Hi everyone,

Took my loading dose of humira  a week and a half ago so just thought i'd see what other peoples experiences with the drug are.

I had to stop cyclosporine just after xmas as id been on it for too long, i was gutted about this as it had worked for me with amazing results. Instantly had a MASSIVE flair which has only just calmed down.
I've really struggled this past couple of months mentally, i think having been used to being psoriasis free for the best part of a year it was such a shock to the system to be covered head to toe  within a couple of weeks of stopping. I really took it for granted being clear, its hard to explain how it effects EVERY single thing you do in day to day life.

Anyway enough of the depressing stuff, I'm trying to stop feeling sorry for myself now that I've started the new medication but I've seen no difference whatsoever, i know its only been couple of weeks but there has been nothing, the cyclosporine worked so quickly!

I realise I'm just being very impatient but was just wondering if there were others that had tried humira and if it had worked for them?

Thanks for reading
Jamie

Hi friends,
I just signed on 2- 20 - 17.
74 year old white male.
Psoriasis patient for 55 years.
Treatments back in the 60s were scarce.
Coal tar, baths with various oils, oat meal, etc.
Then came UVA light treatments and methotrexate
Then psoralen capsules were added to UVA treatments and those PUVA treatments helped control my psoriasis until about 3 years ago.
UVB helped some more then even that lost effectiveness.
5 years ago I was infected with Lyme disease. That screwed everything up.
Last year I finally agreed to try a biologic. 
I started Humira in February of 2016. It worked very well and I tolerated it well. It helped my psoriatic arthritis too.
2 months ago Humira began to fail. I start Taltz in 2 weeks.
Here's hoping it will help.
Phil

This study looked at the risk of depression, suicidal ideation, and suicide attempt in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis patients.

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Background:
Sparse information is available concerning mental health issues in psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS) patients.

Objective:
To estimate risk of depression, suicidal ideation, and suicide attempt in patients with psoriasis, PsA, and AS, respectively, compared with the general population.

Methods:
This population-based cohort study analyzed 36,214 psoriasis patients, 5,138 PsA patients, and 1,878 AS patients who were frequency-matched with a general population cohort. Annual incidence rate of depression, suicidal ideation, and suicide attempt was calculated separately for psoriasis, PsA and AS.

Results:
There was an increased risk of depression in the three cohorts; adjusted IRR: psoriasis, 1.14 (95% CI, 1.11, 1.17); PsA, 1.22 (95% CI, 1.16, 1.29); AS, 1.34 (95% CI, 1.23, 1.47). There was no significantly increased risk for suicidal ideations or suicide attempt among psoriasis, PsA, or AS patients.

Limitations:
Patients were not excluded if previously diagnosed with depression, suicidal ideation, or suicide attempt. Suicide attempt and completed suicide analyses were not adjusted for presence of depression. Use of systemic psoriasis treatment to measure severe psoriasis could lead to psoriasis severity misclassification.

Conclusion:
The risk of depression, but not suicidal ideation or suicide attempt, was significantly increased in patients with psoriasis, PsA, and AS.

This study looked at psoriasis patients preferences for attributes of biological treatments.

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Background and objectives:
Treatment satisfaction can be improved by integrating patients’ preferences into shared decision-making. We recently investigated patients’ preferences for attributes of biologicals, and showed high preferences for safety and efficacy. The objective of the present study was to assess the impact of treatment experience on these preferences.

Patients and methods:
Preferences for outcome (probability of 50 % and 90 % improvement, time until response, sustainability of success, probability of mild and severe adverse events, probability of ACR 20 response) and process attributes (treatment location, frequency, duration, and delivery method) were analyzed in 200 participants with moderate-to-severe psoriasis using conjoint analysis. The impact of current and previous therapies, disease duration, and treatment satisfaction on ‘Relative Importance Scores’ was determined by analysis of variance, post hoc tests, and multivariate regression.

Results:
Participants presently on topical therapy (p = 0.02) or phototherapy (p = 0.032) placed more importance on treatment duration than others. Individuals who had previously been given traditional systemic agents (p = 0.028) or biologicals (p = 0.044) favored sustainability more than others. With an increasing number of systemic agents ever received (p = 0.045) and longer disease duration (p = 0.018), the latter attribute became increasingly important.

Conclusions:
Patients’ preferences for biologicals vary in correlation with treatment experience and disease duration, aspects to be addressed in the context of shared decision-making.

This study looked at the use of phototherapy in combination with Fumaderm

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Background:
While treatment of patients with moderate-to-severe psoriasis using a combination of fumaric acid esters (FAE, Fumaderm®) and phototherapy (UV) is common practice, there have been hardly any studies investigating this regimen. Available information is limited to data from a small pilot study. The objective of the present study was to evaluate FAE/UV combination therapy in a larger patient cohort with moderate-to-severe psoriasis.

Patients and methods:
In this prospective noninterventional multicenter study, data from patients treated with FAE/UV combination therapy was assessed with regard to efficacy (PGA‚ PASI, DLQI, EQ-5D), safety, and dosage over a twelve-month period. The findings were subsequently compared to data from a previous retrospective study on FAE monotherapy.

Results:
Data from 363 patients was included in the analysis. Efficacy measures improved substantially on combination therapy. Compared to FAE monotherapy, FAE/UV therapy led to a faster clinical response, however, there was no difference in efficacy after 12 months. Neither the duration nor the type of phototherapy had an impact on efficacy. In general, combination therapy was well tolerated. Seven percent of patients experienced adverse events.

Conclusions:
FAE/UV combination therapy is effective and well tolerated in patients with moderate-to-severe psoriasis. Such treatment may induce a faster therapeutic response, and appears to be useful, particularly in the first three months of FAE therapy.

Well here is a dilemma.  I just noticed that the foot rest portion of my off white leather lazy boy has become stained with my use of the Dovobet on my my lower legs.... How the blazes am I going to get that off?

Anyone got any suggestions?  

PS:  Sigh, another irritation or side effect from this scourge of a condition.

I have been plagued with both Psoriasis and Psa for almost my entire adult life. Tried everything from creams to lights to biologics. I have gone untreated for 4 years. I have psoriasis over 90 percent of my body. I just had my first Methotrexate injection a week ago.  Within 2 days the bright red skin had already begun to fade and the insane itching 24/7 was lessening.  I was beginning to feel human again.  Tomorrow I get dressed number 2.  As of now, the itching is very minor and redness is there but slight with minor scaling.  It sucked to be me.  I'm hoping and praying to get a halfway pleasant summer this year.  I also have Psa pretty severely, and possibly fibromyalgia. So far not much better with the arthritis pain and may reintroduce Enbrel in several weeks, as that is the only drug that ever actually controlled my pain.

Following on from this post Brodalumab could be approved for psoriasis soon the FDA have now given approval for the use of Siliq (brodalumab) for the treatment of adults with moderate-to-severe plaque psoriasis.

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Siliq is administered as an injection.

Siliq is intended for patients who are candidates for systemic therapy (treatment using substances that travel through the bloodstream, after being taken by mouth or injected) or phototherapy (ultraviolet light treatment) and have failed to respond, or have stopped responding to other systemic therapies.

"Moderate-to-severe plaque psoriasis can cause significant skin irritation and discomfort for patients, and today’s approval provides patients with another treatment option for their psoriasis," said Julie Beitz, M.D., director of the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research. "Patients and their health care providers should discuss the benefits and risks of Siliq before considering treatment."

Psoriasis is a skin condition that causes patches of skin redness and flaking. Psoriasis is an autoimmune disorder that occurs more commonly in patients with a family history of the disease, and most often begins in people between the ages of 15 and 35. The most common form of psoriasis is plaque psoriasis, in which patients develop thick, red skin with flaky, silver-white scales.

Siliq’s active ingredient (brodalumab) binds to a protein that causes inflammation, inhibiting the inflammatory response that plays a role in the development of plaque psoriasis.

Siliq’s safety and efficacy were established in three randomized, placebo-controlled clinical trials with a total of 4,373 adult participants with moderate-to-severe plaque psoriasis who were candidates for systemic therapy or phototherapy. More patients treated with Siliq compared to placebo had skin that was clear or almost clear, as assessed by scoring of the extent, nature and severity of psoriatic changes of the skin.

Suicidal ideation and behavior, including completed suicides, have occurred in patients treated with Siliq during clinical trials. Siliq users with a history of suicidality or depression had an increased incidence of suicidal ideation and behavior compared to users without this history. A causal association between treatment with Siliq and increased risk of suicidal ideation and behavior has not been established.

Because of the observed risk of suicidal ideation and behavior, the labeling for Siliq includes a Boxed Warning and the drug is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the Siliq REMS Program. Notable requirements of the Siliq REMS Program include the following:

Prescribers must be certified with the program and counsel patients about this risk. Patients with new or worsening symptoms of depression or suicidality should be referred to a mental health professional, as appropriate.
   
Patients must sign a Patient-Prescriber Agreement Form and be made aware of the need to seek medical attention should they experience new or worsening suicidal thoughts or behavior, feelings of depression, anxiety or other mood changes.
   
Pharmacies must be certified with the program and must only dispense to patients who are authorized to receive Siliq.

Siliq is also approved with a Medication Guide to inform patients of the risk of suicidal ideation and behavior, and that because Siliq is a medication that affects the immune system, patients may have a greater risk of getting an infection, or an allergic or autoimmune condition. Patients with Crohn’s disease should not use Siliq. Health care providers should also evaluate patients for tuberculosis (TB) infection prior to initiating treatment with Siliq. Health care providers should not administer Siliq to patients with active TB infection, and should avoid immunizations with live vaccines in patients being treated with Siliq.

The most common adverse reactions reported with the use of Siliq include joint pain (arthralgia), headache, fatigue, diarrhea, throat pain (oropharyngeal pain), nausea, muscle pain (myalgia), injection site reactions, influenza, low white blood cell count (neutropenia) and fungal (tinea) infections.

Hello, I'm Michael from Poland and I found this forum because my dad's psoriasis disease. He used a lot of resources, but nothing helps, therefore, I would like to learn from You something about the use of CBD oils and cream.

So I have just joined the forum and I'm starting this tread with updates on my current treatment in the hope that it can assist someone else in the future. 

Brief intro and background: I'm 34 and I have had moderate guttate p since '97. Arms, legs, belly, back, scalp, nails, buttocks, basically everywhere but never on palms nor feet. My p is very active and I have never been fully clear since the first episode in '97, with the spots that are always present in all parts of the body and quickly enlarge in a few days and regularly develop into larger patches. They can go completely away in a few weeks with or without local medication but at the same time there are always new spots appearing somewhere else. Having said that, summer helps me a lot and usually a few days of sunbathing and seas bring the p down to a level where I'm not clear completely but I feel comfortable going back in the office. I would say sufficiently clear. Doctors always told me I'm "moderate" even though I recall 3-4 moments where I was severely covered in red patches, particularly in the face and legs. 

(One thing that has always surprised me is the symmetrical aspect of the p. There's a large patch under the right armpit? I knew that in a couple days there would be a large patch under the left one, very similar in shape). 

First of all, I had many many many local medications in the past but I took systemic medication only once in 1997, it was methotrexate. After that, it has been betamethasone and calcipotriol most of the time, UV, and that's basically it. I have never done thermal treatments either, even though it seems they are very popular here in northern Italy and you can do up to 12 treatments for free if prescribed by the doctor. I don't know why they haven't let me do that yet but oh well. 

Now I'm experiencing diffuse p over the entire body after a long period of stress and my dermatologist has prescribed:

- Dovobet    (which I started on February 6)
- Neotigason (10mg once a day  - which I started on February 13th so it will be 3 days today)

This is the first time I am taking these. I had never heard them before but I admit I've never looked around for new drugs. 

Dovobet so far (10 days) has been really great. I noticed an initial worsening but now the larger patches are almost gone. The small spots are a bit of an issue because there's too many and its difficult to put a small drop of product exactly on the spot and keep it there.

Neotigason, it's still too early to comment on it and I have been told I need to wait at least 4 weeks which seems to be confirmed by other users here. I'm a bit worred about the side effects and I really hope this drowsiness I'm feeling today is not due to the medication: my eyes are all fuzzy. We'll see tomorrow.

Hello All, 

I have just registered as a new member after a couple of days of serious lurking, particularly the diary-type threads which I find to be very useful and interesting. Great community!

I was first diagnosed with moderate guttate p in 1997 and I have never been completely clear ever since. Been on several medications with partial success but most years I would just be patient in the winter months until summertime when sun and sea greatly helped me. In August 2016 I experienced one of my most severe reappearances since I can remember, due mostly to stress I suppose: greater responsibilities at work, suddendly needed to quickly find a new house, and the birth of our first baby (I love him but sleep deprivation hit me really hard!). I have then decided to visit again a dermatologist (first time in many years) and I am now on Dovobet (starting Feb. 6) and Neotigason (starting Feb. 13). I am new to these medications so I'm really hopeful. I can't wait to see how it goes and in the meantime I will be happy to read other members' experience with these. 

Thanks everyone.

This study assessed the prevalence of psoriasis around stoma sites and identify the most effective treatment.

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Background:
Psoriasis is a common skin condition, affecting 1.3–2.2% of the population. The prevalence of psoriasis has previously been reported as 11.2% in patients with Crohn disease (CD) and 5.7% in patients with ulcerative colitis.

Aim:
To assess the prevalence of psoriasis around stoma sites and identify the most effective treatment.

Methods:
A departmental database of all patients attendings stoma clinic was accessed between 1 May 2003 and 15 October 2015. Psoriasis response was determined by clinical resolution of psoriatic plaques in terms of erythema, induration, scaling and stoma bag adherence.

Results:
Of 1665 patients, 78 (4.7%) had psoriasis affecting their abdominal stoma. In 8 patients (11.5%), a thicker hydrocolloid stoma bag barrier was sufficient to resolve the peristomal psoriasis. For 75 patients (96.2%), initial management was with nongreasy topical steroid scalp preparations and their usual barrier in the form of their stoma bag. Patients who did not respond to topical treatments initially or who experienced secondary failure (n = 16; 20.5%) received different systemic treatments [ciclosporin (n = 2), methotrexate (n = 2; 1 patient did not respond) or ultraviolet B narrowband phototherapy (n = 8; 2 nonresponders). One patient received infliximab and four patients received adalimumab for treatment of their CD, and their peristomal psoriasis also responded to these treatments. A further patient was prescribed adalimumab by the dermatology departmetn for the management of psoriasis vulgaris, with good response.

Conclusion:
Peristomal psoriasis is common but potentially under-recognized. Selecting effective treatment that does not hinder bag appliance is crucial for effective management. Effective treatments include hydrocolloid dressings and topical corticosteroid regimens.

This study looked at the clinical profile and outcome of Malaysians with juvenile generalized pustular psoriasis.

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Background:
Limited information exists regarding juvenile generalized pustular psoriasis (GPP). We aim to determine the clinical profile and outcome of Malaysians with juvenile GPP.

Methods:
Review of hospital case notes on patients with juvenile GPP.

Results:
Twenty-seven patients with juvenile GPP were identified. Female to male ratio was 1.4:1. The median age at onset of GPP was 6.5 years. Ten patients had prior psoriasis with a median pre-pustular duration of 2.7 years. Onset of GPP was earlier in patients without prior psoriasis (5.1 years vs. 12.0 years, P = 0.002). Precipitating factors identified included stress, upper respiratory tract infection, systemic steroid use, vaccination, and pregnancy. A positive family history of psoriasis and GPP was present in six and one patient(s), respectively. Twenty-one patients had acute, five annular, and one localized variant of GPP. Arthritis was present in 22.2%. Fever, leukocytosis, and transaminitis were mainly seen in patients with acute GPP at 80.9, 72.2, and 11.1%, respectively. Among 20 patients screened, eight carry IL36RN variants and one has CARD14 mutation. IL36RN-positive patients have more severe disease characterized by early onset, low prevalence of prior plaque psoriasis, high prevalence of systemic inflammation, and need for continuous long-term systemic therapy. Acitretin and cyclosporine were effective in aborting acute GPP in 100% of 16 and 66.7% of six patients treated, respectively. However, relapses were common. Only three of the 17 patients whose initial acute GPP was controlled with systemic agents were successfully weaned off treatment.

Conclusions:
Juvenile GPP is a chronic recalcitrant disease. IL36RN-positive patients have more severe disease.

Hi All,
Just a quick question, I have suffered with Psoriasis for the last 20 years, I have finally found something that works for me Stelara. I am on the 90mg Injection and started treatment in October 2016, I will be having my first 3 monthly injection on Thursday 16th February, after having the 2 injections 1 month apart.
For the first time in 20 years I now do not have to cover up out of embarrassment and am wearing shorts and T-shirts, all be it spoilt in the Florida Sunshine,
My question is, having been in the USA for the last 18 months and returning to the UK permanently at the end of March, I have continued to pay my class 3 National Insurance throughout my time here for a meagre pension and other benefits, should I need them. 
Is Stelara readily available in The UK, particularly Brighton which is where I will be moving back to ? Or is it a postcode lottery with regard to funding ?
Any information would be greatly appreciated as having found something that finally works I would now hate to go back to being as I was previously. 

Thanks in advance,

Ashley

Not been on for a couple of years. Hope everyone I used to chat with is doing ok.
Do people still have the get togethers?

I'm from Manchester UK

Would be nice to chat with someone reasonably local

Dave

This study looked at the relationship of geographic tongue in psoriasis patients. Geographic tongue is an inflammatory condition of the mucous membrane of the tongue.

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Background:
Few studies have examined the clinical features of geographic tongue (GT), an inflammatory lesion, making diagnosis and the investigation of oral psoriasis difficult.

Purpose:
To investigate the clinical features of GT to facilitate its identification and understand its relationship with psoriasis.

Methods:
A total of 96 participants diagnosed with GT underwent stomatological and dermatological examinations. The parameters assessed were burning sensation; number, classification, and location of lesions; loss of papillae; severity of GT lesions; and association with fissured tongue (FT). Psoriatic patients (PS) and those without psoriasis (NPS) were compared.

Results:
Burning sensation was reported by 45 (47%) patients, 67 (70%) patients showed active GT, 68 (71%) presented with typical lesions, and 59 (61%) exhibited moderate lesions. GT was associated with FT in 75% of the cases and exhibited a diffused pattern associated with severe lesions. It was also more frequent in the PS group. The comparative analysis between the PS and NPS groups showed significant differences between the groups with regard to gender, presence of burning sensation, and GT severity.

Conclusion:
GT is a symptomatic lesion with a thick halo. In contrast, psoriatic patients are frequently asymptomatic and exhibit severe lesions with greater loss of papillae that are associated with severe FT. The present study is the first to demonstrate clinical differences in the GT of patients with and without psoriasis, suggesting that some GT cases may represent true oral psoriasis and some cases may represent only GT.

BIOREP is one of the first registries of patients with psoriasis treated with biologics in Central and Eastern Europe. This study analyzed the cohort of patients treated with biologics between May 2005 and May 2015.

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Background:
BIOREP is a Czech registry of psoriatic patients on biological treatment in a clinical setting. We describe the characteristics of patients with psoriasis at the time of enrollment and present comparisons with published data from other national registries.

Methods:
We analyzed the cohort of patients treated with biologics between May 2005 and May 2015. Demographic data, previous therapies, comorbidities, and severity of psoriasis were compared with data from other registries – DERMBIO, BIOBADADERM, BADBIR, and PSOBEST.

Results:
A total of 1412 psoriatic patients initiating biological treatment were included with a predominance of males (63.4%). The mean patient age was 50.2 years, and approximately 70.5% of patients were either overweight or obese. The mean baseline Psoriasis Area and Severity Index was 19.8, and the Dermatology Life Quality Index was 16.6. More than one-third of patients (41.0%) reported a history of psoriatic arthritis, and a high proportion of patients (49.5%) with cardiovascular risk factors (hypertension [35.2%], hyperlipidemia [27.7%], diabetes mellitus [11.4%], coronary heart disease [4.9%], and obesity [15.2%]) were observed. Most of the patients had been previously treated with phototherapy (85.4%), acitretin (74.0%), methotrexate (65.7%), or cyclosporine (53.1%).

Conclusion:
BIOREP is one of the first registries of patients with psoriasis treated with biologics in Central and Eastern Europe. Our results found a similar or higher prevalence of comorbidities, long disease duration, and high impact on the quality of life among patients included in Western European registries.

This study evaluated the efficacy and safety of Interleukin 17 treatments for psoriasis. *Cosentyx and Taltz are Interleukin 17 treatments.

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Background:
The interleukin-17 (IL-17) cytokine pathway plays a key role in the development of psoriasis. Antibodies targeting IL-17 or blocking its receptor may be a new therapeutic approach for psoriasis. To assist treatment selection in daily practice, it is essential to understand the benefit and risk profile of IL-17 antagonists.

Objective:
We performed a meta-analysis to evaluate the efficacy and safety of IL-17 antagonists in patients with psoriasis.

Methods:
We searched a number of databases for relevant randomized controlled trials (RCTs) published before May 2016. The following outcomes were evaluated: Psoriasis Area and Severity Index (PASI) 75, 90, 100 response, Investigator's Global Assessment (IGA) score of 0 or 1 response, adverse events (AEs) and withdrawals. The meta-analysis was performed using Review Manager 5.2 software.

Results:
Nine RCTs with 5951 patients were included. IL-17 antagonists achieved higher PASI 75, 90, 100 response rates and Dermatology Life Quality Index 0 or 1 response rates than placebo and a lower incidence of discontinuations due to lack of efficacy. In the safety analysis, no significant differences were found between the IL-17 antagonists and placebo in the proportion of patients with serious AEs, cardiovascular disease and discontinuations due to AEs. However, IL-17 antagonists were associated with a higher proportion of patients with any AEs and infections than placebo.

Conclusion:
IL-17 antagonists were effective, with an acceptable safety profile, for patients with plaque psoriasis. Vigilance because of the potential for infection will be necessary for IL-17 antagonists.

Recently I started using ketogenic diet (high fat, low carb and moderate protein) and am seeing amazing improvement with my psoriasis and psoriatic arthritis.

Hi
Im currently taking 3 x 120mg of fumaderm per day. I take one at 6am before setting off for work. The second about 2/3 pm. and the final one about 9pm before bed.
Its the first one in the morning that gets me. I only have a cup of tea before setting off for work. I go to the Lou before setting off and all seems pretty normal, but after an hours drive to work I am at the toilet for the next three hours probably up to ten visits. my stomach rarely settles until lunch time. I eat my lunch about 10am and after more visits my stomach settles. The other two tablets are relatively easy to tolerate. I am quite happy with the results as it is just starting to work. Can anyone shed any light on why this first tablet hits me so hard. I apologise for the subject t know who else to ask. but don't know who else to ask.