Hi all, 

So I went to see my Derm today as my P has been flaring up again. 

I've been on acitretin (35mg daily) for the past 4-5 months which did an ok job at clearing (despite taking a good 2 months to clear). Anyway, it started to fizzle out and I had to use creams to keep my P at bay, which, is fine when using the creams but as soon as I stopped it would come straight back. 

So after reading many positive reviews on here, I have decided I want to make the switch to Fumaderm/Skilarence. I recommended this to my derm who also gave it glowing reviews (well Fumaderm, he wasn't actually aware of Skilarence). However, as I go private he said that Skilarence/Fumaderm is ridiculously expensive to be paying myself and would be in the thousands of pounds a year region. He said the best way would be to see a GP and get a referral (ideally to St Guy's) and get the prescription through the NHS. In the meantime, I'm bumping my acitretin dose to 50mg daily to see if that helps at all. 

The problem is, I am not actually registered with a GP. To save myself the hassle of booking more time off work, registering with a GP, booking an appointment etc etc...which would take weeks, I am considering using an online GP to get the referral. 

My question is, has anyone on here from the UK ever had experience with using an online GP for psoriasis?

Greetings from New Jersey - land of extortionate property taxes and horrific commutes.     

     I have been taking Cosentyx for five months.  

     In that time I am constantly exhausted, and have cold symptoms including sore throat, nasal congestion, headaches,  and fatigue.  

     Is anyone else out there having these issues, and, if so (and more importantly!)  how do you deal with them?  My MD told me I just have to get used to it and deal with it.  I would like to know if anyone has found a way to deal with these issues. 

     Thanking you in advance, 

            -Vicki

Hi all, 

I'm a 36-year-old type 1 diabetic who was diagnosed with psoriasis in my late 20s, I want to say by 2008 or 2009 I for sure had it, because I had my son in 2010 and I had it then. But that was actually before I was diagnosed with type 1 diabetes. After I had my son, my pancreas just stopping working and my psoriasis got worse. It started on my legs, then I had it on my scalp. Since then I've had it on my elbows and in and around my belly button. Not good, but manageable, somewhat. 

Over the years I've noticed it pretty much was in the same spots, and at times it would get better, but the past month or six weeks, it's grown. Drastically. It's now on my forearms, ribcage, lower back, upper right shoulder and one spot on my upper thigh. I can't wear anything but long-sleeved shirts because it is so hideous. My child leaves the room when I change clothes and not because he's giving me privacy--because it's so awful to look at. I would say it's doubled in the areas its affecting at least. 

The worst part is, I just started a new job and I have no PTO. Despite that, I had to stay home for two days with my son who had the flu and I had to take off a half-day Monday to let AT&T into my house to connect my wifi as I just moved. Monday afternoon, the company owners called me in and said I was pushing it. I had planned to tell them I needed to see a doctor asap, but after learning my job was on the line, I didn't. 

I've done some research and from what I can tell, it sounds like I need to just go to the ER. I can't do that until Friday, because I HAVE to be at work 830-430 and I'm a single mom. My kid goes to his dad's house Friday nights so I'm going to make an ER visit Friday after work. 

No dermatologist, PCP, minor med or nurse practitioner has ever given me anything but Prednizone, topical creams and at my last visit, when I showed them this worsening breakout, they just gave me hydroxyzine for the itching. but the itching is not the worst of it. It's the pain. It's dry and cracking open on my inner elbows, and simply stretching my arms causes me pain. I can't wear anything but soft cotton clothes, and it's becoming difficult to find something different every day. No one has ever tried an oral medication or an injection. They simply under-treat it. 

I don't have a lot of money to try home remedies unless someone can suggest something that actually works. I'm afraid this breakout will never go away, and I can't live with it. I do the epsom salt baths. they seem to be drying it out more and making it more painful.

I would like to know if anyone has used a really good cream?
I have used lots in the past such as coal tar based,aqueous, e45 etc!probably most of them.
I am new on here and this may of been discussed before.thanks

Hello

Hi

I have been suffering from severe plaque Psoriasis and moderate Psoriasis Arthritis since 2004. After suffering through all kinds of treatments and few hospital stays in Germany (topical, various types of UVB and PUVA, Cyclosporine, methotrexate) by all kinds of dermatologists, finally a dermatologist prescribed Stelara in 2012 and I have been clear since then. I moved to Ireland from Germany in 2015 and the new Irish dermatologist continued the prescription based on the letter from my German dermatologist.

Now, I am likely to get a job in the UK and might move there. Can someone knowledgeable about the UK system help me understand how easy it is to get it prescribed in the UK? Do have to bring in my entire medical history from Germany and Ireland or is a letter from my current Irish dermatologist and the previous letter to him from the German dermatologist suffice? I may not have any private health insurance in the UK and would have to rely on the state system.

Hi everyone, I had answered another thread but Jim encouraged me to start a new thread about my journey with Taltz. I’ve suffered from psoriasis for at least the past 20;years - it could be quite mild at times but then would come back with a vengeance. I used to cover my legs and arms in makeup and would cry in embarrassment when going to the hairdresser.

I tried every topical treatment but relief was so temporary. Phototherapy also provided some short-term relief but I felt I was going to be saddled with this for the rest of my life.

I had been wary of some of the biologic treatments because of the side effects, but I was getting desperate.Then I happened to see a TV ad for Taltz and asked my dermatologist about it. He said it was clearly the most exciting new treatment he has seen - with very little risk - so he signed me on for a clinical trial.

I started Taltz last May, and I haven’t looked back since! As I outlined in another thread, those first two injections were torture - I had received some very perfunctory instructions, but then the technician was watching me so I quickly decided that the upper thigh would be the most discreet place while being observed. OUCH! The first one hurt like hell but I had to steel myself to just get through the second one.

Since then I have had the regular doses sent to my home and I have no problem administering it myself. Through trial and error I have found that the best place to inject is my lower belly a few inches from my belly button. Very little reaction and the sting lasts less than a minute.

With Taltz, I became 100% clear within three months. I am now almost 9 months into treatment with a dose once a month, and remain clear. 

I can’t tell you how much of a new lease on life this has given me. For someone who wore long skirts and 3/4 length sleeves just one year ago on a visit to Florida, during this most recent trip I proudly wore shorts and sleeveless tops!  This summer will ROCK!

I wish everyone the best in your own personal journey with this awful disease - I am thrilled to share that my experience with Taltz has been nothing short of a miracle LOL ? 

  Sheryl

Hi everyone, 
I want to get a tattoo related to psoriasis. I know it might affect my skin but i really want to. Is there an international official symbol of psoriasis? As fas as i know the orange-orchid ribbon isn't official.
Have any ideas? 
Thank you.

Hi everyone. Last Summer was when I noticed something wrong with my skin. The Dr. at that time said I had Ringworm. So for months, we were treating it like it was fungal. It only got worse. I finally went back to the Dermatologist and he said it was not fungal and that it was Psoriasis. I noticed my osteoarthritis flaring up as well. He told me it was due to psoriasis.   I have what looks like ringworm on steroids on my scalp, ear canals, around my waist, my down under parts and legs. He sent me in for a blood test. Come to find out I have latent TB! Ugh! The medications for both conditions are very powerful and take a toll on your body. I am not sure I want to do any of it. Thank you for reading this and any advice is very welcome.

Didnt realise that its been over 3 years since I visited here. The last time I was trying fumerderm. It didnt work for me. Tried Humira, then enbrel. Both with some success. Switched to Stelera and have been almost psoriasis free since that time.
Been overweight all my life and last May I underwent a gastric bypass operation. Had to stop the Stelera for a while, but only suffered a small outbreak. Since then have a couple of tiny patches. Unfortunately one is on my face. Gone from over 16 stone to under 12. Going on holiday in june and I have bought myself a bikini. Never worn a bikini in my life before. With the psoriasis clearance and weight lose my body image confidence has soared. First time in my life I can look in the mirror and like what I see. I look fab and dont care what anyone else thinks.
BTW..... getting this fab feeling also included almost 2 years of intense therapy to deal with my demons of my past.

This study suggests biomarkers are better at detecting psoriatic arthritis than C-reactive protein (CRP) levels alone.

Quote:

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Objective:
There is a high prevalence of undiagnosed psoriatic arthritis (PsA) in patients with psoriasis. Identifying soluble biomarkers for PsA will help in screening psoriasis patients for appropriate rheumatology referral. We therefore aimed to investigate whether serum levels of novel markers previously discovered by quantitative mass spectrometric analysis of synovial fluid and skin biopsies performs better than the C-reactive protein (CRP) level in differentiating PsA patients from those with psoriasis without PsA (PsC).

Methods:
In this case–control study, serum samples were obtained from 100 subjects with PsA, 100 with PsC, and 100 healthy controls. Patients with PsA and PsC were group matched for age, sex, psoriasis duration, and Psoriasis Area and Severity Index and were not currently receiving biologic treatment. Using enzyme-linked immunosorbent assay, 4 high-priority markers (Mac-2-binding protein [M2BP], CD5-like protein [CD5L], myeloperoxidase [MPO], and integrin β5 [ITGβ5]), as well as previously established markers (matrix metalloproteinase 3 [MMP-3] and CRP level) were assayed. Data were analyzed using logistic regression. Receiver operating characteristic (ROC) curves were plotted.

Results:
In comparisons to controls, CD5L, ITGβ5, M2BP, MPO, MMP-3, and CRP level were independently associated with PsA, while only CD5L, M2BP, and MPO were independently associated with PsC alone. In comparisons to PsC, ITGβ5, M2BP, and CRP level were independently associated with PsA. ROC analysis of this model shows an area under the curve (AUC) of 0.85 (95% confidence interval [95% CI] 0.80–0.90). The model that included CRP level alone had an AUC of 0.71 (95% CI 0.64–0.78).

Conclusion:
CD5L, ITGβ5, M2BP, MPO, MMP-3, and CRP level are markers for PsA. The combination of ITGβ5, M2BP, and CRP level differentiates PsA from PsC, and performs better than CRP level alone.

(Sun-25-02-2018, 20:35 PM)Fred Wrote:

(Sun-25-02-2018, 19:48 PM)D Foster Wrote:

(Sun-25-02-2018, 15:15 PM)Fred Wrote:

(Sun-25-02-2018, 09:33 AM)ajack Wrote: I was also told that raw eggs and raw fish is off the menu.

I'm not sure who told you that but they are wrong. There is no reason to avoid any foods or drinks with Stelara or any Bio as far as I know.

I was told that anything that held bugs such as pate,as you said raw eggs etc and to be very careful with things like bean sprouts which can contain salmonella. I was also told when I was on MTX to avoid anything that could contain bugs as with all these kind of treatments your immune system is very low so anything nasty can really be a big problem.

I don't want to derail Artemies thread, but I would like to know of any evidence about avoiding any foods whilst on a Bio. So if anyone does have evidence please PM me as I would like to read up on it and publish the findings in a new thread.

 Hi all feeling fed up, p back after 30 years. Used Dovonex for 6 weeks now, spots getting bigger on hands, arms and legs, elbows starting to clear though. 
Any comments would be helpful.
By the way I had several sore throats before my flare up!!

This study looked at the burden associated with chronic spontaneous urticaria (CSU) vs Psoriasis (PsO)

Quote:

---

Background:
Quantification of burden of chronic spontaneous urticaria (CSU) vs. psoriasis (PsO) is limited.

Objective:
To evaluate the burden associated with CSU vs. PsO of all severities (overall PsO), mild and moderate/severe PsO.

Methods:
This retrospective cross-sectional analysis compared data from adult patients with chronic urticaria (CU), used as a proxy for CSU, and PsO from the National Health and Wellness Survey in France, Germany, Italy, Spain and the United Kingdom. Outcomes included mental and physical component summary scores (MCS and PCS) calculated from the Short Form (SF)-36v2 or SF-12v2, SF-6D health utility scores, self-reported psychological complaints (anxiety, depression and sleep difficulties), work productivity and activity impairment, and self-reported healthcare resource utilization. Bivariate and multivariate analyses for each outcome and comparative groups were conducted.

Results:
This analysis included 769 CU and 7857 PsO (26.9% moderate/severe) patients. Following adjustment for covariates, CU patients showed a greater health-related quality of life (HRQoL) impairment vs. overall PsO (MCS: −2.4, PCS: −1.6, SF-6D: −0.03; all P < 0.001). CU patients showed a higher risk of anxiety, depression and sleep difficulties [odds ratio (OR): 1.63, 1.34 and 1.56, respectively; all P < 0.01] and greater healthcare resource use vs. overall PsO. The overall activity impairment was significantly greater in CU patients than in overall PsO patients (P = 0.001), while the impact on work was not significantly different. The results vs. moderate/severe PsO group showed no significant differences on all outcomes.

Conclusion:
Burden of illness in CU is higher than PsO of all severities but similar to that observed in moderate/severe PsO. Both diseases have a similar negative impact on work productivity.

This study looked at the efficacy and compliance of psoriasis patients treated with Otezla (apremilast) in a real world setting.

Quote:

---

Background:
Apremilast is a novel oral phosphodiesterase-4 inhibitor approved for psoriasis treatment. Randomized trials have documented its efficacy and safety, but data on real-world patients are scarce.

Objectives:
We aim to characterize psoriasis patients treated with apremilast in a real-world setting and calculate drug survival as an important measure of efficacy and compliance.

Methods:
All patients with psoriasis who received apremilast between 1 April 2015 and 19 January 2017 were evaluated every 4 weeks, and we documented: age, weight, height, smoking status, family history of psoriasis, joint involvement, previous treatments, psoriasis area severity index (PASI) scores, and the onset and duration of adverse events (AE). Efficacy was analysed by PASI50, PASI75 and PASI90, reflecting the improvement of skin lesions compared to the PASI-baseline. Kaplan–Meier statistics were used for drug survival estimates.

Results:
Forty-eight patients were included. The median apremilast drug survival was 12.5 weeks (range 1–87). Three patients (6.3%) reached PASI90, nine (18.8%) PASI75 and eight patients (16.7%) PASI50. Patient weight inversely correlated with a PASI50 response (P < 0.05, n = 37), and none of the obese patients (BMI > 30.0, n = 6) reached PASI75, compared to 32% of the non-obese patients (BMI < 30.0, n = 31). Thirty-one patients (64.6%) reported at least one AE, most frequently diarrhoea (n = 21, 43.8%), headache (n = 7, 14.6%) and joint pain (n = 5, 10.4%).

Conclusions:
Despite differences between real-world and trial patients, apremilast is safe and effective for the treatment of skin psoriasis in the daily practice. Up to 40% of patients will reach PASI50 or higher, but only few patients will reach PASI90. Bodyweight might affect drug efficacy.

I have been put back on Enbrel. I was on it 10+ years before. It stopped working for me so a few years ago I was on Humira. And over a year ago on Cosentyx. I haven't been on anything for a year. So I am concerned that Enbrel might not work this time around. Is there anyone that has been on Enbrel and then stopped and started it back after years of being on it? What has been your experience?

This study looked at the association between Human Leukocyte Antigen (HLA) genetic susceptibility markers and sonographic enthesitis in psoriatic arthritis ( PsA)

Quote:

---

Objective:
Enthesitis is an important pathophysiologic component in psoriatic arthritis (PsA). Human Leukocyte Antigen (HLA) genes are implicated in the pathogenesis of PsA. Little is known about the relation between HLA genetic susceptibility markers and enthesitis in PsA patients. Our aim was to examine the association between HLA genetic susceptibility markers and sonographic enthesitis in PsA.

Methods:
A cross-sectional analysis was conducted in patients with PsA. Sonographic enthesitis was assessed according to the MAdrid Sonography Enthesitis Index (MASEI) scoring system. HLA genotyping was performed using sequence-specific oligonucleotide probes. The association between 6 HLA susceptibility markers of PsA and the severity of sonographic enthesitis was assessed using multivariable regression models adjusted for age, sex, BMI and disease duration.

Results:
Two hundred and twenty-five patients were included, 57% male with mean (s.d.) age of 55.8 (12.9) years and PsA duration of 16.4 (12.3) years. In the multivariable regression model HLA-B*27 (β 4.24, 95% CI 0.02, 8.46) was associated with a higher enthesitis score and the interaction between HLA-B*27 and PsA duration was statistically significant, showing an increasing effect of HLA-B*27 with longer PsA duration (β 4.62, 95% CI 1.38, 7.86).

Conclusion:
HLA-B*27 is associated with more severe sonographic enthesitis in PsA, particularly in patients with longer disease duration. This finding highlights the possible role of genetic variants in predisposing to PsA subphenotypes.

This study suggests Stelara  (ustekinumab) may reduce the risk of heart attack and stroke.

Quote:

---

An antibody used to treat the skin disease psoriasis is also effective at reducing aortic inflammation, a key marker of future risk of major cardiovascular events. Researchers from the Perelman School of Medicine at the University of Pennsylvania, in collaboration with the National Heart, Lung, and Blood Institute, led a randomized, double-blind, placebo-controlled study and found patients who took the drug ustekinumab had a 19 percent improvement in aortic inflammation, as measured and confirmed by imaging, when compared to the placebo group.

“The type of inflammation we see in psoriasis is similar to what we see in atherosclerosis – a type of heart disease that involves the build-up of fats, cholesterol, and inflammatory cells in the artery walls,” Gelfand said. “Since ustekinumab blocks the specific pathways involved in in both skin and cardiovascular inflammation, we wanted to test whether it can improve aortic vascular inflammation.”

Psoriasis patients were randomly divided into two groups, with 21 patients in the placebo group and 22 patients receiving the treatment. The primary outcome was aortic inflammation, as measured by 18-FDG-PET/CT scans – an imaging technique that reveals inflammation in the aorta. The imaging was performed before treatment and at 12 weeks. The treatment group saw a 6.6 percent decrease in aortic inflammation, while the placebo group saw a 12 percent increase, meaning the drug is responsible for a 19 percent improvement relative to untreated patients. As expected, ustekinumab also resulted in a dramatic improvement in skin inflammation as well, with 77 percent of treated patients achieving a 75 percent or better improvement in psoriasis activity, compared to just 10.5 percent in the placebo group. Both findings were highly statistically significant (p≤0.001).

“This is the first placebo-controlled trial of a biologic drug to show a benefit in aortic inflammation, a key marker of cardiovascular disease,” Gelfand said. “The effect is similar to what we would expect if we put the patient on a statin.”

Gelfand, who conducted the study in collaboration with Nehal N. Mehta, MD MSCE, Chief of the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute, confirmed their results by having a second, separate lab independently evaluate imaging data.

“This study represents promise that this treatment may reduce the risk of heart attack and stroke in the future. It’s an encouraging finding,” Gelfand said.

The trial is ongoing, and Gelfand says his team will evaluate these patients at a longer follow up to see if the effects are sustainable and if patients continue to improve.

This study looked at the efficacy and safety through 5 years of treatment with Cosentyx (secukinumab) for psoriasis.

Quote:

---

Background:
Secukinumab, a fully human monoclonal antibody that selectively neutralizes IL-17A, has been shown to have significant efficacy and a favorable safety profile in the treatment of moderate to severe psoriasis and psoriatic arthritis.

Objective:
To assess the efficacy and safety of secukinumab through 5 years of treatment in moderate to severe psoriasis.

Methods:
In the core SCULPTURE study, Psoriasis Area and Severity Index (PASI) 75 responders at Week 12 continued receiving subcutaneous secukinumab until Year 1. Thereafter, patients entered the extension phase and continued treatment as per the core trial. Treatment was double-blinded until the end of Year 3 and open-label from Year 4. Here we focus on the 300 mg fixed-interval (every 4 weeks) treatment, the recommended per label dose. Efficacy data are primarily reported as observed but multiple imputation (MI) and last observation carried forward (LOCF) techniques were also undertaken as supportive analyses.

Results:
At Year 1, 168 patients entered the extension study and at the end of Year 5, 126 patients completed 300mg (every 4 weeks) treatment. PASI 75/90/100 responses at Year 1 (88.9%, 68.5% and 43.8%, respectively) were sustained to Year 5 (88.5%, 66.4% and 41%). PASI responses were consistent regardless of the analysis undertaken (as observed, MI, or LOCF). The average improvement in mean PASI was approximately 90% through 5 years compared to core study baseline. DLQI (dermatology life quality index) 0/1 response also sustained through 5 years (72.7% at Year 1 and 65.5% at Year 5). The safety profile of secukinumab remained favorable, with no cumulative or unexpected safety concerns identified.

Conclusion:
Secukinumab 300 mg treatment delivered high and sustained levels of skin clearance and improved quality of life through 5 years in patients with moderate to severe psoriasis. Favorable safety established in the secukinumab phase 2/3 program was maintained to 5 years.

Has anyone tried a handheld NB UVB unit?

I just bought a Duralume 2X handheld unit for my scalp ps.

The seller bought it and used it twice, then found out she had scaring and it was not useful to her.

I never did any research, but it seems like the Dermalume 2X is an older unit. I paid $280 shipping in.

Did I screw up? Should I have bought a different unit? Its design seems a little clunky...

Are there new units that are better?