I am writing again on behalf of my husband who is 77. He was taken off the Ciclosporin and the Fumaderm because although it helped his psoriasis very much, it apparently caused liver kidney problems. He had been tried on various creams for a period of two years and also Acitretin before these more potent drugs were offered.
His kidney function went down to 9% and he was in hospital for a week - he is now out and his kidney function is slowly rising. Not sure of cause of drop from 50-9% over two weeks - could be painkillers, antibiotics psoriasis drugs.

To cut a long story short he is on the very lowest dose of ACitretin of 25g a day. Last year the dermatologist said that if the Fumaderm did not work he would have to go for the Bio injections. Well he has been for initial assessment and the man said his condition was not bad enough for it to be considered. His skin is peeling off in sheets of his feet, risk of infection a nightmare especially as antibiotics could cause kidney problems and neither of us have any quality of life as he is struggling to walk.

I know Bio's are a last resort and I know they cost the NHS a lot of money. I did contact Eric's dermatologist by phone just to make sure I understood correctly that he had wanted to progress the Bio option, and he said he did given the circumstances and the fact we had tried the other options. He did say he would write urgently to the Head of the Bio Unit and put our case forward. This was  2 weeks ago. The Nephrologist has said she will contact the Dermo so we can try and get some kind of treatment plan as I understand that Bio's can take a while to kick in.

I just wonder if anyone had to fight to this degree? I do know Eric is difficult with his co-morbidities and also his Lupus but  we are literally looking at having to buy a wheelchair soon or he will be totally housebound. 

Any comments gratefully received.  WE cannot afford to go privately with the Bio injections and forgive me, we have both been high rate tax payers for most of our lives. Is this just NHS lack of communication between Departments?             Helena

This study looked at the relationship between psoriasis and hepatitis C.

Quote:

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Background:
Multiple studies have noted an association between hepatitis C and psoriasis, but it is not known whether psoriasis is a result of treatment modalities for hepatitis C or a result of hepatitis C alone.

Objective:
To examine the relationship between psoriasis and hepatitis C by measuring the expression of cathelicidin, TLR9 and IFNγ in psoriatic lesional and non-lesional skin in HCV-positive and negative psoriatic patients.

Methods:
Two 2 mm punch biopsies of lesional and non-lesional skin in 10 patients who were HCV-negative psoriatics and seven HCV-positive psoriatics were used to measure cathelicidin, TLR9 and IFNγ mRNA expression by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR).

Results:
The mRNA levels of cathelicidin, TLR9 and IFNγ were significantly higher in both non-lesional and lesional skin of HCV-positive patients with psoriasis as compared to HCV-negative psoriatic patients. Additionally, the IFNγ level in lesional skin of HCV-positive psoriatic patients was higher than the IFNγ level seen in non-lesional skin of those same patients.

Conclusion:
These findings suggest that HCV infection upregulates these inflammatory cytokines, possibly increasing susceptibility to developing psoriasis.

For those of you thinking about using a telemedicine website or app to diagnose psoriasis you may want to think again.

Quote:

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Abstract:

Importance:  
Evidence supports use of teleconsultation for improving patient access to dermatology. However, little is known about the quality of rapidly expanding direct-to-consumer (DTC) telemedicine websites and smartphone apps diagnosing and treating skin disease.

Objective:  
To assess the performance of DTC teledermatology services.

Design and Participants:  
Simulated patients submitted a series of structured dermatologic cases with photographs, including neoplastic, inflammatory, and infectious conditions, using regional and national DTC telemedicine websites and smartphone apps offering services to California residents.

Main Outcomes and Measures:  
Choice of clinician, transparency of credentials, clinician location, demographic and medical data requested, diagnoses given, treatments recommended or prescribed, adverse effects discussed, care coordination.

Results:  
We received responses for 62 clinical encounters from 16 DTC telemedicine websites from February 4 to March 11, 2016. None asked for identification or raised concerns about pseudonym use or falsified photographs. During most encounters (42 [68%]), patients were assigned a clinician without any choice. Only 16 (26%) disclosed information about clinician licensure, and some used internationally based physicians without California licenses. Few collected the name of an existing primary care physician (14 [23%]) or offered to send records (6 [10%]). A diagnosis or likely diagnosis was proffered in 48 encounters (77%). Prescription medications were ordered in 31 of 48 diagnosed cases (65%), and relevant adverse effects or pregnancy risks were disclosed in a minority (10 of 31 [32%] and 6 of 14 [43%], respectively). Websites made several correct diagnoses in clinical scenarios where photographs alone were adequate, but when basic additional history elements (eg, fever, hypertrichosis, oligomenorrhea) were important, they regularly failed to ask simple relevant questions and diagnostic performance was poor. Major diagnoses were repeatedly missed, including secondary syphilis, eczema herpeticum, gram-negative folliculitis, and polycystic ovarian syndrome. Regardless of the diagnoses given, treatments prescribed were sometimes at odds with existing guidelines.

Conclusions and Relevance:  
Telemedicine has potential to expand access to high-value health care. Our findings, however, raise concerns about the quality of skin disease diagnosis and treatment provided by many DTC telemedicine websites. Ongoing expansion of health plan coverage of these services may be premature. Until improvements are made, patients risk using health care services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination. We offer several suggestions to improve the quality of DTC telemedicine websites and apps and avoid further growth of fragmented, low-quality care.

Quote:In the case of secondary syphilis with unusual plaques, the patient was not asked about his recent fever (even when he proactively reported it on ROS), and no clinician seemed concerned that his diffuse eruption began so acutely only 3 weeks previously without a history of prior skin eruptions (uncommon in patients with large-plaque psoriasis). Seven of the 8 clinicians diagnosed psoriasis, including 1 who did not ask for photographs. One clinician (an emergency physician) made no diagnosis and referred the patient to see a local dermatologist, and another (a Sweden-based physician) who diagnosed psoriasis suggested that the patient see a local dermatologist for treatment. This patient received prescriptions for class I or II topical steroids in 5 encounters and was told to use moisturizers and take lukewarm baths in another.

The young man with highly infectious secondary syphilis was not asked about his recent fevers, attention was not paid to the unusually sudden onset he described, and all but 1 of the websites accepted the diagnosis of psoriasis the patient himself offered. This not only left him at substantial risk from untreated syphilis, but was a public health failure given the urgent need for contact tracing and risks of ongoing transmission.

My friends psoriasis has been pretty persistently affecting hi sfingernails and toenails.
Would like to get that fied and or find somebody who knows more lot about it.
thank you.

HI EVERYONE!

This study looked at the working of antipsoriatic effect of calcipotriol.

Quote:

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Background:
Calcipotriol ameliorates psoriasis through inducing keratinocyte apoptosis and inhibiting nuclear factor kappa B (NF-κB) activation, while zinc finger protein A20 exhibits an anti-apoptotic effect on various types of cells.

Objectives:
To understand the potential role of A20 in calcipotriol function.

Materials and methods:
The A20 levels were evaluated in the psoriatic skins from both human patients and K14-vascular endothelial growth factor (VEGF) transgenic mice that received or did not receive topical calcipotriol treatment. The in vitro effect of calcipotriol on A20 expression and the downstream NF-κB pathway was studied using a model of human foreskin keratinocytes (HFKs) that were stimulated with psoriatic cytokines [M5, a cocktail of interleukin (IL)-1a, IL-17A, IL-22, Oncostatin M and tumour necrosis factor-α, each at 10 ng mL−1].

Results:
A20 expression was enhanced in both psoriatic tissues and keratinocytes when compared with controls, but decreased on calcipotriol treatment. The transfection of A20 small interfering RNA (siRNA) improved cell differentiation, and inhibited psoriatic inflammation in a HFK model. Moreover, the nuclear expression of NF-κB p65 decreased on A20 downregulation in psoriatic tissues and keratinocytes. Interestingly, calcipotriol enhanced the binding of A20 to ring finger protein 114 (RNF114) and A20-binding inhibitor of NF-κB-1 (ABIN-1) in HFKs, two negative regulators of the NF-κB pathway.

Conclusions:
Calcipotriol exhibits its antipsoriatic function through suppressing A20 expression and stabilizing negative regulators of the NF-κB pathway.

The Blue Lagoon Geothermal Spa in Iceland is to offer free treatment to it's countries psoriasis patients.

Quote:

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Iceland’s famous Blue Lagoon has revealed plans to save the Icelandic State millions in medical bills by providing free treatment for Icelandic sufferers of psoriasis.

The Blue Lagoon has provided treatment to sufferers of psoriasis since 1994. The treatment offered is certified by Icelandic health authorities as an official treatment option.

Until now, the cost of the treatment has been covered by the Icelandic social security for patients insured in Iceland. The Blue Lagoon has now decided to provide such treatment for free, saving the State some ISK 25 million (approx. €175,000) a year.

Patients need a prescription from their doctor to qualify for the free treatment, and some 3,000 sessions are expected annually.

This case has often been mentioned in discussions about Fumaderm (DMF) on Psoriasis Club and can sometimes end up in heated conversations which have taken some threads off topic. I personally don't have an opinion about it, but as it is back in the news again I thought I would post it here for future reference. And should it get brought up again in other threads we can move posts here.

Quote:

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Balak and Hajdarbegovic (Aug. 6 issue) discuss an old case of Kaposi’s sarcoma2 in a patient with psoriasis who was treated with Fumaderm, a drug containing different fumaric acid esters (FAE). The authors claim that the patient had normal total lymphocyte counts before the diagnosis of Kaposi’s sarcoma, whereas the original publication shows counts of 500 to 800 per cubic millimeter for more than 18 months.

In the same issue of the Journal, van Kester et al. report a case of suspected generalized varicella–zoster virus (VZV) infection in a 23-year-old patient with psoriasis who was treated with a compounded Dutch FAE preparation for 2 months, without the development of lymphocytopenia. The authors conclude that FAE treatment may reactivate VZV infection in the absence of lymphocytopenia. However, from the clinical picture and in the absence of IgG antibodies to VZV, other interpretations need to be considered, including adult chickenpox and generalized zoster related to preexisting immune deficiencies or irrespective of immunosuppression.

Both letters reference a report previously published in the Journal of a case of progressive multifocal leukoencephalopathy (PML) in a patient with psoriasis who was treated with a compounded Dutch FAE preparation for approximately 2 years, which was reported to have occurred without severe lymphocytopenia. Such a conclusion is questionable, because lymphocytes were not monitored for 19 months before the diagnosis of PML, and the extent of lymphocytopenia during that period is unknown.

We conclude that PML and other opportunistic infections have not been observed during FAE therapy without lymphocytopenia and in the presence of appropriate monitoring and drug-discontinuation rules.

---

Drs. Balak and Hajdarbegovic reply: Reich et al. emphasize that the case of dimethyl fumarate (DMF)–related Kaposi’s sarcoma was linked to a moderate lymphocytopenia and that current drug-monitoring rules remain applicable. We conclude that the occurrence of immunosuppressive adverse events during DMF treatment is not restricted to lymphocytopenia in which the lymphocyte count is less than 500 per cubic millimeter. Illustratively, another case of treatment-related PML was reported in a patient with psoriasis who was treated with DMF and had lymphocyte counts of 500 to 1000 per cubic millimeter. In response, psoriasis guidelines have increased the threshold for dose adjustment or discontinuation of DMF in the event of a count of less than 700 lymphocytes per cubic millimeter. These drug-discontinuation rules remain to be validated. More important, absolute lymphocyte counts seem to be insensitive indicators of an increased risk of infections.1 DMF-associated moderate lymphocytopenia with selective reductions in lymphocyte subpopulations could confer a predisposition to PML, as is the case with idiopathic CD4+ lymphocytopenia.

In view of the increasing use of DMF, there is a need for more awareness and appropriate monitoring strategies to minimize risks of immunosuppression. Meanwhile, PML should be considered in patients receiving DMF who present with progressive neurologic symptoms, irrespective of the severity of lymphocytopenia.

---

Dr. van Kester and colleagues reply: We agree with Reich et al. that other interpretations of the clinical findings in our patient are possible, but these interpretations are not very likely. Varicella infection develops in 95% of the Dutch population during childhood, and our patient had reported having a previous varicella infection when he was a child, which makes the possibility of a primary varicella infection unlikely. Except for his psoriasis, our patient was healthy, and he had no history of repeated infections. We did not see an indication to exclude preexisting immunodeficiencies or human immunodeficiency virus infection, but we cannot completely rule out this unlikely explanation for the clinical findings in our patient. Therefore, we conclude that reactivation of VZV infection by FAE treatment is the most likely interpretation of the clinical findings in our patient.

---

Dr. Murk and colleagues reply: Reich et al. question our conclusion that DMF may induce PML without severe lymphocytopenia, because screening of lymphocytes in our patient contains a 19-month gap. However, none of three lymphocyte counts in the 6 months before symptom onset was below 792 cells per cubic millimeter. Moreover, three cases of FAE-associated PML without severe lymphocytopenia were published recently, corroborating our conclusion.

FAEs affect lymphocyte function, the number of lymphocytes, and the ratio of CD4 cells to CD8 cells.4 In our patient, the lymphocyte count was just below normal, with 880 cells per cubic millimeter; CD4 cells were reduced to 270 cells per cubic millimeter, and CD8 cells were reduced to 40 cells per cubic millimeter. Accordingly, a recent study showed CD4 and CD8 lymphocytopenia with a total lymphocyte count above 500 cells per cubic millimeter with DMF treatment, which is relevant because CD8 lymphocytopenia might confer a predisposition to JC-virus replication. These new insights should be taken into account when lymphocyte counts are monitored in patients receiving DMF.  

Hi
I'm new to this forum. Going through a difficult patch with my treatment at the moment. Had the condition since being a kid (now a bit older at 56). I was on acetretin for about 15 years which worked fine, only had a few patches on my legs which was easily controlled with Dovabet.
I started to get some pain and restriction in my neck which on x-Ray showed to be caused by bone spikes in my vertebrae. I was taken off acetretin immediately and started on Fumaderm. My dermatologist wanted a very slow build up of the dose and after 4 months I am only up to 1 tablet (blue) per day. Side effects aren't too bad but the psoriasis has flared up massively. I am now covered in patches and areas covered in smaller spots. Worst thing is that the palms of my hands are covered, very scaly, cracked and very sore. I've never had it on my hands before.
I would welcome any advice from members on Fumaderm. When are any positive effects likely to kick in? Any advice for soothing the hands?
Cheers
Mark

This study set out to see if infections and antibiotic use are independently associated with psoriasis in children.

Quote:

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Importance:  
Antibiotics disrupt human microbiota and have been associated with several pediatric autoimmune diseases. Psoriasis activity has been linked to group A streptococcal and viral infections.

Objective:  
To determine whether antibiotic exposure and infections are independently associated with incident psoriasis in children.

Design, Setting, and Participants:  
This nested case-control study used data from the Health Improvement Network database, a population-representative electronic health records database from the United Kingdom, from June 27, 1994, through January 15, 2013. Data were analyzed from September 17, 2014, through August 12, 2015. Children aged 1 to 15 years with newly diagnosed psoriasis (n = 845) were compared with age- and sex-matched controls (n = 8450) randomly chosen at the time of psoriasis diagnosis from general practices with at least one case, excluding children with immunodeficiency, inflammatory bowel disease, and juvenile arthritis.

Exposures:  
Systemic antibacterial prescriptions and infections of the skin and other sites within 2 years before psoriasis diagnosis.

Main Outcomes and Measures:  
Incident psoriasis as determined by validated diagnostic codes. The association of antibiotic exposure and infections with incident psoriasis was determined by conditional logistic regression, adjusting for confounders.
Results  After adjusting for matching, country, socioeconomic deprivation, outpatient visits, and infections within the past 2 years, antibiotic exposure in the last 2 years was weakly associated with incident psoriasis (adjusted odds ratio [aOR], 1.2; 95% CI, 1.0-1.5). The associations for infections of skin (aOR, 1.5; 95% CI, 1.2-1.7) and other sites (aOR, 1.3; 95% CI, 1.1-1.6) were similar. Untreated nonskin infections (aOR, 1.5; 95% CI, 1.3-1.8) but not antibiotic-treated nonskin infections (aOR, 1.1; 95% CI, 0.9-1.4) were associated with psoriasis. Results were similar when using a lifetime exposure window. Different classes of antibiotics and age of first antibiotic exposure were also not associated with psoriasis. The findings did not substantively change when excluding periods of varying length before diagnosis.

Conclusions and Relevance:  
Infections are associated with the development of pediatric psoriasis, but antibiotics do not appear to contribute substantially to that risk.

Hi all

Even dovobet is only every so often.
I have tried every cream prescribed over the years.

I have decided to do my own research/trial

Currently i am using Sorion creme

Jay

The future of psoriasis treatment is changing, and it's moving along very fast. This past few years have seen a huge increase in the number of Bio treatments and I was wondering how others see the future of psoriasis treatments.

Will it be an oral treatment, a cream, a spray, an injection, a natural treatment or maybe something we have not seen yet ?

As some of you know I have my contacts that pass me the latest information as it happens and I publish it as soon as I know, but I have noticed that most of the stuff I publish recently is concerned with the Bio treatments.

You may also know I'm a big fan of the Bio treatments as they gave me back my life, however I try not to be biased in the news reports so I'm curious to what others think the psoriasis treatment of the future will be.  

Over to you.

Hi 

Im jay & new to this forum. 
I havd has psorasis for nearly 20 years. I don't know the type think gluttate

This study looked at the psychometric properties of the Itch Numeric Rating Scale (Itch NRS) in patients with psoriasis.

Quote:

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Background:
Itching is a profoundly distressing symptom for many patients with psoriasis, but it has not been rigorously studied using validated tools for this condition.

Objectives:
This study investigated the psychometric properties of the Itch Numeric Rating Scale (Itch NRS), a single-item patient-reported outcome (PRO) measuring the worst itching severity due to psoriasis in the past 24 h.

Methods:
Using disease-specific clinician-rated and PRO data from one phase II and three phase III randomized clinical studies of subjects with moderate-to-severe plaque psoriasis, the Itch NRS was evaluated for test–retest reliability, construct validity and responsiveness. A responder definition was explored using anchor- and distribution-based methods.

Results:
Test–retest reliability analyses supported the reproducibility of the measure (intraclass correlation coefficient range 0·71–0·74). To support the construct validity of the Itch NRS, large cross-sectional correlations with the Dermatology Life Quality Index (DLQI) Symptoms and Feelings domain (r ≥ 0·60 at baseline and r ≥ 0·80 at week 12) supported a priori hypotheses, while large correlations (r ≥ 0·71) between changes in Itch NRS scores and changes in DLQI Symptoms and Feelings domain scores from baseline to week 12 established responsiveness. A 4-point change was optimal for demonstrating a level of clinically meaningful improvement in itch severity after 12 weeks of treatment, which corresponds with marked clinical improvements in plaque psoriasis.

Conclusions:
The Itch NRS demonstrated sufficient reliability, validity and responsiveness, and appropriate interpretation standards for evaluating change over time in itch severity among patients with moderate-to-severe plaque psoriasis when validated using clinical trial data for this condition.

Hi all...

Ï'm new here... I just stumbled about this forum a few weeks ago while I was looking for some info/experiences about a possible Etretinato/Acitritin treatment that my Doc proposed to me.

That was real good Info that I found here... Especially it was the Story of kh924 that gave me the motivation to start with this treatment.

I'm now two weeks with this... Not sure... but I beleve it somehow works... All those heavy plaque-spots slowly turn into light red spots only. But they itch like hell !!! Yes really!!! Like  Hell!!!! Can hardly sleep with this ;(


Well... Anyway... Still full of hope...  let's see...


Mike

Can I add photos to my threads/posts ?
If so, how. 

This study suggests that Cyclosporin could be safe when pregnancy occurs.

Quote:

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Problem:
Cyclosporin A (CYS A) is an immunosuppressant agent administered in autoimmune diseases, and its use during pregnancy and lactation is a debated topic.

Method of study:
The demographic characteristics, the activity of the underlying disease, and the onset of fetal–maternal complications have been investigated in 21 consecutive patients (2 RA, 14 SLE, 2 PA, 1 SjS, 1 DM, 1 Churg–Strauss vasculitis), treated with CYS A throughout 29 gestations. A subanalysis of the SLE group was performed.

Results:
We recorded a live birth rate of 86.2%. The median gestational age at birth was 38.2 weeks. The prevalence of maternal–fetal complications showed no differences with general population. Disease flares appeared in 4% of patients during gestation and in 12% during puerperium.

Conclusion:
We found no evidence justifying the suspension of CYS A when a pregnancy occurs. The drug does not appear to promote maternal–fetal complications and should be continued in patients who benefit from therapy. Data regarding breast-feeding during therapy are still scarce, but no evidence of toxicity has emerged.

Hello all-


Thanks again for sharing with me your experiences and results of your treatments. I will try and do the same.

I started Cosentyx one week ago, yesterday I took my second dose. 

For those whom are a little Trypanophobic (Fear of Needles), well the injections are easy to administer and almost completely painless.
Very similar to the auto-injectors given to us on the Fire Department. You choose the location to administer wether be it your arm, oblique, or upper thighs.
I have chosen my stomach for the first few doses. I will probably try my legs next.

So far the only symptoms I have felt is some slight lethargy and a runny nose.

My wife claims that my back looks like it's clearing. What's interesting is that in only one week the redness seems to be dissipating. (Fingers Crossed)

Also, my legs remain a bit itchy, but only in specific locations. I have no itchiness in my upper body. Again, a positive.

Well, I'll check back again. 

I hope this works. Enbrel didn't take and Otezla was a hellish experience for me.

I wish you all relief and clear skin. 

Ric

Quote:

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Fertiliser or manure cells transform into war cells when they are repeatedly exposed to inflammatory mechanisms. This was written by the LUMC, the Leiden University Hospital, in the journal of Allergy and a clinical immunology.
This discovery can lead to new treatments of chronical diseases like allergies.
The immune system uses inflammation to fight invaders like viruses. When the system is not able to remove the threat, the inflammation mechanism stays active. This happens with auto immune diseases and allergies. This leads to a lot of damage to the tissue.

The medics/researchers wanted to know if immune cells with that kind of chronic diseases change after a while. They researched fertiliser (manure) cells: cells that are in contact with the outside world and are involved with allergic reactions. The fertiliser cells indeed appeared to transform after repeated exposure to inflammatory mechanisms. After this change they started to activate inflammatory molecules much stronger.
The researchers think that medication that reverses this change, can also reverse the symptoms of chronical immune diseases.

Hello,

I have been looking around the site for a while now...and with jiml's help I have been able to add my replys, but I don't know how to ask a question without going on PM.

So if anyone is there here's the question:

How do you know the difference between psoriasis arthritis and osteoarthritis?

I don't do the doctors anymore...the first thing they say is "do you smoke?" I want to reply  "well I didn't smoke when I was four?"

So...any help with the arthritis thing?  would be very greatful

Fifty

Not sure I have done this right either?  sorry