This is a small study looking at the efficacy and safety of Acitretin in childhood and adolescent psoriasis patients.

Quote:

---

Background:
Acitretin is licensed for and is most commonly used to treat psoriasis. Little information exists about its efficacy and safety in childhood and adolescent psoriasis.

Methods:
Retrospective analysis of a group of children and adolescents (<17 years of age) with moderate to severe plaque psoriasis treated with acitretin between 2010 and 2014 at Italian dermatology clinics. Patients were identified through databases or registries.

Results:
The study population consisted of 18 patients with a median age of 9.5 years at the start of therapy. The median maintenance dosage per day was 0.41 mg/kg. Eight patients (44.4%) achieved complete clearance or good improvement of their psoriasis, defined as improvement from baseline of 75% or more on the Psoriasis Area and Severity Index at week 16. Three had three or more courses of treatment with short disease-free intervals. In three patients, acitretin treatment was ongoing at the time of data collection. The mean total duration of treatment in responders was 22.7 months. One patient discontinued treatment because of arthralgia. The remaining nine patients (50%) discontinued treatment because it was ineffective. Mucocutaneous adverse effects occurred in all patients, but did not affect therapy maintenance.

Conclusions:
In this retrospective case series, acitretin was a moderately effective, well-tolerated treatment in children with moderate to severe plaque psoriasis. Given the small number of patients, statements about long-term safety are not possible.

Hello, and I hope today was better than the last. I am waiting to hear about patient assistance, but I'm wondering, is Novartis generous, is your insurance amazing, or are you paying out of pocket? Because I am literally falling apart head to toe and don't see how I can afford this until 2020. 

This Danish study suggests there is an increased risk of periodontitis in psoriasis patients.

Quote:

---

Background:
Psoriasis and periodontitis are chronic inflammatory disorders with overlapping inflammatory pathways, but data on risk of periodontitis in psoriasis are scarce and a possible pathogenic link is poorly understood.

Objective:
We investigated the association between psoriasis and periodontitis in a nationwide cohort study.

Methods:
All Danish individuals aged ≥18 years between 1 January 1997 and 31 December 2011 (n = 5,470,428), including 54 210 and 6988 patients with mild and severe psoriasis, and 6428 with psoriatic arthritis, were linked through administrative registers. Incidence rate ratios (IRRs) were estimated by Poisson regression.

Results:
Incidence rates of periodontitis per 10 000 person-years were 3.07 (3.03–3.12), 5.89 (1.07–6.84), 8.27 (5.50–12.45) and 11.12 (7.87–15.73) for the reference population, mild psoriasis, severe psoriasis and psoriatic arthritis respectively. Adjusted IRRs were (1.66; 1.43–1.94) for mild psoriasis, (2.24; 1.46–3.44) for severe psoriasis and (3.48; 2.46–4.92) for psoriatic arthritis. Similar results were found when a case–control design was applied.

Conclusions:
We found a significant psoriasis-associated increased risk of periodontitis, which was highest in patients with severe psoriasis and psoriatic arthritis.

This German study suggests psoriasis patients do better on Bio treatments.

Quote:

---

Background:
Psoriasis is associated with significant patient burden. Few studies have specifically measured patient preferences and benefits.

Objectives:
Outcomes assessment using the Patient Benefit Index (PBI) in nationwide psoriasis surveys comparing health care in 2007 and 2014.

Methods:
This was a non-interventional, cross-sectional survey conducted in 2007 and 2014 in randomly selected dermatological practices and clinics recording by a) physicians: comorbidity, clinical severity (PASI, GCA), and b) patients: quality of life (DLQI, EQ-5D), patient-relevant therapeutic benefits (PBI) and previous and curent treatments.

Results:
In 2014, a total of n = 1265 patients (43.4% female, mean age 51.9 ± 14.3 years.; mean disease duration 21.6 ± 15.4 years.) were included. Overall PBI was 2.8 ± 1.1. A total of 91.6% of patients showed a more than minimum clinically relevant benefit (PBI>1). Patients treated with biologics and biologics combined with conventional systemics showed the highest benefit compared to patients with conventional systemic treatment and patients treated with topical steroids. In comparison with the 2007 survey (n = 2009), there was an increase in PBI from 2.5 ± 1.1 to 2.8 ± 1.1 and a gain of patients with high benefits (PBI ≥3) by 30% (38.5% vs. 49.4%).

Conclusion:
In German routine care, psoriasis patients have shown increased therapeutic benefits over time with highest benefits deriving from biologics combined with systemics.

After reading a lot about LDN, I decided to try it.
I was earlier recommended MTX but the first dose zombified me for around 3 days and I have been looking at alternatives since.

BTW, I am 36 years old.

So, I started liquid LDN on July 10 (2 mg).
Took 2 mg daily for 7 days.

I was experiencing pain in my ribs, fingers and toes (symptoms of PsA) and LDN gave me almost instant relief.
The pain is gone now and hasn't come back though it's too early to say how long this remission will last.

However, my whole body developed these red bumpy spots after I started LDN and therefore, I had to stop taking it.

These spots are going down in number and intensity three days after I have stopped LDN.

Additionally, my nail psoriasis has become worse as one of the fingernails had small amount of blood coming from the sides (though it seems to have subsided now on its own)

I never had such bad psoriasis on my ears. My ears are covered in plaque so much that I can't go out.

I think the red spots are due to the filler used in the tablets that i used to prepare liquid LDN.

But I am not sure about the psoriasis on ears.

Just wanted to share this experience.

I didn't find anything on the forum so I wanted to see if anyone had any experience with the Dead Sea or the Blue Lagoon. I am interested in going, but the Dead Sea is on the other side of the world and obviously expensive to the point of almost being prohibitive.

This is a summary of a  systemic review for the use of fumaric acid esters in the treatment of psoriasis.

Quote:

---

Summary:
Fumaric acid esters (FAEs) are increasingly used as a systemic treatment for psoriasis, but there are still uncertainties regarding their suitability. The objective of this systematic review was to assess the evidence for the efficacy and safety of FAEs in psoriasis treatment.

A systematic literature search was performed in seven databases up to 17 August 2015. Inclusion criteria were studies that reported clinical effects of FAEs in patients with psoriasis without restrictions in study design, language or publication date. Methodological quality of randomized controlled trials (RCTs) and overall level of quality were assessed using the Cochrane risk of bias tool and the Grading of Recommendation, Assessment, Development and Evaluation approach, respectively.

A total of 68 articles were included. There were seven RCTs (total 449 patients) that had an unclear risk of bias and were too clinically heterogeneous to allow a meta-analysis. Overall, mean Psoriasis Area and Severity Index decreased by 42–65% following 12–16 weeks of treatment. There were 37 observational studies (a total of 3457 patients) that supported the RCT findings, but most were uncontrolled with a high risk of bias.

Commonly reported adverse events included gastrointestinal complaints and flushing, leading to treatment withdrawal in 6–40% of patients. Several case-reports described rare adverse events, such as renal Fanconi syndrome and progressive multifocal leukoencephalopathy. There was a lack of studies focusing on long-term use and comparisons with other treatments.

This review concluded that there is low-quality evidence to recommend the use of oral FAEs to treat plaque psoriasis in adult patients. Studies focusing on long-term safety and comparison with systemic psoriasis treatments could lead to a better understanding of the role of FAEs as a treatment for psoriasis.

Following on from this report Brodalumab still in the running for psoriasis treatment Brodalumab has been given FDA Advisory Committees recommendation with conditions related to product labelling and post-marketing risk management obligations.

Quote:

---

Valeant Pharmaceuticals International, Inc. (NYSE: VRX and TSX: VRX) today announced that the Dermatologic and Ophthalmic Drugs Advisory Committee appointed by the U.S. Food and Drug Administration (FDA) has voted by a margin of 18 to 0 for the approval of brodalumab injection, 210 mg, for adult patients with moderate-to-severe plaque psoriasis with conditions related to product labeling and post-marketing/risk management obligations.

The committee's recommendation will be considered by the FDA in its review of the Biologics License Applications (BLA) for brodalumab, a monoclonal antibody that targets the IL-17 receptor.  As previously announced, the FDA assigned a Prescription Drug User Fee Act (PDUFA) action date of November 16, 2016.

"The positive recommendation by the FDA's advisory committee represents an important milestone toward our goal of delivering brodalumab to patients who suffer from moderate-to-severe plaque psoriasis," said Joseph C. Papa, chairman and chief executive officer.  "Brodalumab has the potential to improve the lives of many patients suffering from this chronic, debilitating disease, and we greatly appreciated the opportunity to present our body of evidence to the panel.  We look forward to working collaboratively with the FDA as it continues its review process."

"Brodalumab is an extraordinary drug that has meaningfully improved the quality of life of some of my most difficult-to-treat psoriasis patients, many of whom achieved complete skin clearance with this treatment," said Dr. Mark Lebwohl, Chairman, Department of Dermatology, Mount Sinai School of Medicine. "I am very pleased that the Advisory Committee has recommended that this life-changing treatment should be available to psoriasis patients who require a treatment with brodalumab's unique mechanism of action, and I look forward to prescribing this therapy to patients who are suffering from the devastating effects of moderate to severe plaque psoriasis."

As previously announced, the Marketing Authorisation Application (MAA) for brodalumab in psoriasis was accepted by the European Medicines Agency (EMA) in Q42015. In August 2015, Valeant entered into a collaboration agreement with AstraZeneca (AZN.LN, NYSE:AZN ) granting Valeant an exclusive license to develop and commercialize brodalumab globally, except in Japan and certain other Asian countries where rights are held by Kyowa Hakko Kirin Co., Ltd.  In July 2016, AstraZeneca and Valeant amended Valeant's license for brodalumab to terminate Valeant's right to develop and commercialize brodalumab in Europe.  LEO Pharma currently holds exclusive rights to develop and commercialize brodalumab in Europe, and Valeant holds the license to develop and commercialize brodalumab in the U.S and other territories, other than Japan and certain other Asian countries. In July 2016, brodalumab was granted approval from the Ministry of Health, Labour and Welfare Japan.  

Hi all.  From browsing seems the liver plays a roll in Psoriasis.  And also obesity (me) + more.   My annual blood test at my local doctor always comes back with a highlight that it is in poor shape.

So what is needed to get my liver reading back to 'healthy'?

Had scalp psoriasis for about five years.  Its since spread to one lower leg and now starting to take up residence on my lower belly.  My usual treatment / control I've found to be most enjoyable is a good scratch. Since have been advised that far better is a pair of mittens (thick ones).

Tried dif. stuff but once i get on top of the psoriasis I tend to forget about it and treatment laps.   My wife has researched for me more intensely than I and so far we have dropped the cortisone stuff and are trying to go natural.  Best so far is licorice herb + fenegreek.  Both simmer-boiled for 10-15 mins. then water stored in fridge & painted on with a shaving brush when needed. 

I haven't tried diet yet.  But just ate choc. 2 days straight.  My tummy + leg psoriasis are itchy-itchy and flaring.  So I've come seeking 'internal' advice.  What do I need to avoid etc.  Reg. blood tests indicate poor liver + too low Vit. D

So far, I'm way to chubby and are about to start walking daily.  Hopefully you guys are gonna suggest other ways to combat this through changing diet etc.

best
AaLF

Sandoz a Novartis company has announced it has been given FDA approval for a biosimilar of Enbrel (etanercept) to treat multiple inflammatory diseases including psoriasis.

Quote:

---

Sandoz, a Novartis division and leader in biosimilars, announced today that the US Food and Drug Administration (FDA) Arthritis Advisory Committee recommended approval of its proposed biosimilar etanercept. The committee voted unanimously (20-0), in support of biosimilar etanercept for all five indications of the reference product, including rheumatoid arthritis (RA), plaque psoriasis (PsO), psoriatic psoriasis (PsA), ankylosing spondylitis (AS) and polyarticular juvenile idiopathic arthritis (JIA).

“We are encouraged by today’s favorable advisory committee recommendation for our proposed biosimilar etanercept,” said Mark McCamish, M.D., Ph.D., Head of Global Biopharmaceutical Development, Sandoz. “As a global market leader in biosimilars, we are pleased to move one step closer toward our goal of expanding patient access with our proposed biosimilar etanercept, and look forward to continuing to work with the FDA as they complete their review of our application.”

The recommendation was provided after the presentation of data from a global development program including analytical, pre-clinical and clinical studies of the Sandoz biosimilar etanercept, which demonstrated biosimilarity to the reference product. Clinical studies included four comparative pharmacokinetic (PK) studies in 216 healthy volunteers† and a confirmatory efficacy and safety similarity study in 531 patients with chronic plaque psoriasis.

The FDA frequently seeks the advice of its advisory committees as it reviews and decides whether to approve applications, although the agency does not always follow their recommendations.

In December 2015, the European Medicines Agency (EMA) accepted Sandoz Marketing Authorization Application (MAA) for its biosimilar to Amgen’s EU-licensed Enbrel®, which seeks approval for the same indications as the reference product.

Sandoz is committed to providing patient access to high-quality, life-enhancing biosimilars. It is the pioneer and global market leader and currently markets three biosimilars worldwide. Sandoz has a leading pipeline with several biosimilars in late stage development, including assets in immunology and oncology. As part of the Novartis Group, Sandoz is well-positioned to lead the biosimilars industry based on its experience and capabilities in development, manufacturing and commercialization.

About GP2015
GP2015, the Sandoz proposed biosimilar of Enbrel®, has been studied in a global development program, which included a comprehensive comparison of GP2015 and Enbrel® at the analytical, non-clinical, and clinical levels, including data from four pharmacokinetic (PK) studies (GP15-101, GP15-102, GP15-103 and GP15-104†) involving a total of 216 healthy volunteers, as well as data from a confirmatory efficacy and safety study of 531 patients with moderate-to-severe chronic plaque psoriasis (PsO) (GP15-302). The development program also included five non-clinical studies. The proposed indications for GP2015 are identical to the indications for Enbrel® in rheumatoid arthritis (RA), PsO, psoriatic psoriasis (PsA), ankylosing spondylitis (AS) and polyarticular juvenile idiopathic arthritis (JIA).

Hi all,

Another new member here, I'm Abz (Abdul) from just outside of Birmingham (UK).  Now I myself am not a sufferer of Psoriasis but my wife is.

I've joined basically to get a better understanding of this condition and maybe some advice when it comes to treatments, etc.

About my wife, she's 26 years old and has suffered with psoriasis for around 10 years it initially started as scalp psoriasis but within the last 1-2 years she now has arthritis and plantar fasciitis due to the psoriasis, and now the psoriasis has spread to legs arms and torso. It really is getting her down and I will do absolutely anything to help.

We've been to the Dr's many times and tried all their lotions and potions.  A while back she was on Methotrexate but this caused her hair to start falling out, bruising easily and generally feeling run down so she's stopped taking it.  They have offered her Humeira injections but, she believes the Methotrexate was poison enough she doesn't want to inject anything.

The arthritis is really getting her down as she says she feels much older than she is and might not be able to go through another pregnancy with the pains she's experiencing.

Ideally she would like to go down a natural treatment route, but which one??? I've done so much reading and research on the internet my eyes have turned square and I no longer know the difference between which is genuine and which is a scam.

I did come across one cream that seemed to be a wonder cream every review I read was positive, results within days, all natural (and legal) ingrediants, very very reasonably priced (some moisturizers are dearer), some people saying you only need to apply the cream two or 3 times a year!!!! This sounded like most of my wifes' answers in a tub, but and it's a big but, the EU bufoons banned this cream from being produced and sold in Europe.  I even contacted the manufacturers thinking they may sell the product outside of the EU, but no they've stopped making it altogether.  

Some of you may know it or have tried it Potters Psorasolv, if anyone has tried it please can you tell me the results you got, if they're as good as I've read I will buy the ingredients or travel the earth to get them and mix it myself that's how much I want to help my wife.

Anyway, apologies for the long first post, I hope you guys don't mind that I'm not a psoriasis sufferer myself, but I look forward to speaking and getting on with you all.

Kindest regards

Abz

Hi all
Am following Fred's advice and starting a thread here.

Long story short. Dermotologist has taken me off acitretin as of yesterday and wants to put me on Ciclosporin. I am a bit wary as the side effects with this seem even worse and it looks like I am susceptible.

So any thoughts or advice would be appreciated.

Thanks

S

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

Quote:

---

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.

Quote:

---

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.