This study looked at perceived stigmatization in psoriasis.

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Background:
The physical appearance of psoriasis can be cosmetically disfiguring, resulting in a substantial social burden for patients. An important aspect of this burden is the experience of stigmatization. While stigmatization is known to be disabling and stressful for patients, little is known about its correlates, and effective interventions are lacking.

Objectives:
To examine predictor variables for perceived stigmatization in psoriasis.

Methods:
Questionnaires were administered to 514 patients with psoriasis in a cross-sectional study. Zero-order correlation and multiple-regression analyses were conducted including sociodemographic, disease-related, personality, illness cognitions and social support predictor variables.

Results:
Stigmatization was experienced by 73% of patients to some degree, and correlated with all five categories of predictor variables. In multiple-regression analyses, stigmatization was associated with higher impact on daily life; lower education; higher disease visibility, severity and duration; higher levels of social inhibition; having a type D personality; and not having a partner.

Conclusions:
The results indicate that perceived stigmatization is common in psoriasis, and can be predicted by sociodemographic, disease-related and personality variables. These predictor variables provide indications of which patients are especially vulnerable regarding perceived stigmatization, which might be used in treatment.

This study looked at mortality rates in psoriasis patients over a 15 year period.

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Background:
The burden of psoriasis across many world regions is high and there is a recognized need to better understand the epidemiology of this common skin disorder.

Objectives:
To examine changes in the prevalence and incidence of psoriasis, and mortality rates over a 15-year period.

Methods:
Cohort study involving analysis of longitudinal electronic health records between 1999 and 2013 using the U.K. Clinical Practice Research Datalink (CPRD).

Results:
The prevalence of psoriasis increased steadily from 2·3% (2297 cases per 100 000) in 1999 to 2·8% (2815 per 100 000) in 2013, which does not appear to be attributable to changes in incidence rates. We observed peaks in age bands characteristic of early-onset (type I) and late-onset (type II) psoriasis, and changes in incidence and prevalence rates with increasing latitude in the U.K. All-cause mortality rates for the general population and for patients with psoriasis have decreased over the last 15 years. However, the risk of all-cause mortality for patients with psoriasis remains elevated compared with people without psoriasis (hazard ratio 1·21; 95% confidence interval 1·13–1·3) and we found no significant change in this relative excess mortality gap over time.

Conclusions:
We found an increasing population living longer with psoriasis in the U.K., which has important implications for healthcare service delivery and for resource allocation. Importantly, early mortality in patients with psoriasis remains elevated compared with the general population and we found no evidence of change in this premature mortality gap.

Hi  all 1st time post!! Just wanted to ask is there any recommendations for plaque psoriasis I have some on my knees & elbows.  Not too bad Im lucky but wud love to be completely rid of it for once.  Had it since Im 14 & age 39 now ?
Also what age does psoriasis arthritis usually start & what are the initial symptoms

Thanks so much guys

Hi just joined the club to get info on
Fumaric acid. Just into second week and fear the worst with side effects. Can the trots and cramps be reduced with IBS remedies?

After years of complete resolution of skin issues, I suddenly have had an area on my arm recur. A plaque about 2 inches in diameter and some scalp issues as well. I take 0.8 of 25mg/ml sub cu weekly. Also take the prescribed folic acid daily
I have researched everything I can find that might address this MTX therapy failure... and found no information discussing this.
Has anyone here had this issue? and if so what were you able to "do" about it?
Thank you.

I had my regularly scheduled appointment today which I knew would result in a change in medication for my psoriasis and psoriatic arthritis.  

As expected, Cosentyx is not going to happen, largely because of insurance demands and cost.

I have used sulfasalazine and most recently Otezla, which worked great, but failed after about a year.  I told her I didn't want to use Methotrexate, and she said she thought I was past that point anyways.  

So...drumroll please...

Humira.  She is on the conservative side and wants to try the biologic with a large data set, so here we go.  I trust her, so I'm ok with this.

Awaiting the TB test results and will likely start in a week and a half.  I'm not going to lie, I'm nervous about compromising my immune system.  Hopefully I'll  be ok.  But I got to the point where I just hurt too much and had to raise the white flag.

We shall see.

I'm finishing my second week or so of dimethyl fumarate. Week 1, I took 30mg daily (based on initial Fumaderm dosing), although I just have the powdered DMF from a chemist) with N-Acetyl-Cysteine, and this week I took 100mg daily for a few days before switching to 200mg every other day. I don't plan to increase this dosage until I get new labs and have been on it for another 6 weeks or so, although I'm welcome to other ideas. I've been having some hair loss lately, but that started before I started the DMF, so I'm not sure what the cause is. New supplements I am taking for it include zinc, a bioavailable B5 (Pyroxidal 5 Phosphate), lithium (5mg to help drive B vitamins into cells) and boron. I pour the correct dose of each one into one giant capsule and swallow it. I haven't had any side effects, so today at lunch I tried the DMF without cysteine--still no cramps, flushing, or heartburn. I do tend to have an iron-clad stomach and regularly take 20 supplements a day, including various digestive enzymes and probiotics, so this doesn't surprise me. My neck, which seems to be a cross of guttate and plaque psoriasis, is actually getting worse, as it often does when I try taking zinc and B vitamins such as P5P. The reason seems to be that zinc releases unbound copper, which irritates skin as the body tries to clear it, but I'm going to see a new practitioner soon to see his take on it--the dermatologist wants steroids or methotrexate, and is admitting that the Otezla is no longer doing anything for me: I might just stop it for a while.

Hello everyone.
First post. I have suffered with p since childhood and was prescribed methatrexate which kept my p under control for quite a few years. However about 5 years ago after complaining to various derms that I was feeling ill and run down I came off it. about the same time I came down with a massive internal infection which took four years and lots of surgery to control. during which time ive had a lot of light therapy and this has been a good help. 
After my final surgery I returned to work the following Monday with vigour, I was laughing with my workmates happy that my surgery was over and done with when suddenly I started to get pain in my upper chest and throat. I turned to my mate and said, eh new pain today chum, in my chest and just laughed it off and saw the day out.
I got home and the pain was still there so we went to A&E to get checked out. Yes a heart attack, I was whisked off to the operating theatre where a stent was fitted and discharged a couple of days later. Question is :- My derm is aware of the situation and wants to put me on Fumaderm, Im concerned because the surgery I had has left me slightly incontinent and thats when my stomach is operating normally. Secondly is anyone aware of any adverse effects on the heart or stents. Im 59 by the way and have kept my sense of humour.

Hi Everyone,

I've suffered with Psoriasis for 30 years and tried all sorts of lotions, creams PUVA treatment, cyclosporian and lastly MTX which worked fantastically, the only thing to have every cleared my psoriasis up. Sadly I've been taken off of it as was affecting my liver to much 3 months of bad blood results ending in derm doctor saying I couldn't have it anymore fall stop.
So I have been moved on Acitretin only been on it 2 weeks today my psoriasis have gone crazy covered badly especially my lower legs they feel like they are burning now and itchy which I have never suffered with, and my lips have gone so dry and sore.
Am worried as only 2 weeks in and already getting side effects, will these get worse or better in other peoples opinions?
Thinking of stopping the drug as cant believe just how bad they have become right on top of Christmas

Any advise greatly appreciated  xx

This study suggests the Flightless 1 (FLii) could be a new approach for the fight against psoriasis.

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Background:
Psoriasis is a common chronic skin condition characterized by excessive inflammation and aberrant epidermal proliferation. Flightless I (Flii) is an actin-remodelling protein that regulates these processes, suggesting a possible role in psoriasis.

Objectives:
We sought to determine whether a benefit in psoriasiform dermatitis might occur after modulating Flii gene expression or reducing its levels using neutralizing antibodies.

Methods:
Biopsies of psoriatic skin lesions from patients were assessed for Flii levels. Psoriasis-like lesions were induced in Flii heterozygous (Flii+/−), wild-type (Flii+/+) and Flii transgenic (FliiTg/Tg) mice using topical application of imiquimod. Additionally, psoriasis-induced wild-type mice were treated with topical application of Flii neutralizing antibodies and erythema, inflammation and histology were assessed.

Results:
Flii was elevated in psoriatic lesions from patients with psoriasis compared with normal human skin. Reducing Flii decreased erythema, inflammatory cell infiltrate, proinflammatory cytokines and the thickness of the epidermis. Topical application of Flii neutralizing antibodies to wild-type mice treated with imiquimod resulted in significantly reduced psoriasiform dermatitis.

Conclusions:
Flii is a novel target involved in psoriasiform dermatitis and reducing cutaneous Flii could potentially be a new approach for treating patients with psoriasis.

This study looked at anti drug antibodies (ADA) levels and clinical efficacy in psoriasis patients using Humira and Enbrel

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Background:
An algorithm based on measurement of a serum tumour necrosis factor antagonists (anti-TNF) and antidrug antibodies (ADA) has been proposed previously to guide dose escalation or therapy switching in the early (i.e. the first months of) treatment of psoriasis by anti-TNF. In long-term treatment of responding patients with psoriasis, it is usual to empirically reduce standard doses of anti-TNF to reduce exposure while maintaining clinical response. The relationship between serum anti-TNF, ADA levels and clinical efficacy in long-term treated patients with psoriasis has not yet been determined, so the potential role of these parameters in guiding dose escalation in this scenario is unknown.

Aims:
To evaluate the relationship between drug/ADA levels and clinical efficacy in a group of patients with psoriasis undergoing long-term treatment with adalimumab or etanercept.

Methods:
This was a single-centre, prospective, cohort study of patients with psoriasis receiving adalimumab or etanercept for a minimum of 48 weeks. All patients were started on the standard dose, but some adalimumab users had a reduced frequency of administration. Clinical efficacy was measured using the Psoriasis Area and Severity Index. Serum concentrations were measured by ELISA. Clinical assessment and blood sample collection were carried out simultaneously within 24 h before the next drug administration.

Results:
In total, 21 patients were enrolled (67 simultaneous clinical and serum determinations: 38 receiving adalimumab, 29 receiving etanercept). We did not find any association between serum anti-TNF levels and clinical response. None of the patients developed ADA.

Conclusions:
ADA and anti-TNF levels are not related to clinical effectiveness in patients with psoriasis undergoing long-term treatment with adalimumab or etanercept.

   Hi!  I am already playing Christmas melodies from the past - to get me in the spirit!  I'm glad that I found this site.  Looking forward to contacts and great advice. 

I've recently started on Cosentyx - into my second month and I am delighted!  I did take Humira but had a very bad flare up, then lost the good affects.  The problem was - flu shot at work - no one to get advice from - both my Doctors were away.  I read on line that as long as it wasn't a live specimen it was ok to take.  NOT a good idea.  I got very sick, for one thing and then the Humira no longer worked for me.  I have been putting up with extensive psoriasis on my legs (once considered  attractive) and periodically some on my elbows, for many, many years.  I am just grateful that it didn't start in my twenties or thirties.  I would have been even more devastated.  My Mom had it, but not as badly.  She was very upset to find out that I was affected, but didn't live long enough to see it take over like a monster!  So here I am, but there is more to me.  I am a type 2 diabetic in my 60's (I don't want you to think I'm REALLY old, because I have a young spirit and people tell me I look 10 years younger).  Ok, so now I will say that I have two wonderful children that are close to my heart but far away.  My son runs a home appraising business in Calgary and has been very successful.  My daughter is in Markham, Ontario and works as a wildlife conservationist.  She got her Masters in Scotland.  I was born in Germany and immigrated at the age of 5, with my parents.  I am very CANADIAN.  I am a Registered Nurse - once retired very early, but returned to work when I moved here, due to boredom and desire to travel.  I am on my own with two cats.  Life is good, but it could be better.  I look forward to communication with others.  It's lonely being on your own. So, I'll close for now and say "thanks for letting me be a member and Merry Christmas to all!"

We have a few of these studies on Psoriasis Club and this one concludes that patients with periodontitis have a significantly elevated risk of psoriasis.

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Background:
The association between periodontitis and systemic diseases has been increasingly recognized. However, the data on the association between periodontitis and psoriasis are still limited.

Objectives:
To summarize all available data on the association between periodontitis and the risk of psoriasis.

Methods:
Two investigators independently searched published studies indexed in MEDLINE and EMBASE databases from inception to July 2016 using a search strategy that included terms for psoriasis and periodontitis. Studies were included if the following criteria were met: (i) case–control or cohort study comparing the risk of psoriasis in subjects with and without periodontitis; (ii) subjects without periodontitis were used as comparators in cohort studies while participants without psoriasis were used as controls in case–control studies; and (iii) effect estimates and 95% confidence intervals (CI) were provided. Point estimates and standard errors from each study were extracted and combined together using the generic inverse variance technique described by DerSimonian and Laird.

Results:
Two cohort studies and three case–control studies met the inclusion criteria and were included in the meta-analysis. The pooled risk ratio of psoriasis in patients with periodontitis versus comparators was 1.55 (95% CI, 1.35–1.77). The statistical heterogeneity was insignificant with an I2 of 18%. Subgroup analysis according to study design revealed a significantly higher risk among patients with periodontitis with a pooled RR of 1.50 (95% CI, 1.37–1.64) for cohort studies and a pooled RR of 2.33 (95% CI, 1.51–3.60) for case–control studies.

Conclusions:
Patients with periodontitis have a significantly elevated risk of psoriasis.

Valeant Pharmaceuticals  have announced positive results from a Phase 3, multicenter double-blind, randomized, vehicle-controlled clinical study to assess the safety and efficacy of IDP-118 (halobetasol propionate and tazarotene) lotion in the treatment of plaque psoriasis.

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Valeant Pharmaceuticals International, Inc. (NYSE: VRX and TSX: VRX) ("Valeant") today announced positive results from a Phase 3, multicenter double-blind, randomized, vehicle-controlled clinical study to assess the safety and efficacy of IDP-118 (halobetasol propionate and tazarotene) lotion in the treatment of plaque psoriasis.

Within the Phase 3 study of 215 adult subjects with moderate to severe psoriasis, IDP-118 showed statistical significance to vehicle with a treatment success rate of 45.33% and a p<0.001.  The primary endpoint of the 12-week study was achievement of a "clear" to "almost clear" score based on an Investigator Global Assessment (IGA) at 8 weeks, and at least 2 grade improvement in the IGA at weeks 12, 6, 4 and 2 as secondary endpoints.

"We are pleased to share the positive results from the Phase 3 study of this important new formulation," stated Joseph C. Papa, Chairman and Chief Executive Officer.  "Psoriasis is often difficult to treat, and dealing with this life-long condition can significantly impact a patient's quality of life.  Valeant remains committed to continued research into innovative new treatments to improve the lives of those who suffer from psoriasis."

While halobetasol propionate and tazarotene are both approved and used to treat plaque psoriasis, each has certain attributes that can influence the treatment duration owing to potential adverse events.  Based on existing data from our clinical studies, the combination of these ingredients in IDP-118 with a dual mechanism of action potentially allows for expanded use of these active ingredients with reduced adverse events.

The Phase 3 program was preceded by a successful Phase 2 study where the combination product IDP-118, with a treatment success rate of 52.5%, was superior to each of the actives halobetasol propionate and tazarotene as well as the vehicle. Valeant expects to have data from a second confirmatory pivotal Phase 3 study in 2017.

Dave here.  42 years old, psoriasis symptoms for ~20yrs, arthritis for ~8 years.

I've typically been a medication minimalist as much as possible over the years, but with the arthritis steadily getting worse, I've given in to things I don't want to take.

I have Celebrex for the pain when needed.  DMARDs started as sulfasalazine and then Otezla.

I was in love with Otezla.  Worked great for about a year, then a somewhat spontaneous decline in efficacy.  I have quit the medication for 3 weeks before I go see my Rheumy next week, just so I could get a feel of whether it was actually working period anymore or not.  IMO, it's at about 30-40% of what it was doing for me at its peak, so I'm not sure it's worth taking anymore.  But since being off Otezla, I've felt fairly bad.

As I said, I'm going in next week to likely start a new course of treatment.  I've been reading up just trying to get a sense of what is out there, so I'm fairly well-versed.

Methotrexate - I don't want to take it.  Bad vibes is all... no other reasonable reason.

I've been reading about Cosyntex, which looks like it's at least a more specific biologic than Humira or Enbrel, right?  Not sure if I have that right but I'll see what my doc wants to do with me.  Immune suppressors give me the heebie-jeebies as well. 

Anyone with a significant background in medicine on here, I'd like to throw this little nugget out there:  I'm fully aware this could be coincidence, but since I've been symptomatic with the arthritis, I've not had more than a bad cold in terms of sickness.  If I've had a fever in that time, it's a very short period of time... maybe an evening or something like that.  I haven't had the flu, and I work in an environment with community computer workstations, so decent germ exposure.  Nothing else has really changed in that time.

Anyways, just saying hello and telling my story.  I'm tired of hurting.  I used to run, play softball, hike... just stayed as active as possible.  Now I spend a lot of time in hot baths.  Hopefully I can find a remedy that won't wreck other parts of my body in the process.

This meta-analysis evaluated IL-17 levels in patients with psoriasis. IL-17 is targeted by the new bio's:
Cosentyx (secukinumab) and Taltz (ixekizumab)

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Background:
Emerging evidence indicates that plasma interleukin (IL)-17 levels may be associated with increased risk of psoriasis, but the individual published results are inconclusive.

Aim:
To evaluate IL-17 levels in patients with psoriasis using a meta-analysis of studies comparing IL-17 levels in controls and in patients with psoriasis.

Methods:
All relevant studies were identified by searching pub med, Web of Science and MEDLINE databases before 1 November 2015. Pooled risk estimates were calculated by random-effects models. Crude OR and standardized mean difference (SMD) with corresponding 95% CI were also calculated.

Results:
In total, eight cross-sectional study studies were included in the final analysis. The mean plasma levels of IL-17 were higher in patients with psoriasis than in healthy controls (SMD = 0.47, 95% CI = 0.07–0.86, P < 0.001).

Conclusions:
Based on this literature review, there appears to be a positive association between IL-17 plasma levels and psoriasis.

Lycera has announced it has initiated a phase2 trial of LYC-30937-EC for psoriasis. YC-30937, a first-in-class, oral, gut-directed ATPase modulator, is designed to selectively target and induce cell death (apoptosis) in disease-causing immune cells (T-lymphocytes) based on their unique metabolic features, while sparing normal cells.

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Lycera Corp., a privately held biopharmaceutical company developing breakthrough immune modulatory medicines, announced today the initiation of a Phase 2 clinical trial of the Company’s lead therapeutic candidate, LYC-30937-Enteric Coated, in patients with psoriasis. Psoriasis is often a debilitating skin disease that is estimated to affect as many as 7.5 million people in the United States, with approximately 1.5 – 3 million cases being diagnosed as moderate.  Current systemic therapeutics for the treatment of moderate-to-severe psoriasis result in 75% improvement in the Psoriasis Area Severity Index (PASI) in approximately 80% of patients, but require injections and often lead to side effects, including pronounced immune suppression.  A significant need exists for more convenient, orally dosed psoriasis treatments that provide high PASI scores and low rates of adverse events.

“We continue to make substantial progress with our development of novel immune modulators and are very pleased to have initiated our second Phase 2 clinical trial with our first-in-class ATPase modulator this year. Moreover, this study marks a major accomplishment for the investigation of a gut-directed therapy to target the treatment of peripheral autoimmune disease,” said Paul Sekhri, President and CEO of Lycera. “Based upon the results of our preclinical studies, we believe LYC-30937-EC can impact pathogenic lymphocytes that traffic through the human gastrointestinal tract before these lymphocytes can migrate to distal tissues, such as the skin, causing psoriasis.  If successful, this trial may lead the way to exploring LYC-30937-EC in other diseases, such as rheumatoid arthritis and multiple sclerosis.”

“Psoriasis can pose a significant burden for patients, i.e., chronic itching, stinging, and pain, having a profound negative impact on daily functions and diminished quality of life,” stated Jerry Bagel, M.D., Medical Director for the Psoriasis Treatment Center of Central New Jersey and an investigator in the Phase 2 study. “In addition, many patients experience depression, decreased self-esteem, and anxiety, and new oral therapies would be helpful. I believe LYC-30937-EC represents a unique mechanism of action and a promising approach to targeting the cells that cause inflammation and are the hallmark of psoriasis.”

Lycera’s Phase 2 study UPRISE (gUt-directed LYC-30937-EC study in Psoriasis as oRal treatment for autoImmune diseaSE) is a randomized, double-blind, placebo-controlled parallel group trial designed to assess the efficacy and safety of LYC-30937-EC given orally once daily in subjects with moderate psoriasis. The study is expected to enroll up to 30 patients, randomized on a 2:1 basis to receive either treatment with LYC-30937-EC or placebo. Subjects will be treated for 12 weeks, with an additional 2-week safety follow-up. The primary efficacy endpoint will be the change in mean PASI Score and Investigator global assessment; safety will be measured over 14 weeks.

Hi I'm new I have been suffering from psoriasis for about 25 yrs it's not to bad at the moment i just wanted to share with everyone the way I have gotten mine under control. I have been taken vitamin D about 4000 iud a day and magnesium 1 a day I also use a Philips hand held Uvb device which I use once a day and I went cold turkey and came off steiod cream and use coconut oil instead o and also a 20 billion probiotics one a day it has made a big difference 
I hope this helps someone as I know how dis stressing this horrible thing is x

  Hi all.   I am waiting for a nurse to arrive from Oxford ( I am in Somerset) to give me training on how to use cosentyx, it will be my first injection today after an incredibly long wait.  I feel very anxious. She should be here within the hour and I have taken the syringes out if the fridge.  Please wish me luck!   

I first had psoriasis about 20 years ago, in my ears, which developed into chronic plaque psoriasis over time.   I have tried many treatments, all the usual creams and moisturisers. Light therapy, acitretin, methotrexate for past 6 years and it stopped working about 6  onths ago.

My worst time ever came in 2008.     I had phototherapy with such a bad reaction resulting in third degree burns after (5 low dose treatments)  I was extremely ill when everywhere got infected,  bedridden and then hospitalised. Housebound for 5 months.   ( the consultant I was under threatened me not to take legal action - there was suspicion that the nurse set the machine wrong, we did later take legal action ) anyway, the outcome was It left me in a wheelchair for a year with severely damaged and scarred backs of both legs. I still cannot walk far and still need a wheelchair. 

I changed hospitals and was started on methotrexate which has kept thing mainly in check with occasional blips.  This year I have another serious outbreak which has led to me being started on the cosentyx.  I have been housebound since August, and can only wear very very soft clothes.  As you will all know, the pain and soreness can be unbearable especially when completely covered in psoriasis.  The wired thing is that this time my outbreak was the guttate type, she had then all joined up to make huge areas like the plaques.  

I have a wonderful husband   who helps me, and some lovely neighbours and friends.   I often wonder what would of happened to me without their help. I feel very lucky.   I am so glad to have found this group, everyone is very friendly.  I no longer feel alone with others who understand.

Thank you for taking the time to read my post, you all have a good day 

Hey guys, I'm Nick. I first started with rosacea on my face, which became much worse and led to eczema and seborrheic dermatitis after some dermatologists tried to help. I fixed it myself with herbs and supplements, but after a few years I had issues and went back to the dermatologist, got worse...anyway, that's the cycle I've done 5 or 6 times now, with the latest problem being plaque and guttate psoriasis on my neck and arms that got much worse when my derm suggested (before doing a biopsy) athlete's foot cream in case it was fungal, and I took a lot of B vitamins and zinc (probably unbound copper dumping, but the biochemical angle gets technical real quick).  Otezla helped at first but not so much now, but because I work at a hospital with all sorts of nasty diseases, I don't really want to take anything that decreases my immunity. I took my first, tiny dose of dimethyl fumarate today and tolerated it well, and am trying to slowly increase my zinc levels too. Nice to meet you all.