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)

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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.

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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)

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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.

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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.

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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?

Lilly have said they will be presenting new Taltz data and Phase 2 efficacy, safety and patient-reported outcomes data for mirikizumab in moderate-to-severe plaque psoriasis. at the American Academy of Dermatology (AAD) annual meeting taking place Feb. 16-20, 2018.

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Eli Lilly announced that it will present new data for Taltz® (ixekizumab) at the American Academy of Dermatology (AAD) annual meeting taking place Feb. 16-20, 2018, in San Diego, Calif.

The data include eight abstracts for Taltz, featuring two oral presentations highlighting patient-reported outcomes from a Phase 3 clinical trial evaluating Taltz for the treatment of moderate-to-severe genital psoriasis, as well as findings from the Corrona Psoriasis Registry on Taltz patient clinical characteristics and treatment history. Two abstracts evaluating the efficacy and safety of Taltz for the treatment of active psoriatic arthritis will also be presented.

Additionally, Lilly will present Phase 2 efficacy, safety and patient-reported outcomes data for mirikizumab in moderate-to-severe plaque psoriasis. One abstract from the Closer Together Survey, a survey where nearly 2,000 people with moderate-to-severe psoriasis from 17 countries cross Europe and Canada shared how psoriasis impacts their quality of life and their overall satisfaction with treatment, will also be presented.

The U.S. Food and Drug Administration (FDA) has accepted Jemdel as a new drug application to treat psoriasis.  

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Ortho Dermatologics, a division of Valeant Pharmaceuticals International, Inc. today announced that the U.S. Food and Drug Administration (FDA) accepted the New Drug Application for JEMDEL™1 (halobetasol propionate 0.01%) (IDP-122) lotion with a PDUFA action date of Oct. 5, 2018. If approved, JEMDEL will be the first high-potency topical steroid treatment for plaque psoriasis with dosing for as long as eight weeks. In the clinical trials, the most common adverse event was upper respiratory tract infection.

Hi, I’m a newbie to these groups so I’m hoping that I post this in the right area. I’ve had psoriasis probably 50 years now and I think I’ve had every treatment known to man. Right now I am taking Tremfya and I am almost 100% clear.   I also had fabulous results with Stelera, but my dermatologist said Tremfya is even better. However I did my third shot a week and a half ago and I’ve had diarrhea now for nine days. I have had some lab tests done and I’m waiting for the results.  I’m thinking that this may be a side effect of Tremfya as diarrhea is listed as one of the top side effects. Is anyone else experiencing anything similar?

Hello, everyone.   I'm new to this forum and I thought that I'd reach out to my fellow psoriasis sufferers and see if I can get some advice on how to deal with an issue that has recently come up.

I had to quit my job a few months ago due to depression and anxiety. Because of this, I have lost my insurance which wasn't good for much, EXCEPT for paying for my clobetasol solution that I used for my scalp psoriasis.

I don't know how many of you have used this medication, but in spite of the warnings that steroids are not good for you, I couldn't stop using it completely. I've had psoriasis since early childhood and I am now 31, so I have been squirting this stuff on my scalp for most of my life now. Back when I had more money I did purchase at least $100 worth of essential and carrier oils in order to create a natural treatment that I had learned about online, but it didn't do anything except for make my hair oily.

I am on my last insurance-funded bottle of clobetasol and I think I only have about a day's worth left in there. I have been going as long as I can stand without it, but as soon as my scalp starts to scale up and bleed, I can't help but reach for the clobetasol. I am beginning to worry now because as some of you may know, clobetasol used to be extremely affordable and has since gone up to several hundred dollars in price. I definitely can't afford it now that I don't have the insurance I had with my last job.

Have any of you had success with natural treatments? It would be awesome if I could find something that isn't going to gunk up my hair as well, but at this point I'll be happy to find anything that is affordable and that will prevent my scalp from bleeding and flaking.

Any advice would be extremely appreciated!

I have just warched a local programme called Inside Out in which 40 people in UK have died from fire through using emmollient creams like Cetraben , Diprobase and that type containing paraffin . The latest was recently in Beverley were a person with psoriasis was smoking in the lounge watching tv after using the cream just burst into flames and died later in hospital with over 30% burns, no warnings are on the containers at all, this is a widespread problem that I have never heard of.

Following on from this report Scotland says no for Kyntheum to treat psoriasis The National Institute for Health and Care Excellence (NICE) has issued draft guidance recommending Kyntheum (brodalumab) for psoriasis.

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Brodalumab is recommended as an option for treating plaque psoriasis in adults, only if:

The disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10.

The disease has not responded to other systemic therapies, including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet A radiation), or these options are contraindicated or not tolerated.

The company provides the drug with the discount agreed in the patient access scheme.

Hello  everyone, I am new to this forum and new to psoriasis although it is in my family. My father had it, my sister started when she was 18 and my two daughters have it. I am 67 years old and have been clear of it, how lucky is that? My sister had it all over her body and is now in a wheelchair due to Psoriatic Arthritis. 

About 18 months ago I was diagnosed with psoriatic arthritis although I had no skin problems. I was certainly in denial of the diagnosis. But not now! I have now been diagnosed with Flexural/Inverse Psoriasis and boy does it itch and so sore. It is at present in my armpits and genital areas and now on my eyelids and slowly spreading. I have been prescribed a topical cream for my arms and other areas except for my eyelids. It was suggested I use Vaseline on my eye lids.

My question is anyone any thoughts of deodorants I would be able to use and also ideas of anything for my eyelids apart from vaseline?

Many thanks and thanks for being there

Bumble bee  

I lost you all - but have found you again - jeeze a lot has happened x

Novartis have announced a label update to the use of Cosentyx for scalp psoriasis in the USA.

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Novartis announced today that the US Food and Drug Administration (FDA) has approved a label update for Cosentyx® (secukinumab) The updated label includes Cosentyx data in moderate-to-severe scalp psoriasis - one of the difficult-to-treat forms of the disease, which affects approximately half of all psoriasis patients.The label update is effective in the US immediately, and is based on the proven efficacy and consistent safety profile of Cosentyx from a dedicated Phase III scalp psoriasis trial.

Having been prescribed enstilar by my dermatology department, and given a letter to take to my doctor so he could issue it ...I was surprised when I opened the package to have been given dovobet gel ...I queried this with the pharmacy department who assured me it was a generic version ....

Had I not been a member here I would probably have accepted that

But I said have you got your facts right the letter from the hospital clearly said Enstilar foam .....I asked her to double check with the doctor ......Because there is no generic version of enstilar
That evening I got a call saying that enstilar would be waiting for me to collect

Now I know there's no difference in the active ingredients to the gel, but the foam is supposed to be easier to apply and  from what I've read the propellant makes it easier for the skin to absorb...

The reason for bringing this up is so others can question if given gel instead of foam and be sure they are correct ....there is no generic version

This study assessed the effect of systemic and biological drugs on psoriasis patients carotid intima-media thickness (IMT).

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Background:
Psoriasis has been related to a large number of cardiovascular risk factors such as hypertension, diabetes mellitus and arteriosclerosis. The increased carotid intima-media thickness (IMT) could be considered to be a marker of generalized arteriosclerosis.

Objective:
To assess the effect of systemic and biological drugs on psoriatic patients′ carotid IMT.

Methods:
A prospective study was performed. We studied 53 patients with moderate and severe psoriasis from our psoriasis dermatological unit, analyzing lipid and glucose metabolism and performing a carotid IMT sonography before introduction of systemic and biological drugs. After that, we performed an 8-month closely analytic and sonographic follow-up.

Results:
The IMT of the psoriatic patients treated with biological drugs tended to decrease, although this occurrence was not statistically significant (p=0.086). The subgroup analysis revealed that patients treated with Methotrexate (p=0,045) and Anti Il-12/23 (p=0,010) presented a decrease of their IMT levels. This analysis also showed a decrease in glycaemia and insulin levels in patients treated with TNF-alpha Inhibitors and Ustekinumab.

Conclusions:
Our study suggest that the carotid-IMT may benefits from treatment with biological drugs, particularly Anti IL-12/23, and methotrexate in patients suffering from moderate and severe psoriasis. However, larger longitudinal studies should be performed in order to fully confirm these results.

This study set out to assess the effect of an intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe chronic plaque psoriasis.

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Aim:
Warren et al set out to assess the effect of an intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe chronic plaque psoriasis.

Setting and design:
This is a prospective, double-blind, randomised (3:1), placebo-controlled study, conducted across 16 centres in Germany, France, the Netherlands, and the UK.

Study exposure:
Methotrexate-naïve adults with a diagnosis of moderate to severe chronic plaque psoriasis for at least 6 months before baseline were randomly assigned to receive weekly subcutaneous injections of either methotrexate at a starting dose of 17.5 mg, or placebo for 16 weeks (first phase).Dose escalation to 22.5 mg/week was implemented after 8 weeks if patients did not achieve PASI 50. Treatment was combined with folic acid 5 mg/week. The first phase of the study was followed by an open-label period from 16-52 weeks (second phase), in which both groups received weekly methotrexate injections. At week 24, dose escalation to 22.5 mg/week was possible in patients not achieving PASI 50.

Outcomes:
Psoriasis severity was measured using the PASI (Psoriasis Area and Severity Index). The authors also used two other psoriasis severity measures and two quality of life measures, looked at safety indices and performed a sub-study analysing paired skin biopsies at baseline and week 16 (histopathology, immunohistochemistry and expression of interleukin (IL)17A, interferon-γ and tumour necrosis factor-α).

Primary outcome measures:
The primary outcome was the proportion of patients reaching PASI 75 at week 16.

Results:
120 patients were included in this trial, most of whom were middle-aged white men with longstanding psoriasis and a mean BMI of 30.1 kg/m2. PASI 75 was achieved in 41% of patients receiving methotrexate vs. 10% of patients receiving placebo (RR 3.93, 95% CI 1.31–11.81; p=0.0026) at week 16. Subcutaneous methotrexate was generally well tolerated, with no serious adverse events related to this treatment over the 52-week study.

Conclusions:
Warren et al conclude that the 52-week risk-benefit profile of subcutaneous methotrexate is favourable in patients with psoriasis.