Hi Folks - I've recently started with Fumaderm now on 120 mg X 3 times per day .....see my consultant on 18 th Jan.....with upping the dosage I assume ........not real visible improvement yet but some of the " anger " has gone from the soreness on both calfs.

Just a question /advice from you that have used this medication .....I shall be out of the U.K. early April until abt 26 June ......so I will not be able to have blood tests during this period ......will this be ok or any suggestions thanks Vince

I've been on Acitretin for about 2 years and my psoriasis has never been better.  The worst side-effect I am experiencing, and it has become almost an obsession for me, is my dry lips.  It's not even so much that they are dry, it's as if the skin cells are overproducing.  I have taken to trimming the excess dry skin cells carefully with a small pair of scissors, but an hour or two later, it needs done again.

I have tried every kind of lip balm, even "Acnibex" which is supposedly specifically for the dry lips caused by retinoids, but nothing brings them under control.

How is everyone else dealing with this?  It's getting to the point that I feel like giving up on the Acitretin, even though I know the psoriasis would come back.

So,
If like me you have had the joy of blood tests over and over due to the meds you have been taking, I wonder if like me your iron levels were on the lower end of the scale?
Yes being female does tend to play about with iron levels, but through my time on meds and then pregnancies I have always been anemic or close to it.
I have read in a book, (sorry can't remember the name of it, but if anyone is intrested I shall try to find out) that psoriasis and anemia are linked!
I also found it intresting that over my many blood tests, pregnancies and general life as a psoriasis suffer that only one GP has ever flagged up this link to me.
If my tiredness levels are still a bit rubbish as my 5 month old starts to wean then I think I may discuss my iron levels more with my GP and pick his brains on it a bit more.
(Im waiting to see if I get called in soon because of the vast amount of moisturiser Im requesting)

This study suggests anxiety may be missed using the Dermatology Life Quality Index (DLQI) test on psoriasis patients.

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Background:
National Institute for Health and Care Excellence guidance recommends assessment of psychological and social well-being in people with psoriasis.

Objectives:
To screen systematically for depression and anxiety in patients with psoriasis in routine clinical practice and to identify at-risk groups for psychiatric morbidity.

Methods:
Consecutive patients attending a single, tertiary centre over a 10-month period were invited to complete the Patient Health Questionnaire Depression Scale (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Dermatology Life Quality Index (DLQI) as part of IMPARTS: Integrating Mental and Physical Healthcare: Research, Training and Services. Information on demographics, treatment and clinical disease severity was collated from electronic patient records. Regression models were used to identify at-risk groups for psychiatric morbidity.

Results:
Of 607 patients included (56·2% on biologics), 9·9% (95% confidence interval 7·5–12·3%) screened positive for major depressive disorder (MDD) and 13·1% (79/604) (95% confidence interval 10·4–15·8%) for generalized anxiety disorder (GAD; GAD-7 score > 9). Suicidal ideation was reported in 35% of those with MDD; DLQI was < 10 in 38·3% and 45·6% cases of MDD and GAD, respectively. After adjusting for covariates, the risk of MDD or GAD was significantly higher in women and those with severe clinical disease, psoriatic arthritis and previous depression/anxiety. The risk of GAD was significantly increased with Asian ethnicity and use of topical treatments only.

Conclusions:
Systematic screening for anxiety and depression identifies clinically important levels of depression and anxiety that may be missed using DLQI data alone. Women and those with severe disease, psoriatic arthritis and/or a prior history of psychiatric morbidity may be at particular risk.

I've got a really stubborn bit of psoriasis on my ear.  It's not inside the ear but on the little nobbly bit at the entrance of the ear right above where you'd get your ear pierced. 

Nothing seems to work in removing it. Even the brilliant Enstilar foam doesn't seem to be having much of an affect on it. Yes I know steroid creams shouldn't be used on the face but it was just a test for 2-3 days and I've stopped now. 

Any recommendations? Thanks

This study looked at the association between the germline MTHFR polymorphisms C677T and A1298C with psoriasis risk in a Turkish population.

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Background:
Psoriasis is a common chronic inflammatory skin disease caused by genetic and epigenetic factors. There are conflicting results in the literature about the association between psoriasis and the methylenetetrahydrofolate reductase gene (MTHFR), ranging from strong linkage to no association.

Aim:
To investigate the association between the germline MTHFR polymorphisms C677T and A1298C with psoriasis risk in a Turkish population.

Methods:
The study enrolled 84 patients with psoriasis and 212 healthy controls (HCs) without any history of psoriasis. DNA was extracted from peripheral blood samples of patients and HCs, and real-time PCR was used for genotyping. Results were compared by Pearson χ² test and multiple logistic regression models.

Results:
The frequency of both the MTHFR 677TT and A1298C (homozygous) genotypes was statistically significantly different from HCs. Point mutations were detected in all patients with early-onset psoriasis (before the age of 20 years). The T allele of MTHFR 677 and the C allele of MTHFR 1298 increased psoriasis risk by 12.4- and 17.0-fold, respectively, in patients compared with HCs.

Conclusion:
A possible association was detected betweengermline MTHFR 677 C>T and 1298 A>C genotypes and psoriasis risk in a Turkish population. These results need to be confirmed in further studies with larger sample sizes.

This study looked at arterial inflammation and subcutaneous inflammation in psoriasis patients.

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Background:
Psoriasis is associated with cardiovascular disease; it has been proposed that increased cardiovascular risk is caused by low-grade systemic inflammation involving organs and tissues other than the skin and joints.

Objectives:
To investigate signs of vascular inflammation in untreated patients with moderate-to-severe psoriasis assessed by 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography. A secondary objective was to assess signs of subcutaneous adipose tissue inflammation.

Methods:
This was an observational, controlled clinical study including patients with psoriasis (n = 12, mean ± SD age 61·4 ± 4·1 years, 83% men, mean ± SD Psoriasis Area Severity Index score 14·5 ± 4·3) and matched controls (n = 23, mean ± SD age 60·4 ± 4·5 years, 87% men). Vascular inflammation was measured using aortic maximal standardized uptake values (SUVmax) and the target-to-background ratio (TBRmax) of the whole vessel and aortic segments. Subcutaneous adipose tissue inflammation was assessed and compared with regard to SUVmax and TBRmax.

Results:
Arterial inflammation was increased in patients with psoriasis vs. controls (mean ± SD whole vessel TBRmax 2·46 ± 0·31 vs. 2·09 ± 0·36; P = 0·005). In patients with psoriasis, higher FDG uptake values were observed for all aortic segments except the ascending aorta. Subcutaneous adipose tissue FDG uptake was increased in patients with psoriasis vs. controls (mean ± SD TBRmax 0·49 ± 0·18 vs. 0·31 ± 0·12; P = 0·002). Associations remained significant after adjusting for body mass index and age.

Conclusions:
Global arterial inflammation and subcutaneous inflammation were significantly increased in patients with moderate-to-severe psoriasis compared with controls.

This study looked at the differences in serum metabolomic profiles in psoriasis patients.

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Background:
Recent studies have shown that dysregulated metabolic pathways are linked to psoriasis pathogenesis. However, an extensive, unbiased metabolic analysis in patients with psoriasis has not been completely explored. The metabolome represents the end products of proteomics or cellular processes that may be closely associated with the pathogenesis of psoriasis.

Objectives:
To determine the differences in serum metabolomic profiles among patients with psoriasis and healthy controls with the goal of identifying potential biomarkers in patients with psoriasis.

Materials and methods:
Serum metabolomic profiles from 29 subjects (14 patients with psoriasis and 15 sex- and age-matched healthy controls). The serum metabolites were analysed by gas chromatography-mass spectrometry based on a combined full scan and selected-ion monitoring mode.

Results:
Multivariate statistical analysis of metabolomics data revealed altered serum metabolites between the patients with psoriasis and healthy individuals. Compared with healthy individuals, patients with psoriasis had higher levels of amino acids including asparagine, aspartic acid, isoleucine, phenylalanine, ornithine and proline; higher levels of lactic acid and urea; and lower levels of crotonic acid, azelaic acid, ethanolamine and cholesterol.

Conclusions:
It appears that the glycolysis pathway and amino acid metabolic activity are increased in patients with psoriasis. These metabolic perturbations may stem from increased demand for protein biosynthesis and keratinocyte hyperproliferation. Our findings may help to elucidate the pathogenesis of psoriasis and provide insights into early diagnosis and therapeutic intervention.

Hello!

My name is Kristen, I'm in my early 20's and I was diagnosed with psoriasis ever since I was a junior in high school. Throughout the years I have been using all sorts of products whether it be OTC or from the dermatologist. What sucks is that every single time I find a product that seems to work, my body will start adjusting to it and It Wil no longer work. My psoriasis started on my scalp and has now spread to my back, arms (on my tattoos), middle my chest, and is mostly now on my face. 

I was just wondering what are YOUR products/remedies you use to help or if you have any tips for my psoriasis. (Like if going into the ocean really does help your skin) I know everyone's body is different! 

Any feedback helps

This study looked at the risk of cardiovascular and cerebrovascular morbidity in patients with psoriatic arthritis and it doesn't make good reading.

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Objective:
To assess the magnitude of risk of cardiovascular and cerebrovascular morbidity in patients with psoriatic arthritis (PsA) compared with the general population through a systematic review and meta-analysis of observational studies.

Methods:
We searched the Medline, Embase, and Cochrane databases, as well as abstracts archives from rheumatology conferences. Observational studies that included a PsA diagnosis, cardiovascular or cerebrovascular outcomes, and a comparison group of individuals without psoriasis and rheumatic diseases and were case–control, cross-sectional, or cohort studies, were assessed by 2 researchers. We calculated weighted pooled summary estimates of the maximally adjusted effect size estimates for cardiovascular and cerebrovascular diseases using the random-effects model, and tested for heterogeneity using the I2 statistic.

Results:
Eleven studies, comprising 32,973 patients with PsA, met the inclusion criteria. There was a 43% increased risk of cardiovascular diseases in patients with PsA compared with the general population (pooled odds ratio [OR] 1.43 [95% confidence interval (95% CI) 1.24–1.66]). The risk of incident cardiovascular events was increased by 55% (pooled OR 1.22–1.96). Morbidity risks for myocardial infarction, cerebrovascular diseases, and heart failure were increased by 68%, 22%, and 31%, respectively (pooled OR 1.68 [95% CI 1.31–2.15], pooled OR 1.22 [95% CI 1.05–1.41], and pooled OR 1.31 [95% CI 1.11–1.55], respectively). We identified significant heterogeneity in all main analyses (P < 0.001).

Conclusion:
Cardiovascular and cerebrovascular morbidity are increased by 43% and 22%, respectively, in patients with PsA compared with the general population.

Hello,

My name is Daniel and I am trying Taltz again.  I first tried it in June 2016 and got really sick a couple days after starting.  I don't know if it was related to Taltz, but I was sick 4-5 days.  A couple of those days I couldn't even stand up.  Good times.

My psoriasis has been bothering me a lot more lately so I wanted to try giving it another shot (no fun intended).  I met with my doctor and he was skeptical that Taltz would have made me that sick so we decided to try again.

I took the first two injections tonight about an hour ago (Happy Christmas to me).  I am off work this coming week so if I do get sick again, I at least won't have to worry about that.

The first time I tried Taltz the injections REALLY hurt.  I don't have a high pain tolerance but this was really bad, especially compared to every other biologic injection I've tried over the years.  This time I made sure to take the injectors out at least 30 minutes prior (I can't remember if I did it that long last time) and also used ice packs for 5+ minutes on the injection areas.  It still hurt a lot but it was slightly more tolerable than the first time.

I really hope that getting sick last time was an anomaly and that things go much better this time around.  The week or two after my initial try, it did seem like some of the patches were starting to be less thick but with not continuing the treatment, it came back as before.  I've tried most every biologic available and with the exception of Raptiva, which was pulled years ago, none have worked.  I tried Otezla at the beginning of this year but that didn't work either.  It did improve things slightly but after a couple months, it went back to the way it was.

Here's hoping.  Thanks.

-Daniel

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