ever had moderate-to-severe psoriasis, and must have been receiving prescription treatments at the time of the survey. Multivariable regression analyses were conducted to assess the incremental burden among psoriasis patients with physical and psychological comorbidities, itch, and affected visible and sensitive body areas versus psoriasis patients without these conditions, respectively.

Results:
The study enrolled 3,821 psoriasis patients, from 9 countries, with an average Psoriasis Area and Severity Index score of 6.4. The presence of comorbidities was associated with a significant increase in the likelihood of skin pain, lower QoL, greater work impairment and increased usage of medical resources (except in psoriasis patients with obesity and type II diabetes). Psoriasis patients suffering from itch and those with visible and sensitive affected body areas also had impaired QoL versus those without these conditions.

Conclusion:
Psoriasis patients with physical and psychological comorbidities, itch and, affected visible and sensitive body areas had lower QoL, and greater work impairment compared to those without these conditions.

Hi, I have been reading the forum as a guest for a few years now and decided it was time to try and add something to the debate. I am a 59 year old man and have have plaque and nail psoriasis for around 20 years.
I noticed there is not much history of Apremilast (Otezla) use and I have recently started on it so might be able to add something. 
For what it's worth a short history of my treatments is as follows; 
Various creams - not very effective.
PUVA - worked quite well and I got a home lamp made from an old sunbed which was effective but eventually the Dermatologist decided I had had enough sunlight for one lifetime.
Accitretin - made the psoriasis worse and made my lips peel! Awful stuff (for me anyway).
Ciclosporin - very effective after about 3 months use but had to come off it due to raised blood pressure.
Methotrexate - seemed to work but I only stuck it for a month as I felt run down and slightly ill all the time.
Fumaderm - I have been on and off this for around 2 years, it was very effective clearing nearly everything but my nails, but eventually had to come off due to very low blood count which wasn't recovering. I never quite got over the stomach problems with Fumaderm, never straying too far from the loo until after 11.00 am, but I felt it was worth the discomfort.
Otezla - started 3 weeks ago, no real side effects so far, felt a bit nauseous in the mornings but that's gone now. Hard to tell if it's working yet but it hasn't made it any worse!
I'll try and update on the Otezla in a few weeks time.

As far as I understand it the Bio is absorbed under the skin slowly and spread around the body over a period of time, but could it help psoriasis better or quicker if it was injected nearer to the psoriasis ?

I always inject in the belly, but today I have injected in my legs as that is where Cosentyx seems to be struggling. I doubt it will make any difference but thought it may be worth a try.

I know you should never inject directly into the psoriasis but does anyone have any thoughts on if there are indeed any benefits of injecting nearer the site of the problem  ?

Just started Orencia.  I chose the weekly injection over the infusion.  I just prefer the shorter half life in my body.  Injection was no biggie.  So far I feel absolutely nothing which is kind of good since most of the stuff makes me feel worse.  I'll chime in with more input on how this plays out.  But has anyone else done Orencia.  I know its more for PA, but just curious your thoughts.
Thanks