This study looked at the prevalence of metabolic syndrome (MBS) in Lebanese patients with psoriasis.

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Background:
Psoriasis is a chronic inflammatory disease that affects not only the skin but also other organs as well. Genetic factors play an important role in individual predisposition. Lately, a positive association has been confirmed between psoriasis and metabolic syndrome (MBS), in western as well as in Middle Eastern countries.

Aim:
Assess the prevalence of MBS in Lebanese patients with psoriasis and the differential effect according to types and disease severity.

Methods:
This was a case-control study including 150 psoriasis patients and 150 age- and gender-matched controls admitted to the dermatology clinics at the American University of Beirut-Medical Center, a tertiary care center in Beirut. Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI). Blood samples were collected from fasting subjects and tested for glucose, HDL cholesterol, triglycerides, and C-reactive protein (CRP). Multivariate binary logistic regression models were built to assess the relationship between MBS and psoriasis, after adjustment for smoking as a possible confounding variable.

Results:
Patients with psoriasis were two times more likely to have MBS as compared to controls (35.3% vs 18.0%, P < 0.001) with an odds ratio (OR) of 2.4. All components of MBS were more prevalent in psoriasis patients than in controls. PASI score was greater in patients with MBS than those without MBS (10.5 ± 11.5 vs. 7.0 ± 8.1, P = 0.05). MBS prevalence tended to be higher in the inverse type than in others (52.2% versus 32.3%; P = 0.06) and in patients with nail pitting versus those without (45.3% vs. 28.2%; P = 0.03).

Conclusions:
This was the first study to assess the prevalence of MBS in Lebanese subjects with psoriasis and, to our knowledge, the first study that showed a higher likelihood of MBS in patients with inverse psoriasis and with nail pitting.

Here is a small study that looked at anti-angiogenesis for the treatment of psoriasis. (Anti angiogenic drugs are treatments that stop tumours from growing their own blood vessels)

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Background:
Recent experimental studies revealed that angiogenesis and lymphangiogenesis are closely related to psoriasis. Our microarray analysis suggested that the pro-angiogenic genes platelet endothelial cell adhesion molecule-1 (PECAM1), facio-genital dysplasia-5 (FGD5), prostaglandin-endoperoxide synthase-1 (PTGS1), melanoma cell adhesion molecule (MCAM), vasohibin-2 (VASH2), and stabilin-1 (STAB1) are differentially expressed in dermal mesenchymal stem cells in psoriasis.

Objectives:
The aim of this study was to investigate the mRNA and protein expression of PECAM1, FGD5, PTGS1, MCAM, VASH2, and STAB1 for angiogenesis and the possible mechanisms in psoriasis.

Methods:
We studied 12 patients with plaque psoriasis and 14 healthy controls matched for age and sex. Dermal mesenchymal stem cells were expanded, passaged, and identified by cellular morphology, immunophenotyping, and multipotential differentiation. The mRNA and protein expression of the above-mentioned six genes were confirmed by quantitative real-time reverse transcription–polymerase chain reaction and Western blotting.

Results:
The significantly decreased expression of PECAM1, PTGS1, FGD5, and MCAM at both mRNA and protein level (except VASH2 and STAB1) were demonstrated in mesenchymal stem cells from psoriatic skin lesions compared with non-lesional from healthy controls.

Conclusions:
We provide the first report that pro-angiogenic genes PECAM1, PTGS1, FGD5, and MCAM rather than VASH2 and STAB1 may be play a vital role in pathological dermal angiogenesis disorders of psoriasis. Therefore, anti-angiogenesis is attractive and offers future potential for application in patients with psoriasis.

Curious about anyone's experience with Leflunomide (Arava) as a solo treatment.

My Rheumatologist has me on 20 mg a day for PSA at the same time as I'm on Enbrel (2 injections/week). 
Enbrel costs $21,000 CDA here in Ontario and without insurance - its a ton of money...
Appreciate people's feedback.
With thanks
(itching and scratching less now than before)

Just looking to see if anybody can help. I had an outbreak of psoriasis in 1995 and was given dithro cream (I think it was) and within a few weeks it was all gone. In October last year I was in a car crash which brought on another outbreak but this one is much worse. Every day I wake up to new plaques. The Dr keeps giving me steroid creams which are useless and will not prescribe anything else. I am going back on Friday and was wondering if I can insist that either the Dr prescribes the cream I ask for or if he can refer me to a dermatologist?

I decided to write something positive here also. My psoriasis spots are fading and I have almost no left. My arthritis in my fingers is gone. I feel almost like a "normal" person   I pray that God will let this continue.

Hi guys! I'm Sarah and I'm 29. Let me just say that I have been looking for a support group like this for a long time!!! I was diagnosed 11 years ago. It runs in my family, but not with my immediate family.... Is that weird? My Gma, aunt, and cousin have it, but they all have plaque, and I have guttate. None of them have tried the drugs that I have. They use topical creams and like to take a more natural approach, as some drugs nowadays have quite the list of side effects. I started with topical, tanning, then enbrel, methotrexate... Both of which didn't work and methotrexate gave me really bad stomach pains. My dermatologist then sent me to a psoriasis specialist. He's amazing! He's one of the lead speakers at the psoriasis association (or something like that) lol But anyways, he put me on humira, which worked, but was a really painful shot. I dreaded it. But, my co pay card eventually ran out, so I stopped taking it... Thinking it was already healed, why would it come back? Boy, was I wrong. It was back and the worst it's ever been. I didn't even want to go to the pool because I was always asked if I had poison ivy. Then, he started me on cosentyx about 4 months ago. It's injection as well. I'm wondering if anyone is on it yet? It's incredible. Everything cleared up within weeks, and the shot is so much less painful. The only problem I have with injections is every couple months, my skin gets flushed. My hands, feet, and legs will feel really hot to the touch and my hands and feet feel really swollen. But it goes away the next day. I was wondering if anyone else had this problem? Anyways, I know I'm rambling. But, any extra information I can gain from everyone, or if there's anything I might be able to help with, I'm here. I Am really happy I stumbled upon this website. Thanks for listening.

Here's some good news for psoriasis patients that don't get on with taking pills but would be happy to try Ciclosporine.

Immune Pharmaceuticals Inc. (Immune), a clinical-stage biopharmaceutical company, announced it has entered into an exclusive worldwide licensing and development agreement with BioNanoSim Ltd (BioNanoSim), an Israeli nanotechnology drug delivery company, for a novel topical nano-capsule formulation of cyclosporine.

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Monica Luchi, M.D., Chief Medical Officer of Immune, commented: "Oral cyclosporine, a potent immunosuppressive drug, known to reduce the activity of the immune system by interfering with T-cells, has revolutionized transplantation medicine. Its use in dermatology has been limited to severe cases of psoriasis and atopic dermatitis, because of significant systemic toxicity. In a validated human skin model of atopic dermatitis, a novel topical nano-capsule formulation of cyclosporine A demonstrated comparable efficacy to a high potency topical corticosteroid. We believe that this product candidate could provide an important therapeutic alternative for millions of patients with chronic inflammatory skin disorders such as moderate atopic dermatitis and psoriasis. We intend to accelerate the development of this product candidate under the abbreviated 505(b)(2) drug development pathway permitted by the U.S. Food and Drug Administration."

This topical nano-capsule formulation of cyclosporine incorporates a patented technology invented by Professor Simon Benita, the former Director of the Institute for Drug Research and Head of the School of Pharmacy at the Hebrew University of Jerusalem. Professor Benita has pioneered a nano-drug delivery platform for improving the absorption of poorly absorbed drugs. He recently succeeded in incorporating cyclosporine into a nano-capsule formulation that can be absorbed through the skin.  In validated preclinical animal and human skin models, this new topical formulation was shown to deliver therapeutic levels of cyclosporine to targeted skin layers and to limit systemic absorption. "We believe that this collaboration with Immune will leverage our nanotechnology expertise and advance this novel product candidate into the clinic," said Professor Benita.

LI'm 
Hi this is my first time on a forum looking for a miracle lol.
I gave up smoking 2 years ago 3 months after stopping I got my first small plaque ps today I have huge patches on my knees legs elbows nothing I try seems to stop a new patch apering next test is glycerine mite try smoking again next Lol hopfully a cure will be found for this and an in expensive one at that

Hi.I am Acitretin & very good for my Skin problem but i have a side effect i need to visit the toilets
to urinate often is this normal with this drug.
Richie Beaven.

Here's a study that looked into cold atmospheric plasma (CAP) as a potential therapeutic option for psoriasis.

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Background:

Cold atmospheric plasma (CAP) has shown promise for wound healing, although little is understood of the underpinning mechanisms. Little has been reported so far of its potential use in the treatment of immune-mediated diseases such as psoriasis.

Objectives:
To study CAP-induced cell death and cytokine release in human keratinocytes as a first assessment of possible CAP use for psoriasis.

Methods:
Using a CAP generator free of energetic ions, we observed its effects on keratinocytes in terms of morphology, cell viability and apoptosis, intracellular and mitochondrial reactive oxygen species (ROS), lysosomal integrity and mitochondrial membrane potential; and on secretion and expression of eight cytokines at protein and gene levels.

Results:
CAP-induced reduced cell viability, apoptotic death and production of intracellular and mitochondrial ROS in dose-dependent manner. Mitochondrial dysfunction and lysosomal leakage were found in CAP-treated cells. It also induced release of interleukin (IL)-6, IL-8, tumour necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF), and enhanced the mRNA expression of IL-1β, IL-6, IL-8, IL-10, TNF-α, interferon-γ and VEGF. By contrast, IL-12 declined monotonically.

Conclusions:
The results suggest that with appropriate control of its dose, physical plasma could induce cell death via apoptotic pathways and enable simultaneous reduction in IL-12. These effects may be used to suppress keratinocyte hyperproliferation and to target T-cell activation to control amplification of inflammation. This provides an initial basis for further studies of CAP as a potential therapeutic option for inflammatory and immune-related diseases in dermatology, including psoriasis.

This is an ongoing study from Germany looking at Fumaric acid esters in children with psoriasis.

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Background:
Given that there is no standard systemic treatment for children and adolescents with plaque psoriasis, this non-interventional, multicenter, retrospective study collected data on the efficacy and safety of long-term treatment with fumaric acid esters (FAEs) in this particular patient group.

Patients and methods:
In patients younger than 18 years of age at the start of FAE treatment, data on efficacy and safety was retrospectively collected for at least 36 months.

Results:
Data from 127 patients (aged 6–17 years) was collected for treatment durations of up to 60 months. Physician's Global Assessment, Psoriasis Area and Severity Index, and Body Surface Area showed marked improvement in the first six months. After 36 months, these parameters had, on average, improved by up to two-thirds of baseline values. Thirty-seven patients experienced at least one adverse event (AE), which was FAE-related in 36 individuals. Three AEs (proteinuria (one case), flushing (two cases)) persisted during the observation period while on treatment. Fifteen AEs led to the discontinuation of therapy; nearly all of these cases were related to gastrointestinal disorders.

Conclusions:
The KIDS FUTURE study – for the first time – included a larger population of children and adolescents with psoriasis who were treated with FAEs. The data obtained suggests that long-term FAE therapy in this patient group may be effective and safe. The results are currently being verified in an ongoing clinical study.

Assessment of soluble Receptor activator of nuclear factor kappa-B ligand (RANKL) in psoriasis could identify those at increased risk for psoriatic arthritis.

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Background:
Psoriasis usually precedes the onset of psoriatic arthritis by an average of 10 years in about 70% of patients. Receptor activator of nuclear factor kappa-B ligand (RANKL) is a natural and necessary surface-bound molecule, which is a ligand for osteoprotegrin and functions as a key factor for osteoclast differentiation and activation.

Objective:
Evaluation of the serum level of RANKL in psoriasis and psoriatic arthritis and its correlation with severity of the disease as a trial to predict the occurrence of psoriatic arthritis in such patients.

Method:
This study included 80 subjects; 40 patients had chronic plaque psoriasis, 20 patients had chronic plaque psoriasis with psoriatic arthritis, and 20 were healthy controls. Patients with psoriasis were divided into three subgroups according to psoriasis area severity index score: mild, moderate, and severe. Serum RANKL levels were estimated for all subjects using enzyme-linked immunosorbent assay.

Results:
Serum RANKL level in psoriatic arthritis was significantly higher compared to both patients with plaque psoriasis and control groups. Serum RANKL level significantly correlated to the severity of psoriasis, with a very high correlation coefficient in groups I and II. The diagnostic performance of serum RANKL level for the early prediction of psoriatic arthritis in patients with psoriasis was >170 pg/ml.

Conclusion:
Serum RANKL level could be considered as a useful diagnostic marker for the early prediction of psoriatic arthritis in patients with moderate and severe psoriasis. Assessment of soluble RANKL in psoriasis could identify those at increased risk for psoriatic arthritis, and anti-RANKL agents may be effective in decreasing incidence of psoriatic arthritis.

This 60 case to study looked at inflammatory markers such as sialic acids and the oxidative stress index (OSI) in patients with psoriasis vulgaris. Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage.

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Background and objectives:
Recent studies have implicated the association between oxidative stress and inflammation in pathogenesis of psoriasis and its associated comorbidities. Hence, we undertook to study inflammatory markers such as sialic acids and the oxidative stress index (OSI) in patients with psoriasis vulgaris.

Methods:
Sixty cases and 60 healthy controls were included in this cohort study. Disease severity was assessed by psoriasis area severity index scoring. Serum levels of oxidative stress (total oxidant status, total antioxidant status) and inflammation (highly sensitive C-reactive protein [hs-CRP], total sialic acid, protein bound sialic acid) markers were estimated in controls and cases at baseline and on follow-up. OSI was calculated as the ratio of total oxidant status to total antioxidant status.

Results:
Baseline serum levels of OSI, hs-CRP, and sialic acids were significantly higher in cases compared to controls. Baseline OSI and sialic acids demonstrated a significant correlation with disease severity. After 12 weeks of therapy, there was a significant decline in OSI and serum levels of hs-CRP and sialic acids.

Conclusions:
Our results demonstrate that oxidative stress and inflammation are significantly associated with psoriasis, and treatment with methotrexate results in a significant decline of both the inflammatory and oxidative stress parameters.

This abstract ahead of print looked at the risk of malignancy in patients with psoriasis being treated with biologics.

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There is some debate regarding the risk of developing malignancy and progression of malignancy in patients with psoriasis treated with biologics.

The lack of extensive, long-term, and large studies, including patients with psoriasis, to assess these aforementioned risks makes it difficult to ascertain the safety profile of biologic therapy in these patients. Several studies do support the favorability of the safety profile of biologics in patients with psoriasis in terms of the risk of developing malignancy.

A few studies include patients with a previous history of cancer that were thereafter treated with biologics and show no increased risk of recurrence in those treated with biologics compared to non-biologic therapy. Although recent studies do not show an increased risk of new or recurrent malignancy in patients with psoriasis treated with biologic agents, there is still hesitancy in the widespread use of biologic agents in these patients.

Considering all of the current data and opinions, the benefits of biologic therapy to improve quality of life often outweigh the negligible risk of solid organ malignancy associated with biologics in patients with existing or previous malignancies. Coordinating the management of patients that develop or have a history of previous malignancy with an oncology team is crucial for patient-centered care until clear evidence-based guidelines are developed.

This study looked at Metabolic Syndrome (MBS) in Moroccan patients with psoriasis. Metabolic syndrome is a clustering of at least three of five of the following medical conditions: abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density lipoprotein (HDL) levels.

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Background:
Several recent reports have shown a significant association between psoriasis and metabolic syndrome (MBS).

Objective:
The goal of this study was to investigate the prevalence of MBS and, in particular, the main factors that determine this syndrome in Moroccan patients with psoriasis.

Methods:
A case–control study has included 150 patients with psoriasis and 300 controls matched for age and sex, the MBS was defined according to the International Diabetes Foundation, and the severity of psoriasis was assessed by body surface area.

Results:
Mild psoriasis was seen in 10.7%, 40.3% had moderate psoriasis, and 49% had severe psoriasis. MBS was higher in cases than in controls with statistical differences (44.7 vs. 2.7%, odds ratio [OR]: 26 CI: [12.4–54.3]; P = 0.000). Abdominal obesity and dyslipidemia were the only metabolic factors significantly related to psoriasis whereas diabetes, hypertension, smoking, alcohol consumption, and cardiovascular diseases were not significant. MBS increases with age in our patients with psoriasis, whereas there was no relationship between MBS and gender. Hypertension (P = 0.007), diabetes (P = 0.003), and increased level of triglycerides (P = 0.05) and high-density lipoprotein cholesterol (P = 0.003) were associated with the severity of psoriasis.

Conclusion:
Metabolic syndrome is an important comorbidity in patients with psoriasis, and vigilance and enhanced screening may be important in this population, especially patients with severe disease.

I was hoping to be one of those people you hear about who's psoriasis gets better during pregnancy, but I appear not to have this luck. I have an appointment with my consultant in January so will update you all then. I'm assuming the psoriais cannot be of any danger to the baby?

Hi all. 
I have P since I was in high school talk about a crappy time to get that. Struggled forever. I remember taking Skin Cap spray (international) work do good. Flaunted my short shorts

They took that off market so back to light treatment. Pure pain and hell. 

Been on Embrel for several years decided to try something new in Humira. Insert gigantic regret here. About a little over a month in and I'm miserable. It's all back. Went from about 20% to 75%. 

Anyway first time ever really being open about it  so thanks for creating the forum. Glad to be here.

Hi All

New to site but not new to P & PA   But the site looks good with lots advice and info

Just started on another drug FUMADERM very hopeful about this ?

Baz

The risk of of cancer amongst psoriasis patients has often been spoken about. Here is a population based cohort study that confirms there is an increased risk albeit small.

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Importance:  
The risk of cancer in patients with psoriasis remains a cause of special concern due to the chronic inflammatory nature of the disease, the use of immune-suppressive treatments and UV therapies, and the increased prevalence of comorbid, well-established risk factors for cancer, such as smoking and obesity, all of which may increase the risk of carcinogenesis.

Objective:  
To compare the overall risk of cancer, and specific cancers of interest, in patients with psoriasis compared with patients without psoriasis.

Design, Setting, and Participants:  
Population-based cohort study of patients ages 18 to 89 years with no medical history of human immunodeficiency virus, cancer, organ transplants, or hereditary disease (albinism and xeroderma pigmentosum), prior to the start date, conducted using The Health Improvement Network, a primary care medical records database in the United Kingdom. The data analyzed had been collected prospectively from 2002 through January 2014. The analysis was completed in August 2015.

Exposures of Interest:  
Patients with at least 1 diagnostic code for psoriasis were classified as having moderate-to-severe disease if they had been prescribed psoralen, methotrexate, cyclosporine, acitretin, adalimumab, etanercept, infliximab, or ustekinumab or phototherapy for psoriasis. Patients were classified as having mild disease if they never received treatment with any of these agents.

Main Outcomes and Measures:  
Incident cancer diagnosis.

Results:
A total of 937 716 control group patients without psoriasis, matched on date and practice visit, and 198 366 patients with psoriasis (186 076 with mild psoriasis and 12 290 with moderate-to-severe disease) were included in the analysis. The adjusted hazards ratios (aHRs) with 95% CIs for any incident cancer excluding nonmelanoma skin cancer (NMSC) were 1.06 (95% CI, 1.02-1.09), 1.06 (95% CI, 1.02-1.09), and 1.08 (95% CI, 0.96-1.22) in the overall, mild, and severe psoriasis group. The aHRs for incident lymphoma were 1.34 (95% CI, 1.18-1.51), 1.31 (95% CI, 1.15-1.49), and 1.89 (95% CI, 1.25-2.86); for NMSC, 1.12 (95% CI, 1.07-1.16), 1.09 (95% CI, 1.05-1.13), and 1.61 (95% CI, 1.42-1.84); and for lung cancer, 1.15 (95% CI, 1.03-1.27), 1.12 (95% CI, 1.01-1.25), and 1.62 (95% CI, 1.16-2.28) in the overall, mild, and severe psoriasis groups, respectively. No significant association was seen with cancer of the breast, colon, prostate, or leukemia.

Conclusions and Relevance:  
The association between psoriasis and cancer, albeit small, was present in our cohort of patients with psoriasis. This association was primarily driven by NMSC, lymphoma, and lung cancer.

hi ppls
          has  anyone tryd taking olive leaf extract capsules to help with the condition called ppp or Palmo-planter. mine is on my hands & feet.