Another study looking at obstructive sleep apnea in patients with psoriasis.

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Background:
Psoriasis is a chronic inflammatory skin disorder that is associated with the metabolic syndrome and its components. An association between obstructive sleep apnea (OSA) and the metabolic syndrome was previously observed.

Objectives:
To investigate the association between psoriasis and OSA in a comprehensive community-based database.

Materials and methods:
The study was performed utilizing the medical database of Clalit Health Services. Patients with psoriasis were compared to controls regarding the prevalence of OSA in a case–control study. A logistic multivariate model was used to control for independent covariates.

Results:
The study included 12,336 patients with psoriasis ≥21 years and 24,008 age- and sex-matched controls. The prevalence of OSA in patients with psoriasis was increased compared to the control group (2.7%, 1.5%, respectively, P < 0.001). Multivariate analysis adjusting for age, sex, ethnicity, body mass index, chronic obstructive pulmonary disease, hypothyroidism, hyperlipidemia, and peptic disease demonstrated a significant association between psoriasis and OSA (odds ratio = 1.27, 95% confidence interval 1.08–1.49, P < 0.001).

Conclusion:
We found an association between psoriasis and OSA among a large cohort of patients with psoriasis. Clinicians should take into account that patients with psoriasis may have undiagnosed OSA.

I am wondering if Psoriasis occurs on the face as commonly as other areas on the body?

Hi everyone, 

I am in my 30's, from New York. I've been dealing with psoriasis since I was 19, though it was only on my scalp at that time. Since then, I have had flare ups that have taken more and more of my body. I saw remission once, when I was very active and it was glorious, but I have since reverted back. I believe my case of psoriasis to be directly related to the stress in my life and my lifestyle. I work a lot and have given everything to work in the past. 

It would be nice to be part of a community that understands the joys of living with psoriasis so I look forward to speaking with you. 

Chris

My other halfs step dad has psoriasis and has recently started Otezla and got amazing clearance with no side effects.  I've never heard of it before! Is anyone else on it?

This might be a better spot to continue..........

I guess if I were starting a new treatment I would want to set some parameters by which to evaluate it. Sticking with a treatment for six months waiting for an effect is of no interest to me. My disease has been severe and unforgiving, and I dont see myself having such patience. Fred's reference to the WHO report on psoriasis also outlined a case of unemployment and homelessness from uncontrolled disease, so the consequences of non-treatment are not trivial.

I would also want to see some evidence of effectiveness. I believe there was a pilot study of ldn in Glasgow at the end of 2013; A three month trial. No results released. My guess is that it did bugger all.

Hi All

I was diagnosed with Palmar Plantar Psoriasis 12 months ago and had no luck with the various topical steroid creams and emollients that my GP and Consultant Dermatologist prescribed over that time.

After a particularly bad flare-up I took to my bed because of the pain and discomfort and decided to do some research on the internet. I figured I had nothing to lose as the conventional treatments were not helping me at all. At best they were holding the symptoms at bay (barely) and I was using more and more of the steroids in an attempt to clear my skin, what little there was left of it. So, paper thin skin on hands and feet and multiple lesions filled with pus. Not good.

On doing a lot of reading on forums like this and other psoriasis related sites I came to the conclusion that diet may well play a big part in causing this thing. It seemed that many people reported improvements after removing certain foods from their diets, they called them "trigger foods".

They appeared to be :

gluten

dairy

sugar

I was doubtful about embarking on such a diet as I have never had any food intolerances before, so was obviously skeptical that doing so would help, however, I had no other ideas because I had tried many different supplements over the previous 12 months which had helped a little but only for a short time and the psoriasis just returned to its normal aggressive self.

After 2 weeks of removing all wheat/barley/milk/cheese/sugar/starchy veg from my diet I noticed a big improvement. My hands were much less inflamed and some of the lesions has gone. Wow! Fast forward another 2 weeks and yet more improvement.

However, there was still a low "baseline" activity - small flareups (no-where near as bad as before) that happened every few days. This made me return to the internet and I read that there was a link to psoriasis and "leaky gut syndrome" possibly caused by a candida overgrowth. Think good bacteria in the gut being crowded out by bad bacteria/yeast. Apparently candida can change from a yeast like form to an invasive fungal type form which can cause leaky gut. When this happens stuff that you have eaten can get into your bloodstream causing an immune response. I guess this could explain why certain foods can cause a problem.

OK, so I modified my diet to an anti-candida diet. This is basically the same as above but with bells and whistles to avoid any sort of sugar or starch that might feed the candida. Again I was a bit skeptical, but thought I had nothing to lose.

After another 2 weeks I saw my hands improve immensely and the low level outbreaks were less often and smaller and smaller.

I'm now 6 weeks into this diet and I'm pleased to say my psoriasis is 99% gone. Unbelievable!

12 months of increasing discomfort, intense itching, flaking skin, sores, pain and all the other symptoms you'll be familiar with.... GONE.

I wanted to share my experience on here and I hope it may help someone else.

6 weeks ago I really thought that I was going to have to live with this thing for the rest of my life. I had resigned myself to not being able to work anymore. I was pretty fed up with the whole thing.

My skin still needs to thicken up a bit (I still have no fingerprints, but under a magnifying glass I can see faint outlines returning!) but the worst is definitely behind me.

Hopefully some of you will find this helpful. It may not be a cure for everyone suffering from this but it did cure it for me.

People seem to be reticent about saying "cure" when talking about psoriasis. I do not believe this to be true. I believe it is a gut problem and that it will take time (months) for my gut to return to normal. As such I intend sticking to this diet for 6 months to allow nature to take its course. Then I will reintroduce foods to my diet in small amounts, one at a time for two weeks, and monitor the effects.

I also found that keeping a food diary was very useful in pinpointing foods that aggravate the condition.

I would like to add that both my GP and Consultant stated that psoriasis is not related to diet. I have found the exact opposite to be true.

Also, a pleasant side effect has been losing over 1 and a half stone in this six week period, so I'm also feeling better in myself (and clothes) as well as psoriasis free.

Here are some before and after pictures :

Before

             

After

             



Good luck!

This study looked at the efficacy of the biologic agents Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab) and Stelara (ustekinumab) in the treatment of scalp symptoms in patients suffering from moderate to severe plaque psoriasis.

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Background:
The scalp is a frequent and difficult-to-treat localization of psoriasis. Little evidence exists regarding the use of biologic agents in recalcitrant cases of scalp psoriasis that are resistant to other treatment options.

Objectives:
To evaluate and compare the efficacy of currently available biologic agents (infliximab, etanercept, adalimumab, ustekinumab) in the treatment of scalp symptoms in patients suffering from moderate to severe plaque psoriasis.

Materials and methods:
This retrospective cohort study consisted of a review of the database of all psoriasis patients who suffered from scalp symptoms and received biologic treatment between January 2012 and December 2014. The patients were divided into four groups based on the drug administered. Scalp psoriasis severity was assessed by the Psoriasis Scalp Severity Index (PSSI) at baseline and at weeks 4, 12, 24 and 48. Psoriasis severity was evaluated with the Psoriasis Area and Severity Index (PASI) at the same time points.

Results:
In total, 145 patients were enroled in the study (infliximab n = 35, etanercept n = 30, adalimumab n = 39, ustekinumab n = 41). At week 4, the infliximab group achieved a 74% mean decrease in the PSSI (ΔPSSI), followed by mean decreases of 61.7%, 53.1% and 53.7% in the ustekinumab, etanercept and adalimumab groups respectively. The differences in the ΔPSSI were lower at week 48: ustekinumab 94.9%, infliximab 94.3%, etanercept 83.1% and adalimumab 89.0%. The PASI score improved sufficiently in all treatment groups. Infliximab and ustekinumab exhibited greater efficacy at weeks 4 and 12. This difference was not as prominent as that revealed by the PSSI. At week 48, the differences in the ΔPASI were barely statistically significant (P = 0.048).

Conclusions:
All four biologic agents yielded significant improvement in both scalp and skin lesions. Ustekinumab and infliximab exhibited the greatest efficacy, which was clinically meaningful from the early stages of the study. Adalimumab and etanercept followed, yielding satisfactory improvement rates.

This study set out to investigate whether screening for CVD risk factors in patients with psoriasis in primary care augments the known prevalence of CVD risk factors in a cross-sectional study.

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Background:
Studies assessing cardiovascular disease (CVD) risk factors in patients with psoriasis have been limited by selection bias, inappropriate controls or a reliance on data collected for clinical reasons.

Objectives:
To investigate whether screening for CVD risk factors in patients with psoriasis in primary care augments the known prevalence of CVD risk factors in a cross-sectional study.

Methods:
Patients listed as having psoriasis in primary care were recruited, screened and risk assessed by QRISK2.

Results:
In total, 287 patients attended (mean age 53 years, 57% women, 94% white British, 22% severe disease, 33% self-reported psoriatic arthritis). The proportion with known and screen-detected (previously unknown) risk factors was as follows: hypertension 35% known and 13% screen-detected; hypercholesterolaemia 32% and 37%; diabetes 6·6% and 3·1% and chronic kidney disease 1·1% and 4·5%. At least one screen-detected risk factor was found in 48% and two or more risk factors were found in 21% of patients. One in three patients (37%) not previously known to be at high risk were found to have a high (> 10%) 10-year CVD risk. Among the participants receiving treatment for known CVD risk factors, nearly half had suboptimal levels for blood pressure (46%) and cholesterol (46%).

Conclusions:
Cardiovascular risk factor screening of primary care-based adults with psoriasis identified a high proportion of patients at high CVD risk, with screen-detected risk factors and with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended.

There seem to be quite a few of us in the early days of taking Acitretin and some of the side effects are well known. What I would like to do is start a knowledge base of side effects and their duration for people on or about to start Acitretin. Anything out of the ordinary you may experience will help somebody.

Hmmmmmmmmmmmmmm I'll just pass on the news as I still don't think methotrexate should be used for psoriasis.

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Abstract:

The Australasian Psoriasis Collaboration reviewed methotrexate (MTX) in the management of psoriasis in the Australian and New Zealand setting. The following comments are based on expert opinion and a literature review. Low-dose MTX (< 0.4 mg/kg per week) has a slow onset of action and has moderate to good efficacy, together with an acceptable safety profile. The mechanism of action is anti-inflammatory, rather than immunosuppressive.

For pretreatment, consider testing full blood count (FBC), liver and renal function, non-fasting lipids, hepatitis serology, HbA1c and glucose. Body mass index and abdominal circumference should also be measured. Optional investigations in at-risk groups include an HIV test, a QuantiFERON-TB Gold test and a chest X-ray. In patients without complications, repeat the FBC at 2–4 weeks, then every 3–6 months and the liver/renal function test at 3 months and then every 6 months.

There is little evidence that a MTX test dose is of value. Low-dose MTX rarely causes clinically significant hepatotoxicity in psoriasis. Most treatment-emergent liver toxicity is related to underlying metabolic syndrome and non-alcoholic fatty liver disease or non-alcoholic steatohepatitis. Alcohol itself is not contraindicated, but should be limited to < 20 mg/day. Although MTX is a potential teratogen post-conception, there is little evidence for this pre-conception. MTX does not affect the quality of sperm. There is no evidence that MTX reduces healing, so there is no specific need to stop MTX peri-surgery. MTX may be used in combination with cyclosporine, acitretin, prednisone and anti-tumour necrosis factor biologics.

hello all

i am pawan from india . good to be here. i am having sebo psoriasis since last 4 years and it's worsening day by day. it started with scalp and now its on my nose both sides also. can someone help .

I've had psoriasis for 16 years. I've never been to a doctor for it at all due to a doctor phobia. I'm now about 75% covered. My knees to my feet are covered. My scalp is covered. My torso is covered. My arms are covered. My face is clear, hands are clear, feet are clear and that's it.

Just this summer, I've started getting new symptoms that are extremely terrifying.

Extreme burning on my legs. Almost intolerable. I started to pay close attention to area of my calves. I used some treatments to get all of the scaling off of my lower legs but the burning even got worse. Below the scaling is just thick redness so I started to try and peel that away. I uncovered something that doesn't look like psoriasis. It looks like white little dots and they are extremely painful. I sprayed some hydrogen peroxide on them and it foamed big time and burned like crazy. Eventually it started oozing puss. The pain just won't go away. At first, I was afraid that it was general pustular psoriasis which can be fatal...but the fact that the hydrogen peroxide foamed makes me think it's just some time of subcutaneous skin infection caused by the fact that I scratch constantly.

Is it possible for psoriasis scaling to scale over a skin infection? Has anybody had something so strange happen to them? I'm currently panicking due to the extreme pain. Sorry to make my introduction a complaint but it is desperation that drove me to find a community so that I could share my experience.

Thanks for your time and any responses.

Hello all,

Glad to be here, as I have valuable information on Low Dose Naltrexone (LDN) and I hope to shed some light on this possibly, very benefIcial pharmaceutical.

I have researched PsA thoroughly since being recently diagnosed. And I have much information I would like to share with others that suffer as I do, with this severe inflammatory condition. But in doing a search on your site for LDN,
I see there's little info and it is dated. I would have believed by now, a thread
on LDN would have been stickied. And I'm a bit surprised this is not so.

Did you know that people with PsA are highly likely to develop other
autoimmune diseases?

Did you know LDN benefits many autoimmune disorders including cancer? And
that LDN is so safe, fertility specialists are using it for expecting
mothers? And that it is beneficial to both mother and baby?

I have documented all the studies. Doctors who have shown clinical benefits in their practice and would like to share this valuable information, to those like me, who were slammed with this crippling inflammatory condition.

I was hit hard by PsA this New Years Day (2016). In three days I went from being mobile and active to practically being crippled. Wasn't diagnosed till months later (April). Never been arthritic in my 58 years prior. Now I know why all the old timers move to Florida.The cold really makes this condition unbearable. Now that it is warmer up north here in NYC, things are much better. Been taking care of myself by eating healthy, taking supplemental nutrients, and recently started with LDN (June 7th). I cannot comment on what is helping me, as it could be all these things. The big test will be when it gets cold again. Right now my inflammation markers have dropped which was my immediate concern due to pre-existing conditions (COPD, Cancer recovery). Systemic inflammation is not something you want added with those conditions. This recent autoimmune disorder couldn't have come at a worse time. But as I said I'm improving, but can't be sure why. My Rheumatologist is on board with my decision to try LDN, as I am hesitant about taking any DMARD's. There are many reasons why I'm hesitant about the standard treatments, but I'll cover that another time.

For now, I would just like to say, I'm happy to be here, and welcome any questions about LDN or PsA. I came to help and maybe learn in the process. I try to learn something new everyday.

This study suggests miR-1266 may have an important role in the pathogenesis of psoriasis.

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Background:
Increasing evidence has shown that serum microRNA (miR) levels are useful biomarkers for the diagnosis, prognosis, and therapeutic value in various diseases. Psoriasis is characterized by a specific miR expression profile, with a characteristic miR signature, distinct from that of healthy skin.

Objectives:
To understand the role of miR-1266 in the pathogenesis of psoriasis and to explore if it has the potential as a blood biomarker. We assessed serum miR-1266 levels in patients with psoriasis before and after treatment and compared it with controls. In addition, we evaluated the relationship between miR-1266 and clinical severity in psoriasis before and after treatment.

Methods:
miR-1266 was measured using real-time polymerase chain reaction in 35 patients with chronic plaque psoriasis and 35 healthy controls before and after treatment. Moreover, the correlation between miR-1266 levels and psoriasis area and severity index score was determined.

Results:
Serum miR-1266 levels were considerably higher in patients with psoriasis than in healthy control subjects. Furthermore, miR-1266 levels showed a strong positive correlation with psoriasis area and severity index score before and after treatment, having a marked decline with therapy.

Conclusion:
miR-1266 may have an important role in the pathogenesis of psoriasis vulgaris. This may presumably have possible future implications on the treatment of this chronic disease.

Took my first (pen) injection 6/17 and it hurt like hell but I could tell it was working on the second day.  By day 6, most of the plaque was gone, though I still had the redness everywhere.  Very Impressed to say the least.

Took my second shot Friday 7/1 in my other thigh.  Didn't hurt as bad, but in a few hours I noticed inflammation was getting worse.   Areas that were fading to normal skin color were now much more red and inflamed, whole patches once again raised above normal skin level.

Yesterday and today, the injection site is very swollen and tender... that's not a big deal.  But I seem to be flaring after the second shot.

Anybody else experience this?  This med was working SOOOO much better than the other 3 biologics I've tried and really don't wanna give it up.


For background, I first noticed scalp psoriasis around 2005 and it got progressively worse, and covered honestly half my body by the time I was afforded health insurance, around 6/2014.  Started on Enbrel twice a week, that took a while to take hold but was working.  After a few months, my insurance cut the dose to 1/week and it started coming back.  Tried Humira, no dice.  Tried Stelara, and after the first and second doses it seemed promising but coming back before my first "maintenance dose".

I have been on Acitretin for 3 months. 25mg a day and am 100percent clear with little side effects.

This study tested the proposed CONTEST questionnaire, which was developed to identify patients with psoriasis who have undiagnosed PsA, and compare it with the validated Psoriasis Epidemiology Screening Tool (PEST)

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Background:
Many questionnaires are available for assessment of psoriatic arthritis (PsA), but there is little evidence comparing them.

Objectives:
To test the proposed CONTEST questionnaire, which was developed to identify patients with psoriasis who have undiagnosed PsA, and compare it with the validated Psoriasis Epidemiology Screening Tool (PEST) questionnaire in a primary-care setting.

Methods:
A random sample of adult patients with psoriasis and no diagnosis of arthritis was identified from five general practice surgeries in Yorkshire, U.K. Consenting patients completed both questionnaires and were assessed by a dermatologist and rheumatologist. Diagnosis of PsA was made by the assessing rheumatologist. Receiver operator characteristic (ROC) curve analysis examined the sensitivity and specificity of potential cut points.

Results:
In total 932 packs were sent to recruit 191 (20·5%) participants. Of these, 169 (88·5%) were confirmed to have current or previous psoriasis. Using physician diagnosis 17 (10·1%) were found to have previously undiagnosed PsA, while 90 (53·3%) had another musculoskeletal complaint and 62 (36·7%) had no musculoskeletal problems. Using ROC curve analysis, all of the questionnaires showed a significant ability to identify PsA. The area under the curve (AUC) for the CONTEST questionnaires was slightly higher than that of PEST (0·69 and 0·70 vs. 0·65), but there was no significant difference identified. Examining the sensitivities and specificities for the different cut points suggested that a PEST score ≥ 2 would perform better in this dataset, and the optimal scores for CONTEST and CONTEST plus joint manikin were 3 and 4, respectively.

Conclusions:
The accuracy of the questionnaires to identify PsA appeared similar, with a slightly higher AUC for the CONTEST questionnaires. The optimal cut points in this study appeared lower than in previous studies.

This study set out to see if systemic treatment is any better than UV for psoriasis patients quality of life.

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Background:
Psoriasis is a skin inflammatory chronic disease with negative physical, psychological and social repercussions for those affected. However, patients suffering from mild disease also complain about negative impact on their quality of life, making it difficult for physicians to choose the best treatment strategy.

Objectives:
Understanding the impact of systemic treatments on Quality of Life (QoL) in patients with mild psoriasis in daily practice.

Methods:
This is a monocentric retrospective study analysing patients affected by mild psoriasis [Psoriasis Area and Severity Index (PASI) ≤ 6]. Patients were divided into two groups, depending on the treatment decision taken by the physicians: patients who received local and/or UV light therapies and patients who were treated with systemic therapies as a first choice. PASI and Dermatology Life Quality Index (DLQI) scores were measured at each visit.

Results:
Patients who received systemic therapies as a first choice reported higher QoL impairment, mainly due to psoriasis lesions localized on visible areas. During Follow-up, this group showed better improvement of PASI score and DLQI compared to patients receiving local and/or UV light treatment.

Conclusions:
Our findings highlight the potential benefit of using systemic therapies in patients with mild psoriasis and high QoL impairment. This study will help physicians to make the right therapeutic decision in patients suffering from mild psoriasis.

My name is Sally, i am 59 and have had Psoriasis for 27 years now, diagnosed just after the passing of my Uncle in 1988.

I was hospitalized when first diagnosed as doctors didn't know what it was, and by the time they got around to sending me to a specialist at the hospital, i was covered in it.  Back then i was given coal tar treatments which worked brilliantly, but since they where band here some years back now i have struggled to find anything that works for my plaque Psoroasis,  head and shoulders is brilliant for my scalp, i have tried varies things for my skin though, currently using aveeno, though it stops the itching, it doesn't clear it, E45 makes it itch more as does epaderm.

I would be greatful for any suggestions.

Thanks guys

Hi To All.

I have had this terrible disease for over 25yrs,and in that time have had all the treatments available. No matter what i take the psorasis always comes back,and at the moment i am at breaking point as my plaque psorasis it is worse than ever I am presently on my 3rd week of fumaderm ,and feel if i have permanent sunburn and prickly heat,has anyone else had these symptons ?