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

Hi Folks,
Just wondered if anyone has been on or is using Apremilast (Otezla tablets).
How are you doing on this medication and any 'nasty' side effects.
Thanks. 

Im suffering from psoriasis since 2014..im worried cpz my hair became thinner and my skin is not good anymore as before ive flawless skin..i visited 4 dermatologist anymore they are all giving me almost same treatment but my last dr.gave me dermovate scalp anf skin ointment..but it always comes back..what im gonna do im thinking about the injection cosentyx is that good???

Hey guys.

After 30+ sessions of light therapy not making a bit of difference to my skin and after not being eligible for methotrexate (didn't really fancy taking it anyway) and really not being keen on acitretin (due to reading about the side effects and how much it actually iimprovemprovrs psoriasis) my dermatologist has offered my Fumaderm. Currently waiting for it to arrive at the hospital.

Just got a couple questions for those that have been on it.

I've researched the side effects and I reckon I'll be able to stick them but I just have a question about the flushing...  does the flushing occur at about the same time after taking your dosage and if so how long after is this? I work a 9 to 5 job and would rather avoid the flushing at work if possible. I imagine that's possible on the early doses but may be impossible to avoid once you're taking a few tablets a day?

So, read some experiences here, but could not finder the answer I wanted; Which bio cleared you the fastest?

I don't know which one i Will start or if I have to go through a certain protocol again, but I just would like to know 

As I am taking a break from systemic treatment, I thought I might try some topical, Here are the ingredients:



I dissolve a 7 gram block of camphor in tea tree oil, then add the petroleum jelly, chest rub, 12 crushed aspirin, 50 grams of tar, and a bit of eucalyptus oil. Mixed together it looks like this:



As well as using it on a few spots behind my ears, I will apply it to a spot on my knee:



before applying a waterproof bandage.



I will change this every few days and record my progress. But what about my DMF? I do have a nice ardenium:



but another one has been badly afflicted with root rot:



So I have mixed in a bit of DMF with the soil as well as applying a bit to the infected part of the plant. DMF is a good inhibitor of mold, so fingers crossed.

I've had a flare up, mostly ears and neck, few spots here and there.  I did buy an over the counter tar shampoo, didn't really help and I have problems with how those shampoos really seem to dry out my hair.  Anyway, other than breaking down and trying the shampoo, I saved my money on the over the counter stuff as I've already been there/done that.  The ONLY relief I got while waiting to see my doctor was virgin coconut oil.  

I took two bowls and filled the bottom one with hot but not quite boiling water.  I then put a bit of coconut oil in a smaller bowl and set in inside the bowl with the water.  This dissolved the oil into a liquid form (plus made it a bit warm which I found soothing)

I then used a cotton ball to dab the oil on.  I found this worked better for me than rubbing it on.  This helped a lot when the scaling was dry and crusted.  It softens the scales and even helped with the itchiness for a small amount of time.  It's not a miracle thing..... but wanted to mention how I used it and how it helped offer me some small amount of relief.

About 3 weeks ago, I flared back up with psoriasis. I spent the first week in denial... thinking okay it's just a flare up and will settle back down. This past year or so I had a few "mini flares" that settled down but I knew this one was much worse than those. I think it kept getting worse by the minute. My ears and neck have always been my problem areas and this was no exception. Both ears were pretty bad and I was fairly miserable with it, I even have it in the outer corner of both eyes this time. I finally got in to the dermatologist this past Wednesday. They are looking at starting me on Stelara (which I will start a post about once it happens) so they took blood, sent me for a chest exray and checking with insurance (U.S. here, it's all about the insurance!) The derm also said I needed to get to primary doc to see if I had an ear infection as both ears had been hurting and felt "stopped up" (I managed to get into primary doc that day, both ear canals were swollen shut and with the psoriasis down in my ears he is sending me to ear specialist, but did give me ear drops which are helping with some of that.) Anyway, the dermatologist gave me Taclonex to use for now while I'm waiting on test results etc. I thought I'd write about it, pros and cons.

So the pharmacy had to order the Taclonex and I didn't get it until yesterday. I got 2 bottle of 60 g each. My cost was $40 after insurance. The directions were to apply once per day at bedtime. I found that a bit odd as putting this all on my scalp with nothing covering it sounded like a disaster for my pillow case at night. But I do like to follow direction so figured I'd try it and if too messy then I'd be using it in the daytime.

The consistency was very "oily" which actually turned out well as it wasn't very runny at all. I had many raw spots and it didn't burn which was an added bonus. I did put it on lightly with it being the first time and also with going to bed shortly after. I had to be careful not to get it inside my ears as I have the ear drops (also containing a steroid) but I was still able to coat my ears fairly well without worrying about it dripping into my ear canal. Application was fairly easy, I did have to get my daughter to help with the back of my head. Once it was applied, I did get that "itchfest" feeling of wanting to scratch. I heroically ( ) resisted the urge! After about half an hour, things settled down. By settled down, I mean about the same as when applying coconut oil, it was soothed a bit.

Woke up this morning and I can actually tell a small difference! The skin where the Taclonex was applied is still a bit soft and the scales were "moist" so came off easily. Of course I still itched, but I think it's a bit less itchy than it has been in the mornings. This is after one use so only time will tell how much it is helping (or not) I'll keep this post updated but my hope is that I at least get some marginal relief from this while waiting. I can use this until "clear" or up to 8 weeks. With the holidays, that's about how long the derm expects before I could start Stelara.

Starting Ciclosporine on Friday after dr checks my labs.  Has anyone on here tried it?  Side affects?  I am told kidney and high blood pressure are the most serious and are monitored closely.  This makes me nervous but at a point I have to do something. My hands are so bad I can hardly use them.  My feet are raw so I can barely walk... very painful.  The talz alone is not working.
Kinda new to this sight so also looking for advice on how to use it effectively.? Not sure if I am posting/ replying to the right thread or not

I have 3 out of 10 fingernails plus my big toenail that are lifting off thanks to my dear friend psoriasis.

Are there any ways to prevent or reverse this? I have a 6 tube NB UVB unit, and I expose my fingernails to it, but I assume the light cannot get through the nails.

I don't like steroids, as I find they rebound and other nasty stuff.

Thanks

This Dutch study looked at the cost effectiveness of bio psoriasis treatments.

Quote:

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Background:
Treatment with biologics may be indicated for patients with moderate to severe plaque psoriasis, but comparative evidence on cost-effectiveness is limited. Switching of biologics is common, but it is unclear what the effect is of differences in sequences of biologics.

Objective:
Evaluate the cost-effectiveness of different biologic treatment sequences for psoriasis based on real-world evidence.

Methods:
A sequence model was developed to evaluate the costs and health effects of three consecutive lines of biologic treatments (for example adalimumab-etanercept-ustekinumab versus etanercept-ustekinumab-adalimumab) over a 10-year time horizon in the Netherlands. The model was populated with data from the Dutch BioCAPTURE registry and scientific literature. Analyses were conducted of cost per quality-adjusted life year (QALY) and uncertainty was addressed by probabilistic as well as scenario analyses.

Results:
Treatment of psoriasis with biologics for a 10-year period was estimated to be associated with a cost of € 141,962 to € 148,442 per patient depending on the treatment sequence used. Cumulative health effects ranged from 7.79 to 8.03 QALYs. Starting with adalimumab or ustekinumab seems favourable concerning cost and utilities compared to strategies starting with etanercept, though credible intervals were partly overlapping.

Conclusions:
The order in which biologics are used influences treatment cost-effectiveness, both in terms of costs and health effects. Initiation of a biologic treatment sequence for psoriasis may best be done with adalimumab or ustekinumab; etanercept seems less optimal from a health-economic perspective.

Pfizer announced it has received approval by the FDA for the use of Xeljanz (tofacitinib) in psoriatic arthritis.

Quote:

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Pfizer announced today that the United States Food and Drug Administration (FDA) has approved XELJANZ® 5 mg twice daily (BID) and XELJANZ® XR (tofacitinib) extended release 11 mg once daily (QD) for the treatment of adult patients with active psoriatic arthritis (PsA) who have had an inadequate response or intolerance to methotrexate or other disease-modifying antirheumatic drugs (DMARDs). XELJANZ/XELJANZ XR is the first and only Janus kinase (JAK) inhibitor approved by the FDA for both moderate to severe rheumatoid arthritis (RA) and active PsA.

The recommended dose of XELJANZ/XELJANZ XR is in combination with nonbiologic DMARDs, and use in combination with biologic DMARDs or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.

The FDA approval of XELJANZ for the treatment of adult patients with active PsA was based on data from the Phase 3 Oral Psoriatic Arthritis Trial (OPAL) clinical development program, which consisted of two pivotal studies, OPAL Broaden and OPAL Beyond, as well as available data from an ongoing long-term extension trial, OPAL Balance.

Both pivotal studies met their two primary efficacy endpoints, demonstrating statistically significant improvements in American College of Rheumatology 20 (ACR20) response and change from baseline in the Health Assessment Questionnaire–Disability Index (HAQ-DI) score at three months in patients receiving XELJANZ 5 mg BID treatment in combination with a nonbiologic DMARD, compared to those treated with placebo. In OPAL Broaden, 50% of patients taking XELJANZ 5 mg BID achieved an ACR20 response, compared to 33% of patients taking placebo (p≤0.05), at three months. In OPAL Beyond, 50% of patients achieved an ACR20 response with XELJANZ 5 mg BID, compared to 24% of patients taking placebo (p≤0.05), at three months. In both studies, statistically significant improvements in ACR20 response was also seen with XELJANZ 5 mg BID compared to placebo at week 2, a secondary endpoint and the first post-baseline assessment (OPAL Broaden: 22% and 6% [p=0.0003], respectively; OPAL Beyond: 27% and 13% [p=0.0046], respectively).

The safety profile observed in patients with active psoriatic arthritis treated with XELJANZ was consistent with the safety profile observed in rheumatoid arthritis patients. The most common adverse events observed occurring in greater than 3% of patients on XELJANZ 5 mg BID were nasopharyngitis, upper respiratory tract infection, headache and diarrhea.

Following on from Taltz getting FDA approval for psoriatic arthritis, the Committee for Medicinal Products for Human Use (CHMP) has recommended it for use in Europe too.

Quote:

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On 14 December 2017, the Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion recommending a change to the terms of the marketing authorisation for the medicinal product Taltz.

Taltz, alone or in combination with methotrexate, is indicated for the treatment of active psoriatic arthritis in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drug (DMARD) therapies.”

Detailed recommendations for the use of this product will be described in the updated summary of product characteristics (SmPC), which will be published in the revised European public assessment report (EPAR), and will be available in all official European Union languages after a decision on this change to the marketing authorisation has been granted by the European Commission.

The Scottish Medicines Consortium has said no for Kyntheum (aka Brodalumab / Silq ) in the treatment of psoriasis.

A short statement read:

Quote:

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The committee was unable to accept brodalumab (Kyntheum) for the treatment of moderate to severe plaque psoriasis, a condition which causes red scaly patches on the skin, because of uncertainties in the case made by the submitting company

So I have been on Humira for about 18 months now, and I am starting to notice that its slowly starting to stop working. I take it once every 2 weeks, and during the first week, most symptoms of my psoriatic arthritis disappear, but after like 5-6 days they start coming back. Anyone else having this issue?

Hi everyone, I have been suffering P for the past 15 years, initially patches on my legs and then eventually spreading across the body. I have been on UVB for the past 5 years or so, but find that the effectiveness is wearing down, longer time to clear and whenever I stop , the P comes back faster and with a vengeance. I feel that my skin is drying up and I feel burnt all the time with UVB, hence I am trying out Dovobet gel.

Looking to get some tips on using the gel, it seems fairly effective to me, but it is sticky and leaves a stain on my clothes. So I apply it before I go to work, my office wear is stained, if I apply it before I go to bed, my sheets and clothes are stained as well. My kids like rolling around on the bed and I am not sure whether the dovobet stains have any impact in them.

Can anyone using dovobet gel share how you use dovobet gel and any tips on getting around the staining on clothes. Thank you very much and everyone have a great day.

Hi All

I’ve recently stopped acitretin due to side effects, and not being effective, so methotrexate is next on the list.
I’m starting on 15mg weekly, bit worried about the side effects of this. I know people get mixed results.
How long before seeing a benefit?

Thanks

Liz

This study set out to provide practical recommendations for the management of patients with Psoriatic arthritis (PsA) in the dermatology setting including early diagnosis and treatment.

Quote:

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Background:
Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable.

Objective:
To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Methods:
A consensus document was written by an expert panel composed by dermatologists (n=12) and rheumatologists (n=6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) by using the Delphi method.

Results:
A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biological disease modifying anti rheumatic drugs to be considered for the treatment of PsA have been reported.

Conclusions:
The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.