Hi everyone 
Wonder if anyone can offer any advice ?
I started with methotrexate 2 weeks ago for psoriasis ( 5mg a week followed by 2 folic acid the day after , I have no idea why my derm started with such a low dose but hey Ho ) 
I'm getting a few side effects and just wonder if they are normal such as constant heartburn and the feeling my food isn't going down after eating . I used to get this quite a while ago but since starting methotrexate it is constant ! I also got quite bad upper stomach pain yesterday which did ease off but am just wondering if all this is normal ?
I'm feeling a little nausea , headaches , aching and just generally feeling worn out but have read these are normal ?
Thanks in advance ?

Hi my name is Bob , user name comes from my boss thats what she calls me so now every one at work is now calling me that .I am 57 years young and have had P since i was 22 years old . Same story as most have tried most treatments including methotrexate [ not sure on spelling ] about 15 years ago , Met made me sick but took pain out of hands was on it for about 4 months . last 15 years been on just herbal stuff mainly ,the last 2 years it has gotten worse , big on torso and arms and legs . I have worked all over Australia and it seems to me that climate does not affect it a hole lot ,Australia has a varied climate from Dry , Cold to Tropical . I have just Started Acitretin Actavis 25mg per day ,  whilst researching i found this sight . I have found after a quick look at some threads it has eased my mind in regards to this drug and i am hoping  to add some  input as i go through this process  

Cheers Bob 

I started with psoriasis in 1974 and had it in most parts of the body since, including neck, round the eyes, ears and scalp which I always find the most distressing.  I am lucky whilst my psoriasis has been extensive in attacking parts of my body it has taken many areas in turn.   In 2013 I started with Fumaderm and used it for 18 months and became symptom free, my tablets were 3-4.  My lymphocytes count was never brilliant before taking Fumaderm but did drop and stabalise at around 0.6.  Suddenly they started to drop and I had a call from the hospital asking me to stop as they my count was 0.2.

As a result of the low lymphocytes I was referred to a immunologist who I saw 3 times in 18 months and wanted to monitor the return of my count to acceptable levels, in my case 0.8-1.0.  I had no treatment except a pneumonia injection and recommendation for a flu jab.

In my case the return of psoriasis was very slow, in fact it was around 18 months before I felt the need to use any treatment.  Unfortunately I now have it on the soles of my feet and one nail is heavily infected with it.  My GP referred me to a consultant and I asked to return to Fumaderm and he agreed if my blood count was OK.  Which it was and I have gone onto 120 mg immediately.  Within hours I had the bloating, heating (which I had almost forgotten) and diarrhoea (which I hadn't forgotten)....................it brought a smile to my face as it felt as if it had started working.   I am lucky I can stay round the house most of the next few weeks, I am hoping that the Fumaderm will work fairly quickly and that I can go on a very low dosage or even once it has cleared stop the medication for a time and then go back on it.

Hello,

I am a new member here.  I actually dont have psoriasis but my girlfriend of 3 years was recentlu diagnosed with a moderate case of psoriasis at the age of 31.  

A bit of background on me, like i said i dont have psoriasis but have struggled with eczema when i was younger and seborriheic dermatitis more recently, and therefore know a little bit (and identify a lot!) with the frustration, embarrassment, and overall helplessness that skin disorders like this can cause.  I had some great experiences and learned a lot through boards like this one, so i thought i would sign up here on her behalf (again, shes very shy and not likely to do this on her own) and see if we can find a way to get her condition under control.

About her condition: she never had symptoms until recently. She has small lesions all over her body, but more concentrated on her legs and scalp.  At first we thought it was just dandruff, as her scalp issues manifested first, but as it persisted, worsened and spread to other areas we went to her primary care physician.  She prescribed her a steroid cream, which immediately made me concerned because i have heard horror stories about prolonged use of such creams as well as a development of tolerance and the necessity of increased potency, etc.  However her doctor pretty much dismissed my concerns and continued to prescribe her the steroid.  The cream itself is an oily substance that she is expected to rub into her scalp.  It does seem to help her body but not only is it a huge pain to apply it in her hair but i dont think it is working well because it is not penetrating to all areas on her head.  I had good results with a foam medication when i was suffering from seborriheic dermatitis, and asked her doctor about something like that but she said she didnt think it was necessary.  

Anyhow, she has been using the steroid but she recently ran out and her symtoms flared up (big surprise) worse than before.  She has a dr appointment this week, and i have been urging her to ask to be referred to a specialist.

My question to you folks: 

What are some suggestions with regards to medications? What has worked for you? Are steroid creams pretty much unavoidable for this condition, and/or are there some good "steroid-sparing" meds that could help control the condition so the steroids could be used only for managing flare-ups? Do you have a good recommendation for a topical foam or liquid that works well for the scalp / hairy areas?  Also she has naturally dark skin and dislikes sun exposure (she doesnt like being "too dark", and despite my urging her to get more sun she wont try it out to see if it would help (i hear it would help).  Also she is using neutragena t-gel shampoo with moderate success (another suggestion of mine).

Thanks for your time & support, ill update with more info about her specific prescriptions after our next dr visit.

Thanks,  kc3i

This Danish study gives a bit of good news as it suggests there is no increased risk of self-harm and nonfatal suicide in patients with psoriasis.

Quote:

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Background:
Psoriasis is a common inflammatory skin disease, and inflammation may affect suicidal behaviour. Current data on the incidence and risk of suicidal behaviour in patients with psoriasis are scarce.

Objectives:
We investigated the association between psoriasis and the risk of self-harm and suicide attempts and suicides.

Methods:
All Danish patients aged ≥ 18 years with mild or severe psoriasis (cases) from 1 January 1997 to 31 December 2011 were matched on age, sex and calendar time 1 : 5 with healthy controls. The outcome was a diagnosis of self-harm or a nonfatal suicide attempt, or completed suicide. Incidence rates per 10 000 person-years were calculated, and incidence rate ratios (IRRs) and confidence intervals (CIs) were estimated by Poisson regression models.

Results:
The study cohort comprised 408 663 individuals, including 57 502 and 11 009 patients with mild and severe psoriasis, respectively. In total 280 cases of self-harm or suicide attempts, and 574 suicides occurred during follow-up. There was no increased risk of self-harm or suicide attempts in patients with mild psoriasis (IRR 1·01, 95% CI 0·17–2·01), but this risk was significantly increased in severe psoriasis (IRR 1·69, 95% CI 1·00–2·84). There was no increased risk of suicides in mild (IRR 1·05, 95% CI 0·84–1·32) or severe psoriasis (IRR 0·78, 95% CI 0·45–1·36). Similar results were found when suicides were confirmed by official forensic investigations, and when psoriasis was compared with atopic dermatitis.

Conclusions:
We found limited evidence to suggest an increased risk of self-harm and nonfatal suicide attempts in patients with psoriasis. Importantly, after adjustment for psoriatic arthritis this risk was no longer significantly increased. The risk of completed suicide was also not increased, regardless of psoriasis severity.

Hello to you all, I'm a new member to this fantastic site - what a find!  I have plaque psoriasis covering my arms, legs, bum, hands, scalp and I have had my first Cosentyx injection five days ago.  I can report I am 50% clearer already and can't wait for my next injection on Saturday!

wentnto the hosp today. For my usual appt, been taken off Toctino which made my skin worse, now on myfenox. 2  500 mg twice a day. So will see how we go. Any one got any feed back about these tablets. Was told be about 3 weeks if they will agree with me.

Nice are about to recommend Otezla again. there is a final meeting on 24 August.

For now NHS are making decisions locally using a discounted patient scheme funded by the manufacturer.

So it's available now in some areas and could be more widely available later.

Not sure if anyone used this, but just to make you all aware Polytar shampoo has now become available within the UK again! I know this was a treatment my dad had been disappointed they had discontinued.

This study looked at the frequency of Th17 cells and related cytokines in peripheral blood of patients with psoriasis, and analysed their association with disease severity.

Quote:

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Background:
Recently, a new population of IL-17-producing CD4 T helper (Th) cells, named Th17, was identified and shown to be involved in various inflammatory and autoimmune diseases, including psoriasis.

Aim:
To determine the frequency of Th17 cells and related cytokines in peripheral blood of patients with psoriasis, and to analyse their association with disease severity.

Methods:
This was a prospective study comprising 34 patients with psoriasis and 24 healthy controls. Clinicoepidemiological details of patients were recorded, and severity of psoriasis was assessed by means of the Psoriasis Area and Severity Index. Circulating Th1 and Th17 cells in untreated patients with psoriasis and healthy controls were quantified by flow cytometry. In sera collected from patients with psoriasis and healthy controls, concentrations of IL-17A and IL-23 were examined by ELISA.

Results:
Increased frequencies of CD4+ IL-17A+ T cells were seen in peripheral blood of patients with psoriasis vulgaris (P < 0.001). Although serum IL-17A and IL-23 concentrations were higher in patients with psoriasis than in controls, the results did not reach statistical significance. We could not find any correlation between the studied T cells or related cytokines and the disease severity.

Conclusion:
Increased serum levels of circulating Th17 cells and related cytokines may contribute to the cutaneous pathology of psoriasis, as well as the inflammatory process that is a hallmark of psoriasis.

I though I would write a few words about why I joined the club and what it means to me

I joined the forum in October 2013 When I had problems with my psoriasis medication, I didn't know where to get impartial advice, I searched the Internet but was unable to find any answers until I stumbled onto this site..

I had never been on a forum before and found it difficult to pluck up the courage to post my first question and was pleasantly surprised by the fast friendly response I received......it certainly encouraged me to return and reply to the answers I got....up until I joined this club, I had managed alone through my life with this awful disease trying to keep it hidden, ashamed of the flaky trail I left wherever I went....I always felt that I was alone even when in company the psoriasis is always your dark secret ....family try to understand but can't know how it feels to live with the disease

So coming here was a revelation to me that I wasn't alone and there were people out there with the same problems as me
I find the site very helpful as there are updates on a regular basis of the latest developments of psoriasis treatments, and the members generally keep us updated on their progress ...enabling me to understand more about the disease and the best way to treat it, as told by members,

I like the fact there are very few rules and those that there are are to keep the site safe from spammers and advertisers. Most of the rules are just common sense and easy to abide by. I would sometimes like to give an outside link to some information, but I understand the reasons we don't allow it. The site is totally independent and privately funded, giving all members free access to all the information without requests for donations

I'm of the opinion that if the site has been successful since 2011 it must be doing something right.

I love he ease of navigation and how if lost someone will always help.

I have found it rewarding to be able to talk with new members and try to help them deal with the disease and tell of my experience.....

I would say that although this was the first forum  I ever joined I have visited many since but I find this one the most useful and friendly which is why I keep coming back, and am glad that I was made a forum helper

I have watched the forum flourish over the three years I have been here with a steadily growing friendly membership from around the world

After I joined I was soon posting jokes in the off topic section, and after a while started to post photos in the members photos section .....The off topic section is filled with all manner of topics from gardening to pets ..Railways to holidays you name it it's probably there

In summary this is more than just another psoriasis forum ( although in my opinion the best) it is also a place to forge friendships and comradeship with others with the disease

An interesting article is currently available in the Daily Mail ( a UK newspaper) regarding Enstilar foam. Although it doesn't make it sound like a miracle cure it does give it a big build up. I do get the feeling that the article is written by someone that doesn't have the disease though as I feel they down play the effect of Ps on sufferers a little.

Hi.  I have psoriasis on my penis and have been using hydrocortisone cream to treat it for 5 months now.  I'd say the cream has cleared up 20% of the area.  I noticed something form on my forearm.  I thought I had been cut by a plant or maybe got poison ivy but it didn't go away. Little white spots started to form and then I realized, maybe this is psoriasis.  I was on vacation and in hot sun for several days and I noticed the area on my arm completely cleared up and is 100% gone.  It wasn't a big area but I virtually cannot see any of it still there.  

I have heard that sunlight helps psoriasis.  Being that I've had it on my penis and been using the cream for 5 months now with only a 20% success rate, I am thinking I may need some sun.  

My question is, how well does sunlight typically help psoriasis?  Could it be that what was on my arm was psoriasis and it cleared up the whole area in a few days?  Does it work that well, or does it typically take many sessions of sunbathing... 10, 50?  If not that many and it can clear it up in a few sessions I may need to make the trip to the local nude beach.  Lol.

Hi.  I am wondering if psoriasis once treated leaves a scar?  I have it pretty bad on my penis.  Once treated should I expect for there to be scarring?

Hi there, today is 24 hours into my Cosentyx journey! Excited to say the least! 24 hours since very first injections and the small dots are already much less angry and itchy! And the thick thick plaques are starting to break down a little-can't wait to see the results in a week or a month! I have had psoriasis since 11 years old but got out of hand in early 20's. I've used all the topicals a, UV, Mtx, cyclosporine, humira, infliximab, stellara and now on  Cosentyx. The only thing to ever clear me was infliximab many years ago but after a year of infusions I developed drug induced lupus from it! I'm genuinely so excited to give Cosentyx a try! Love to hear any stories if anyone has any of Cosentyx? How do I post photo's? Would love to share my journey/results ongoing

Hi all, my name is Belinda and I'm 38 from Aus! I have severe psoriasis plaque, nails,scalp and psoriatic arthritis. Have had since 11 years old. I have used all the creams and all the biological and just yesterday started on Cosentyx. Looking forward to being part of the group. No idea how to attach photos but happy to keep you all in loop of Cosentyx progress if someone can advise  as I know it's new and interest is high

This study investigated the expression and tissue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA)

Quote:

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Objective:
To investigate the expression and tissue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA).

Methods:
Quantitative gene expression analysis of Th1, Th17, and Th9 cytokines was performed in intestinal biopsy samples obtained from patients with PsA, HLA−B27−positive patients with ankylosing spondylitis (AS), patients with Crohn's disease (CD), and healthy controls. Expression and tissue distribution of interleukin-23 (IL-23), IL-17, IL-22, IL-9, and IL-9 receptor (IL-9R) were evaluated by immunohistochemistry and confocal microscopy. Flow cytometry was used to study the frequency of Th9 cells among peripheral blood, lamina propria, and synovial fluid mononuclear cells. The functional relevance of IL-9R expression on epithelial cells was assessed in functional in vitro studies. Th9 cells in synovial tissue from patients with PsA were also studied.

Results:
Subclinical gut inflammation in PsA patients was characterized by a clear Th17 and Th22, but not Th1, polarized immune response. Unlike AS and CD, a strong and significant up-regulation of IL-9 was observed in PsA gut, especially among infiltrating mononuclear cells, high endothelial venules, and Paneth cells. IL-9−positive mononuclear cells were demonstrated to be in large part Th9 cells. IL-9 overexpression was accompanied by significant Paneth cell hyperplasia. Paneth cells strongly overexpressed IL-9R, and stimulation of epithelial cells, isolated from PsA patients, with IL-9 resulted in overexpression of α-defensin 5 and IL-23p19. Peripheral and synovial expansion of α4β7+ Th9 cells was also observed in patients with PsA. Increased expression of IL-9 and IL-9R was also found in synovial tissue.

Conclusion:
Strong IL-9/Th9 polarization seems to be the predominant immunologic signature in patients in PsA.

This study assessed if Cosentyx (secukinumab) is associated with sustained inhibition of radiographic progression inhibited radiographic progression in patients with psoriatic arthritis.

Quote:

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Objective:
To assess whether secukinumab treatment in patients with active psoriatic arthritis (PsA) is associated with sustained inhibition of radiographic progression.

Methods:
In this phase III, double-blind, placebo-controlled study, 606 patients with PsA were randomized to receive intravenous (IV) secukinumab at a dose of 10 mg/kg (weeks 0, 2, 4) followed by subcutaneous secukinumab at a dose of 150 mg or 75 mg (the IV > 150 mg and IV > 75 mg groups, respectively) or placebo. Patients were stratified according to prior anti–tumor necrosis factor (anti-TNF) exposure (71% were anti-TNF naive). At week 16, placebo-treated patients who had at least a 20% reduction in the tender and swollen joint counts (responders) continued to receive placebo until week 24; nonresponders were re-randomized to receive secukinumab at a dose of 150 mg or 75 mg. The modified total Sharp/van der Heijde score (SHS) was determined at baseline, week 16 or 24, and week 52.

Results:
In the overall population, radiographic progression was inhibited through 52 weeks; efficacy was demonstrated for both erosion and joint space narrowing scores and in patients who switched from placebo to secukinumab at week 24. Subgroup analyses showed that secukinumab reduced radiographic progression at week 24, regardless of previous anti-TNF treatment. Among anti-TNF–naive patients, the mean changes from baseline to week 24 in the modified total SHS were 0.05 in the pooled secukinumab group and 0.57 in the placebo group; among patients with an inadequate response or intolerance to anti-TNF treatment, the mean changes were 0.16 and 0.58, respectively. Anti-TNF–naive patients showed negligible progression through week 52. Inhibition of structural damage was observed through week 52 irrespective of concomitant methotrexate use. A high proportion of patients receiving secukinumab showed no progression (change in SHS of ≤ 0.5) from baseline to week 24 (82.3% of the IV > 150 mg group and 92.3% of the IV > 75 mg group) and from week 24 to week 52 (85.7% of the IV > 150 mg group and 85.8% of the IV > 75 mg group).

Conclusion:
Secukinumab inhibited radiographic progression over 52 weeks of treatment in patients with active PsA.

Today I have been to the hospital to see the rheumatologist we had a frank discussion and I informed her again that I was reluctant to come off my psoriasis drug ( Fumaderm ) as it works so well . I'm on 4x 120mg tablets a day

But have noticed joint pain recently and have been diagnosed with psoriatic arthritis, the hospital are passing me between dermatology and rheumatology

The rheumatologist wanted me back on methotrexate but I have refused that.

I asked about Cosentyx and Otezla and was told to suggest something she could prescribe ....I mentioned Humira but I haven't got three swollen joints and haven't failed enough oral treatments to get them

Now I'll get to the point I have also been offered leflunomide or Sulfasalazine ....now as I've never been on a DMARD I have no experience of what to expect, and I'm hoping for some guidance here

Ok, so I am not sure if I am posting in the correct place or not.... My name is Deborah and I am 50 years old.  I was diagnosed with PA back in 1997 and for the most part have been on Enbril or a long time.  Unfortunately for me the side effects outweighed the benefits and last November I stopped taking all meds.. ON a plus, I have not been  sick with an upper respitory infection since January and I use to get them 3-5 times a year, down side, my psoriasis and arthritis is at an all time high and I feel horrible.  I am welcome to any advice or suggestions that you all have and I am glad to have finally found a group of people who all have what I do.... Nice to meet you