We're often being told that obesity can make psoriasis worse, but this study suggests that obesity in Children is not associated with disease severity and course.

Quote:

---

Background/Objectives:

The current literature suggests there is a possible connection between paediatric psoriasis and obesity. However, there is a paucity of research on the influence of increased adiposity on the severity of paediatric psoriasis and disease progression. We aimed to compare the prevalence of being overweight or obese in paediatric psoriasis patients and controls and assess the potential impact of being overweight/obese on disease severity and progression of disease.

Methods:

This multicentre prospective case-control study included 289 psoriasis patients (aged < 18 years) treated and followed up by one of the four university hospitals in Turkey. The control group consisted of 151 consecutive age-matched and sex-matched children who lacked a personal or family history of psoriasis. The participants' characteristics, psoriasis-related parametres (e.g., initial subtype, psoriasis area and severity index, presence of psoriatic arthritis) and body mass index were determined.

Results:

The difference between the prevalence of being overweight/obese among psoriatics (28%) and the control group (19%) was significant (P = 0.024). Being overweight/obese had no significant impact on disease severity and unresponsiveness to topical treatment. Within a median follow-up time of 12 months, 23% of our patients with localised disease at disease onset progressed to generalised disease. The impact of being overweight/obese on disease progression was found to be non-significant; however, disease duration was found to have a significant impact on disease progression (P = 0.026).

Conclusions:

Although it is not associated with disease severity and course, increased bodyweight may be a health problem for psoriatic children.

Flixabi a biosimilar of Remicade (infliximab) manufactured and commercialized by Biogen has been given EU approval.

Quote:

---

The European Commission (EC) today granted marketing authorization in the European Union (EU) for FLIXABI®, an infliximab biosimilar referencing Remicade®. FLIXABI was developed by Samsung Bioepis, the joint venture between Samsung BioLogics and Biogen (NASDAQ: BIIB). FLIXABI is indicated for the treatment of adults with rheumatoid arthritis (RA), Crohn’s disease, ulcerative colitis, ankylosing spondylitis, psoriatic arthritis, and psoriasis. Additionally, FLIXABI can be used in patients 6 to 17 years old with severe, active Crohn’s disease or severely active ulcerative colitis.

FLIXABI will be the second anti-TNF biosimilar to be manufactured and commercialized by Biogen in the EU. Earlier this year, Samsung Bioepis received approval for BENEPALI® (etanercept), a biosimilar referencing Enbrel®. Biogen has since launched BENEPALI in several countries across the EU. At an estimated $10Bn a year, anti-TNF therapies are among the EU’s largest drug expenditures. BENEPALI and FLIXABI will offer physicians alternatives that will drive meaningful savings across the EU.

“The approval of FLIXABI marks a major step forward for both Samsung Bioepis and Biogen. It expands our anti-TNF portfolio and furthers Biogen’s commitment to commercializing biosimilars of advanced biologics, while expanding cost-effective treatment options for patients living with chronic inflammatory conditions such as Crohn’s disease and ulcerative colitis,” said Alpna Seth, Ph.D., Senior Vice President and Global Head of the Biosimilars Business Unit at Biogen. “We are delighted to be the first company to bring two anti-TNF biosimilars to patients and physicians across Europe.”

As part of the submission, Samsung Bioepis provided a robust preclinical and clinical data package from head-to-head Phase 1 and Phase 3 clinical trials comparing FLIXABI with the reference product Remicade. Following biosimilar approval guidelines from the European Medicines Agency, the Phase 3 clinical trial for FLIXABI was performed to confirm equivalent efficacy, and to compare safety and immunogenicity with Remicade. The 54-week, double-blind, Phase 3 study was conducted in patients with moderate to severe RA despite methotrexate therapy. The primary end point was the American College of Rheumatology 20% (ACR20) response at week 30 in the per-protocol set (PPS). The primary end point for the study was met, with data showing that patients taking FLIXABI had an equivalent ACR20 response and a comparable safety profile to those taking Remicade.

A total of 584 patients were randomized in a 1:1 ratio to either FLIXABI (N=291, 290 analyzed) or Remicade (N=293) The ACR20 response rate at week 30 in the PPS showed equivalence of FLIXABI to Remicade: 64.1% vs. 66.0%, respectively (adjusted difference −1.88%; 95% CI: −10.26% to 6.51%). The ACR20 response rate at week 54 in the PPS confirmed equivalent efficacy, with results showing 65.3% vs. 69.2%, respectively (adjusted difference 3.07%; 95% CI: −12.00% to 5.86%) ACR20 response in the full analysis set at week 30 and week 54 also showed equivalence of FLIXABI to Remicade: 55.5% vs. 59.0%, respectively (adjusted difference 2.95%; 95% CI: −10.88% to 4.97%) at week 30 and 50.7% vs. 52.6%, respectively (adjusted difference 1.15%; 95% CI: −9.16% to 6.86%) at week 54 FLIXABI was well tolerated, with comparable safety, pharmacokinetics and immunogenicity to Remicade

Hi everyone,

Only recently came across this website and only signed up this morning.
 
I've had P for as long as I can remember, I'm 27 now, I've been on steroid creams, had UV and tried whites tar paste with varying degrees of success but invariably my P would come back stronger than ever after a while.

Recently (7 weeks ago) started on Fumaderm, starting to see some minor improvements now I think, although my moisturising regime is very good at present so could be down to this. I have experienced very little by the way of side effects I have to say, although now and again my bowels are a bit looser and I am a bit gassy! 

Currently on 4 * 120mg per day and due to visit my derm again on the 7th of June.

Glad to read about everybody's experience.

Any input/insights are more than welcome!!

Hello, I'm 55 yrs old and have had p for about 5-6 yrs. I just started my treatment on Taltz 2 days ago. My dr had put me on Humira, and after 4 months i was much worse so he gave me an rx for Taltz. I have p everywhere, arms, legs, chest, back, buttocks, under arms, and toes. I took my first dose of Taltz on Friday morning. Let me tell you, the shots sting like crazy as it is going in. (Cought me by surprise)   it's now been 48 hours and I can already see a marked change. The redness of some of my patches have started to fade. Some  are already about 50% closer to my natural skin color. If it continues to work this good, I'll put up with the sting and smile. I'll keep you posted.

Hi All
I am feeling confused and at a loss with this disease. I have PPP and nail psoriasis and take Methotrexate  and Humira at the moment.  I am on holiday at the moment in a beautiful place and it's the most relaxed and un-stressed I've been in a long time. Before I left home my psoriasis was the worst it's ever been but within 3 days of being her it had almost cleared and I was amazed!  But once I'd been in the sea a couple of times, which my dermatologist said would be good for it, it's back with a vengeance!  My feet look like a whole layer of skin needs to come off and are cut and sore so avoiding sea and sand. My nails look better than they have in ages and just as I said that one started to lift!  I'm in the best place I can be and can't  understand how or why things can change so quickly.  Has anyone tried the Aloe Vera drink and had good results?  Would like to hear people's thoughts. Thanks?

Hi everyone.  I have recently been diagnosed with Psoriasis on my penis.  It has only shown up recently in the past few months.  I did not experience it before.  I went to a doctor who gave me a cortisone cream.  I have been taking it for about 6 weeks.  About 15-20% of the Psoriasis has completely disappeared but the main part is still there.  It has VERY slowly day by day shown improved with the cream.  The doctor said it may go away completely, that it may go away completely but take a year, or that it may not go away.  So I'm just using the cream right now and hoping for the best.  I'm pretty bummed about this.  Of all places.  I suppose it could be worse though.  My main question at this point is if psoriasis typically goes away with treatment, as in if I use the cream for a year is it likely it will 100% go away and not come back?  Or does it typically stay with one throughout life?  Oh boy!... :-/

Hi everyone, although I have had P for several year, this is the first time I began searching for support forums like this one and I am glad I did.   My P has been pretty bad for a long time now and I have been trying to stay away from biologics but decided to try them about 5 months ago. My Dr put me on Humira and after 4 months, not only did I not improve, I got much worse. Yesterday Morning I took my first shots of Taltz. You may think I'm crazy or am seeing thing due to my desire to get clear, but I swear I can already see a change in the way my patches look. Anyways, I hope to make some new friends here and be helped by, and help others.

First post here...
Bee a sufferer of psoriasis for 40+years and are currently having a breakout after coming off fumaderm about 20 months ago.

I'm a bit annoyed with the NHS if im honest. I went to the doctors to get referred to the hospital, to cut a long story short, I booked online to a different hospital as they could see me far quicker than my usual hospital we are talking weeks earlier here. Anyway when I go to this hospital to see about getting fumaderm again, they tell me they cannot prescribe that at this hospital. They then discharge me and I'm now waiting for another referral to the local Hospital.

Not sure why they gave me the option of the other hospital when they can't prescribe what I need.

Recently I have been on betnovate scalp application, this isn't working, it dries the psoriasis up but it doesn't clear it. I've. Been on dovonex, dovobet and are currently.on exorex.

Hello I am 22 years old. I've had guttate psoriasis for 4/5 years. Looking for success stories and starting tommorow I will be starting a diary where I keep track of new things I'm trying in order to get rid of the p!

This is an abstract of a study that looked at the use of light treatment in patients with nail psoriasis.

Quote:

---

Abstract:

Psoriatic involvement of the nail is notoriously refractory to conventional therapy. Nail psoriasis has a high incidence amongst patients with psoriasis. It remains a significant cosmetic problem and thus, has a significant impact on quality of life.

More recently, light and laser therapies have emerged as modalities for treatment of nail psoriasis. In this study, the efficacies of light and laser therapies are systematically reviewed.

Light therapies involve ultraviolet light (with or without photosensitizers) or intense pulsed light. Alternatively, laser therapy in nail psoriasis is primarily administered using a 595-nm pulsed dye laser. These modalities have demonstrated significant improvement in psoriatic nail lesions, and even complete resolution in some cases. Both laser and light modalities have also been tested in combination with other systemic or topical therapeutics, with variable improvement in efficacy. Both laser and light therapies are generally well tolerated.

Side-effects of light therapies include hyperpigmentation, itching and erythema; whereas, side-effects of laser therapy are more frequent and include pain, purpura/petechiae and hyperpigmentation. Patterns of response to therapy were also seen based on presenting characteristics of the nail lesions: subungual hyperkeratosis and onycholysis appeared to be the most responsive to therapy, while nail pitting was the most resistant.

Light or laser therapies have the potential to be an efficient and cost-effective in-office based treatment for nail psoriasis. However, more large-scale clinical trials are needed to assess their efficacy, particularly in combination with other therapeutic modalities.

This study looked at the prevalence of biological liver test abnormalities in psoriasis patients during psoriasis flares.

Quote:

---

Background:
Few epidemiologic data are available regarding biologic liver abnormalities during psoriasis flares.

Objectives:
The aim of this study was to assess the prevalence of biological liver test abnormalities (LTA) in a psoriasis population and the risk factors associated with LTA.

Methods:
A retrospective cross-sectional study in four hospital dermatology tertiary care centres included patients admitted for severe psoriasis flare between 1st January 2010 and 31st December 2011. During the same period, a control population was selected comprising patients admitted for contact and/or atopic eczema. Data were collected on hospital records and biology software. LTA was defined as serum AST and/or ALT and/or ALP concentration above the upper normal limit (UNL) and/or GGT concentration above 2 UNL. Prevalence of LTA with 95% confidence intervals (95% CI) was compared between the psoriatic and control populations. Factors associated with LTA at P < 0.05 were considered for the final multivariate logistic regression model.

Results:
Two hundred and forty psoriasis patients and 96 eczema control patients were included. One hundred and fifty-five(64.6%) of the psoriasis patients were male, aged 55 years on average (±17.6); 192 (80.0%) had plaque-type psoriasis (PV) and 52 (21.6%) had localized (n = 32) or generalized (n = 20) pustular psoriasis (PP). Prevalence of LTA was 36% (95% CI, 30–42) in the psoriatic population, significantly higher than in controls (17%, 95% CI 9.5–25). Risk factors independently associated with LTA comprised PV (OR 3.79; 95% CI 1.48–9.65), PP (OR 3.80; 95% CI 1.40–10.25) and previously diagnosed liver disease (underlying hepatic steatosis, viral hepatitis or excessive alcohol consumption) (OR 3.88; 95% CI 2.02–7.45). No association was found with systemic antipsoriatic drug therapies.

Conclusion:
In severe psoriasis, liver impacting comorbidities and/or specific psoriatic inflammation, the latter mostly in PP cases, more than drug-related liver toxicity, appears to predominantly account for LTA. Clinicians should be aware of this, to avoid unjustified withdrawal of useful systemic drugs.

Hello! I'm Loreta from Philippines and I'm newly diagnosed with psoriasis last March 26, a month after my 16th birthday. See, I'm very active in school and hearing my doctor say that I should "avoid stress" is probably my killer. I love school and all activities. Yet, it's the cause of my problems. 

On another note, I'm new to this illness and I'm getting tired of it. It hurts sometimes and my scalp itches like hell and my nails are starting to be detached from my fingers. It's hard for me to process these things considering that I'm very young and this was very unexpected as we were only eyeing for eczema. 

But, don't get me wrong. Life is still beautiful!!!

Hi everyone,  my name is John Im 68 and Ive just had a bad flare of (P) which has taken me by surprise.  I have in the past maybe once a year had the odd elbow flare but did not know this was (P) so just ignored it and it usually just went away a week or so later. However I have had a very bad problem (which Ive had for a long time)  like two years or so on the sole of my left foot and I kept scratching it so needless to say it just got worse and worse developing into a large red shiny patch until eventually I went to the Doctor last week. I showed him the foot and also the elbows.  He gave me antibiotic cream for the foot which is to be followed by Betnovate Cream for two weeks.  The latter is to be used on the foot and the Elbows.  

It has in the last few days spread to both hands and has made my palms very uncomfortable and itchy with the red patches and lots of small raised blister like bumps, certainly not the best thing to happen to a Guitar player.  It would appear from a number of comments ive read that the intense scratching of the sole of my foot  may well have caused this problem.  I do have a glass of wine each day with my dinner which ive done for years without any problem so I repeat its more likely to be the result of Scratching the foot. It has also affected the scalp at the back of my head.  So its obviously distressing to me as Ive only ever had the odd Elbow irritation.  It looks like I may be making some progress with clearing up the sole of the foot following the antibiotic cream use and im not scratching it now.

I would appreciate if anyone can offer me some ideas that would help with my palms as the other areas I can put up with.  As this outbreak is new to me, is there any chance that this will be a short episode and  dissapear again?  or am I going to be stuck with these difficult palms from here on in. its only 6 days yet but so far the Betnovate hasnt helped.  Has anyone found a product that clears it up for them?  

Sorry to be so long winded.

John

I read Freds post on salt and it made me curious if others have a salt trigger for P.
I have known for years that my plaque P. always was seasonal , foods never seemed to be a trigger for me. It's what I put on them that I now realize is one of my triggers. SALT. I have always added salt to all my foods.

Research in mice shows a high-salt diet can speed the progression of autoimmune diseases. Some may find reducing salt in their diets can help their psoriasis. I have replaced salt with spices and eat no prepared foodsfor the past 3 months.

Below is a quote from a study from a scientific study from UCLA.
"Could something as simple as a high-salt diet cause your psoriasis to progress more quickly? It’s too soon to say for sure, but research published in the journal UCLA Science research Center found that when mice are fed high-salt diets, they overproduce immune-system cells that attack their own tissues."

As we all know autoimmune disease is one where your body mistakes its own cells for foreign invaders and attacks them. Psoriasis is an autoimmune disorder in which something triggers your immune system to mistake normal skin cells as foreigners. You then overproduce new skin cells that cause raised, red, flaky lesions to form as well as PSA.

Quote."The high-salt diet the mice were fed stimulated a type of white blood cells — T-cells called Th17 cells.“It has been clearly shown that Th17 cells trigger psoriasis,” Dr. Yamauchi said." That’s why some of the drugs that have been developed to treat psoriasis, such as the biologic Stelara (ustekinumab), target the pathways driven by Th17 cells. Yamauchi noted that new biologics are in the pipeline for psoriasis that also target the Th17 pathway."

I thought this was interesting for all the PC members taking Stelera if anyone had noticed that eating salt was a trigger. I know now it's one of my triggers. Just as a example of my salt intake it's horrendous. Not good at all for many other reasons. This could be why my P. seems to be worse from drinking Margaritas, salty nuts, pop corn etc., with all that extra salt in prepared foods. Now it makes sence. i have cut down my total salt intake, substitute spices the past 3 months & noticed my P. / itching has calmed down with less spots and itching.

Anyone else noticed what their triggers for P. are and has it helped your Psoriasis to cut out your triggers?
Food, stress, winters, drug reactions,  insect bites, scratches cleaning chemicals?

Hey guys,

I've been fumaderm for almost a year and a half now, and anyone who has read my member journals knows that I had pretty good success with it. I was on 6x120 mg a day. Within a few months, I was virtually clear. I was told to cut down to 5x120mg, due to concerns over my protein levels. The psoriasis patches started to come back, but I wasn't overly concerned at first since it was very minor. Then, after a couple months, I was told to increase my dosage again.

5 months later, and I've noticed that the psoriasis patches are increasing even more. I went from patches on the chest area and lower back, to my stomach, sides and arms. Even my scalp psoriasis has come back. I assumed that by going back up in my dosage that it would improve, not slowly start to come back.

Has this happened to anyone else on fumaderm? I'm starting to worry that the medication is no longer working as it should for me, but I'm hoping that I'm worrying over nothing.

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:

---

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:

---

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!