Hi All,

I'm new to this forum and this will be my first post here.

Im not sure myself when did i noticed about my Psoriasis but it isnt a very huge outbreak till present day. I think I have noticed it for about a couple of years, maybe 2 years or 3. But I have no clue when it actually started. The reason being that my psoriasis is very localised on both my elbows, with appearance of a circular patch with scales (about 5cm*5cm), symmetrical on both elbows. Hence, no one seems to point them out including myself and even my parents, until a couple of years ago when i realise the odd appearance.

However, recently I realised it suddenly appeared on my right knee which worries me a lot. There are currently only 3 distinct spots on my knee but I have been looking at my knees daily hoping a new spot does not appear. My Psoriasis doesnt seem to spread in the course of the 2,3 years that I have known them to exist, except for about 5 random spots in the entire 2,3 years which recovered over time. I normally just ignored them. 

Now that I have grown older, I have started to become concern over this autoimmune disease, to which whether it will spread, whether if it will affect my child in the future, etc. 

Therefore, may I seek any advice or opinions to which whether this is common? Or rather, what are the chances of my Psoriasis not spreading to the rest of my body except my elbows since it lays dormant for the past few years without spreading? And what are the odds of me getting psoriasis arthritis? I have tried to search for answers but the answers i observe are normally for people with large scale outbreaks over their entire body. So i would like to take this opportunity to seek advice from people here whom perhaps face the same issue as me. But of course, all advice are welcomed. 

Thank you all in advance

Bruce

This study looked at liver enzyme abnormalities in psoriasis patients and suggests 57% of problems are associated with drugs.

Quote:

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Background/Objectives:
Psoriasis patients have a higher risk of liver abnormalities such as non-alcoholic fatty liver disease (NAFLD), drug-induced hepatitis, alcoholic hepatitis and neutrophilic cholangitis, than the general population. Associated liver disease limits therapeutic options and necessitates careful monitoring. The aim of the study was to identify liver problems in psoriasis patients and to investigate the underlying causes as well as their course.

Methods:
The files of 518 psoriasis patients were retrospectively reviewed. Among these, 393 patients with relevant laboratory data were analysed for liver enzymes and their relation to the known risk factors for liver disease (obesity, diabetes mellitus, alcohol consumption, hepatotoxic medications, dyslipidemia, psoriatic arthritis and infectious hepatitis).

Results:
Among 393 patients, 24% and 0.8% developed liver enzyme abnormalities and cirrhosis, respectively. The most common factors associated with pathological liver enzymes were drugs (57%) and NAFLD (22%). Other rare causes were alcoholic hepatitis, viral hepatitis, neutrophilic cholangitis, autoimmune hepatitis and toxic hepatitis due to herbal therapy. Drug-induced liver enzyme abnormalities were reversible whereas in patients with NAFLD transaminases tended to fluctuate. One patient with herbal medicine-related cirrhosis died of sepsis.

Conclusion:
Liver enzyme abnormalities are common in psoriasis patients and are mostly associated with drugs and NAFLD. Although most cases can be managed by avoiding hepatotoxic medications and close follow up, severe consequences like cirrhosis may develop.

A few months ago I noticed my feet were hurting when I get out of bed, it took a few minutes to get them going. I also noticed my knuckles were quite painful most of the time, the pain is bearable but I know it's there constantly, my finger nails have always been striated and pitted .

My dermatologist looked and referred me to a rheumatologist who had a look last month without giving me any clues, but arranged to have an ultrasound scan of my hands.

I've been for the scan today and the scan showed some arthritis,
I asked if it was psoriatic arthritis and she said and the doctor who looked were noncommittal, so I have come away not much wiser
My appointment with the rheumatologist is not till July and I was wondering if the ultrasound was a good test for psoriatic arthritis or if there are other tests needed ?

I have just returned from my doctor and told her my scalp psoriasis is so painful I was in tears trying to sleep last night and she said psoriasis doesn't hurt. Has anyone else ever been told that cause believe me mine is extremely painful?

Hi guys, 

I've been browsing the site unregistered, like an undercover keyboard ninja for a few days now and have found the site very helpful and learnt so much more about P then pretty much anywhere else on the net. Really enjoy reading the success stories to, gives a brother some hope. 

I'm 23 and have now suffered from Guttate P for around 3-4 years now. I've been prescribed, Dovobet (red one and blue one), Trimovate, and some more topical creams none of which have worked. 2 years ago I was sent to light therapy which worked very well and apart from a patch on my lower back and calve I was fully clear. However;

I think I remained clear for about 3 months which was the most disheartening part as I did all those sessions only for it to return so soon. It started coming back very slowly, new bit here, new bit there.  For maybe 4-6 months my P came back but really not that bad. I saw my derm who said we should wait for a bit to treat it as I was on some other medication for acne and we wanted to tackle that first. Also I couldn't do more light treatment as enough time hadn't passed since my last treatments. 

More months went by and slowly it was getting worse but within the last 2 weeks its just got really bad. All my guttate marks are bright red, thick scaly and constantly itching. My scalp is terrible as it has so many flakes in it and my groin looks like i've caught a hideous STD. I still have the Trimovate cream which will clear my groin, trunk and pube region within a week but then the P just comes back worse so I cant even treat that. I can see tiny red dots appearing on my body and now on my arms and I know these are just waiting to get bigger and worse. 

I am going to see my derm tomorrow and talk about the best way to tackle this but I am hoping to get some advice from you all here: 

I know the light therapy works well for me, it takes a bit of time but has minimal side effects and I even get a little glow. However, I just don't know whether it is worth it if it comes back so soon like the last time. (I should say I was due for 20 sessions last time and only did 18 as I was basically clear...I dont know whether that makes a difference). Have people here had times where light therapy has been more successful than others and can it be used in conjuction with more serious treatments like fumaderm?

Alot of you here seem to really recommend Fumaderm, it seems to work and seems like a really good long term treatment and prevention for P. The only draw backs are the side effects, I'm just not sure if I can handle them. My question here is do those of you who are on Fumaderm consider it a last resort when a more exhaustive list of treatments has been completed? Also, how long do you need to take it? Do you stop when/if the P clears? 

My next question is about Stelara, I've read a few success stories here but then the numbers aren't exactly blowing me out the water. I would be drawn to this treatment though because the side effects 'appear' to be less apparent than fumaderm but then I haven't found that many stories to do any solid research about Sterala so any feedback here is appreciated. 

To sum my post up, I just want to know the best way for me to find a long term prevention for my guttate to subside. I know light treatment works but dont want to go through weeks of sessions for my P to come back so I am thinking of tackling it with biologics. 

Any help will be appreciated.

Hello, 

I have psoriasis from elbow to my wrist and from knee to foot.
I would like to buy a phototherapy appliance (I need the smallest one to cover small areas).

From my search on the web I couldn't get to a conclusion on which one should I go with...

I would appreciate a first hand recommendation for such an appliance.
As for now the leading appliance I am considering is Kernel KN4003BL.

Recommendation against is also appreciated

Thanks for your time !

I have had psoriasis for years-always on my knees and elbows with the occasional flare up on my legs when experiencing stressful times-I had light treatment for my worst flare up which helped so much. I have always been so self conscious about my psoriasis, always trying to cover it up, not going to swimming pools etc. I hate people staring at it.

Over the past week my psoriasis has decided to flare up again. I had sore throat/cold recently and after researching psoriasis on the internet I believe this can sometimes trigger a break out. 
I always have plaques on my knees and elbows and now have (what I believe to be) guttate spots all over my legs and starting to form on my arms and hands which I have never really had before.

I now have some spots on the top of my back, on my face and ears which I've never had before. Also one solitary little spot on my tummy - I've never had any there before either.

My doctors surgery is completely useless when trying to book an appointment, when I eventually got through no appointments were left. I needed some treatment quite desperately as my legs were so itchy and sore so a doctor was scheduled to telephone me.

After explaining my symptoms she prescribed me dovenex ointment to use alongside E45 (without looking at my psoriasis). I asked if this could be used on my face she said yes but only a small amount. 

When reading through the leaflet when I picked up the prescription, I noticed it was for plaque psoriasis and no you shouldn't put this on your face!

Is there a different treatment needed for guttate psoriasis or is dovenex OK to use? It is very time consuming applying it to each individual spot! 
What can I use on my face if it is advised not to put dovenex on your face? 

I haven't needed to use treatment other than moisturising for a long time so looking for a bit of advise really - my doctors surgery is completely rubbish ?

Hello Group  .
I'm really  happy  I found  this  site .I recall commercials  on TV when i was  young  in the  sixties  " The  heartbreak of  psoriasis.
Well it  must  have  been  even  tougher  back then  because we  do  have  some  creams and  research as well  I'm finding  support  .
Briefly, in the  fall of  2015  i went on a  fishing  trip for a  couple  of  days  .I rented a  trailer at a  park  .I stayed  for 2  nights  .When  I went  home  
I was scratching  bumps  on my ankles and the  back of  my  arms .I noticed some  bad insect  bites  .I believe the  ankles  were flea  bites and  the arms either  bed  bugs  or  spiders. I did  have  some  discomfort  on the  trip  but  I have  been in the  bush  and forests many  times.I believe the  protein from the  insect  bites  caused an immune  system  disruption also had damaged  sunburn skin on one  arm .   
I couldn't  get  rid  of the  bumps  and  red dots  so  I went to the  Dr .He  said  I had  foliculites. He  gave  me  antibiotics  .No  good  .I went  back and pleaded  for  a dermatologist referral.
A well respected  Dr of dermatology after examination  stated that  I had  nummerous  eczema and  psoriasis.I was devastated  to learn there was no  cure .
I am 67  and haven't  had a  pimple  since I was 15. I didn't  know  what  hit  me  . It  is now  4  months  later  and  am  learning  to cope  and  I'm getting better  at  controlling the outbreaks  .What  seems  to work and  what  isn't .I'm very grateful to have  found this  site  and to learn and share  alike  .
   thank you  I value  your  opinions
Reggie  from Toronto Canada

This study looked at the prevalence of nonplaque psoriasis phenotypes. Data was obtained from three prospective cohort studies of 3179 women and 646 men.

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Background:
We present the largest set of US prevalence data for psoriasis to date, obtained from three prospective cohort studies describing validated clinical phenotypes of psoriasis, including novel data about the prevalence of inverse (intertriginous) psoriasis in these groups. Nonplaque psoriasis phenotypes have been largely unmeasured in observational and interventional studies, and this has led to an under-recognition of this aspect of psoriatic disease.

Aim:
To describe the prevalence of nonplaque psoriasis phenotypes in a large prospective cohort.

Methods:
We included 3179 women and 646 men in the analysis. Participants in the Nurses Health Study (NHS) and Health Professionals Follow-up Study (HPFS) with physician-diagnosed psoriasis completed a validated, self-administered questionnaire to assess plaque and nonplaque subsets of psoriasis.

Results:
Psoriasis phenotypes were as follows: plaque 55%, scalp 52%, palmar–plantar 14%, nail 23% and inverse 21% in the NHS (n = 1604); plaque 60%, scalp 56%, palmar–plantar 16%, nail 27% and inverse 24% in the second NHS study (NHS II) (n = 1575); and plaque 55%, scalp 45%, palmar–plantar 12%, nail 27% and inverse 30% in the HPFS (n = 646). Scalp, nail, palmar–plantar and inverse disease represent highly prevalent phenotypes of psoriasis in the USA.

Conclusion:
Scalp, nail, palmar–plantar and inverse disease represent highly prevalent phenotypes of psoriasis.

hi....my names debbie (im new)

ive had the dreaded p for years and for last 8 i have been on Cyclosporine which worked wonders for me but have had to come off as been on to long.   Im now on fumaderm and i have been on it now since mid november. im up to 4 blue tabs a day now and altho the side affects are a pain i can take them if it clears my skin up but its only very slightly better.  should i have seen large improvements by now??  please advise as i was being positive but im now starting to get down.

HAs anyone tried NAET - its a treatment involving systematically removing allergic reactions.  It is a bit costly and allegedly improves psoriasis. I know I react to gluten so I guess iit can be helpful. Has anyone tried it?

Jean

My dermatologist gave me a can of Enstilar to try out. It's a spray with a couple of steroids in it. It's kind of cool and has scrubbing bubbles effect. It's $1000.00 USD for a 60g can. Cool product, but the price tag is a bit over the top.

Enstilar foam

Following on from FDA says no to Xeljanz for psoriasis here is an abstract of a Japanese randomized, double-blind, phase 3 study of Oral Tofacitinib funded by Pfizer Inc.

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Tofacitinib is an oral Janus kinase inhibitor that is being investigated for psoriasis and psoriatic arthritis.

Japanese patients aged 20 years or more with moderate to severe plaque psoriasis and/or psoriatic arthritis were double-blindly randomized 1:1 to tofacitinib 5 or 10 mg b.i.d. for 16 weeks, open-label 10 mg b.i.d. for 4 weeks, then variable 5 or 10 mg b.i.d. to Week 52. Primary end-points at Week 16 were the proportion of patients achieving at least a 75% reduction in Psoriasis Area and Severity Index (PASI75) and Physician's Global Assessment of “clear” or “almost clear” (PGA response) for psoriasis, and 20% or more improvement in American College of Rheumatology criteria (ACR20) for patients with psoriatic arthritis. Safety was assessed throughout. Eighty-seven patients met eligibility criteria for moderate to severe plaque psoriasis (5 mg b.i.d., n = 43; 10 mg b.i.d., n = 44), 12 met eligibility criteria for psoriatic arthritis (5 mg b.i.d., n = 4; 10 mg b.i.d., n = 8) including five who met both criteria (10 mg b.i.d.). At Week 16, 62.8% and 72.7% of patients achieved PASI75 with tofacitinib 5 and 10 mg b.i.d., respectively; 67.4% and 68.2% achieved PGA responses; all patients with psoriatic arthritis achieved ACR20. Responses were maintained through Week 52.

Adverse events occurred in 83% of patients through Week 52, including four (4.3%) serious adverse events and three (3.2%) serious infections (all herpes zoster). No malignancies, cardiovascular events or deaths occurred. Tofacitinib (both doses) demonstrated efficacy in patients with moderate to severe plaque psoriasis and/or psoriatic arthritis through 52 weeks; safety findings were generally consistent with prior studies.

Hi All

Strange readings on a breathalyzer on the morning after one a beer ( one with my dinner the night before 6.30pm )

The reading was that I was over limit at 10 am in morning. 

After a lot a of testing stopping tabs etc and speaking to a few people including the people from the breathalyzer maker.

Fumaderm not on there list of drugs which affect the breathalyzer. ( mine is top rated ) 

TEST

So this morning at 8 am Reading at zero 

Took 120mg with beans on toast. mmmmmm

Retest at 10 am still at zero

Retested at 12 noon Guess what 0.88 over the legal limit to drive 

Retested at 12.20 pm now 0.92 so over the limit

By the way I have retested with chemical type like blow in the bag type both read zero just now (thats because of no alcohol)

Please let me know if anyone else has come across this problem (big)

Also I am only on two tabs a day at the moment working up to 6 a day.

Baz

Hi everyone. Just curious about Otezla! Wanting to get away from the costly biologics, and the unknown of what on God's earth they could be doing to my body after 15 years, I tried Otezla. Aside from headaches, it gave me diarrhea so bad, I literally could never leave the house.  Needless to say, I stopped after the firstpack.  Tell me, how far has anyone gotten, did you have symptoms and did they subside, and did it help your psoriasis, and Psa?

This is a large population based cohort study that looked at the relation of chronic kidney disease in psoriasis patients.

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Aim:
Using a population-based cohort, Wan et al. examined the risk of moderate-to-advanced (stage 3–5) chronic kidney disease (CKD) in patients with psoriasis.

Setting and design:
A population-based cohort was constructed using The Health Improvement Network (THIN) database. THIN is an electronic primary healthcare records database containing routinely collected medical diagnosis and drug prescribing data on > 9 million patients in the U.K. Data were collected prospectively on 143 883 adults (aged 18–90 years) with psoriasis. Of these, 7354 had severe psoriasis, as defined by prescription codes for systemic medication or treatment codes for phototherapy. Patients with psoriasis were matched with up to five nonpsoriasis age- and practice-matched controls. Patients with a diagnosis of CKD before study entry were excluded. In addition, baseline data from the Incident Health Outcomes and Psoriasis Events (iHOPE) study, a cohort of 8731 primary care patients aged 25–64 years with psoriasis, was included. Psoriasis severity was categorized according to body surface area (BSA) involvement as estimated by general practitioners. A similar method using a patient-reported BSA assessment tool was previously validated by the same group. Patients were matched by age and practice with 10 nonpsoriasis controls.

Study exposure:
Psoriasis, identified on the basis of a recorded diagnostic code for psoriasis.

Outcomes:
Incident CKD was defined as the presence of a recorded diagnostic code consistent with moderate-to-advanced (stage 3–5) CKD or laboratory parameters consistent with the diagnosis (estimated glomerular filtration rate < 60 mL min−1 1·73 m−2) during follow-up. Prevalent CKD (as defined above) in the cross-sectional data from the iHOPE study.

Results:
The adjusted hazard ratios for incident CKD were 1·05 [95% confidence interval (CI) 1·02–1·07], 0·99 (95% CI 0·97–1·02) and 1·93 (95% CI 1·79–2·08) in the overall, mild and severe psoriasis groups, respectively. In the nested cross-sectional study (iHOPE) the adjusted prevalence odds ratios for CKD were 0·89 (95% CI 0·72–1·10), 1·36 (95% CI 1·06–1·74) and 1·58 (95% CI 1·07–2·34) in the mild, moderate and severe psoriasis groups, respectively.

Conclusions:
Moderate-to-severe psoriasis is associated with an increased risk of moderate-to-advanced CKD, independently of traditional risk factors.

This small study looked at pediatric psoriasis and systemic therapies.

Quote:

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Background:
Psoriasis has an estimated prevalence of 0.5% to 2.0% in children. There is a paucity of data regarding the management and safety of treatments currently available for children with moderate to severe psoriasis. The aim of this study was to evaluate the treatment response and safety of systemic therapies used to manage moderate to severe pediatric psoriasis in a single referral center. Despite a small sample size, it was hypothesized that multiple therapeutics used for adult psoriasis would have a similar side-effect profile and positive disease response when used in a pediatric population.

Methods:
A retrospective case series evaluated 51 children with moderate to severe psoriasis treated with systemic therapies for adverse event occurrence and for disease response using a 5-point Physician Global Assessment scale.

Results:
Fifty-one patients, some of whom used multiple treatment options, produced 80 treatment data points. Adverse events were reported in 29 of these 80 treatments, with most being minor, subjective side effects. Overall, the most commonly reported side effect was fatigue, which was reported in 7.5% of treatments. Because of the small sample size, the data collected are limited and may not represent a comprehensive safety profile, nor do they allow comparison of efficacy between therapies. This case series found that biologic and immunomodulating therapies provide well-tolerated treatments with positive disease response for moderate to severe pediatric psoriasis.

Conclusion:
Although sample size and study design limit the data from this study, the study provides some guidance where little exists and helps to support the use of these treatments in this setting.

A bit of a biased study as it was funded by Novartis the makers but it suggests Coentyx (secukinumab) significantly improves patient-reported itching, pain, and scaling.

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Background:
Secukinumab is a human interleukin-17A antagonist indicated for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. The objective of this analysis was to measure the treatment response on psoriasis-related itching, pain, and scaling via the Psoriasis Symptom Diary (PSD)©.

Methods:
ERASURE (n = 738) and FIXTURE (n = 1306) were double-blind, multicenter phase 3 studies in adults randomized to secukinumab (300, 150 mg, n = 1144) or placebo (n = 574) (administered at Weeks 0, 1, 2, 3, and 4, followed by dosing every 4 weeks) or a biologic active control (FIXTURE only). Patient-reported itching, pain, and scaling were assessed during the first 12 weeks of treatment using the PSD.

The results reported here are limited to subjects in the secukinumab and placebo treatment groups who completed the PSD. The proportions of subjects achieving prespecified responses (improvement:reduction of at least 2.2 points for itching, 2.2 points for pain, or 2.3 points for scaling) were compared for secukinumab versus placebo.

Results:
Overall, 39% of subjects completed the PSD at baseline and Week 12 (n = 453 secukinumab; 225 placebo). Subjects treated with secukinumab achieved significantly greater improvements in itching, pain, and scaling at Week 12 versus placebo (all P < 0.0001) and had significantly greater proportions of itching, pain, and scaling responders at Week 12 versus placebo (all P < 0.05).

Conclusion:
Secukinumab significantly improves patient-reported itching, pain, and scaling in adults with moderate to severe psoriasis compared with placebo.

Hi been on fumaderm  for a year got a letter at xmas saying blood count is low and to lower dosage
Had bloods taken a few weeks ago and still low but my skins breaking out again and on my fave and hands bad
Do I up the dosage myself to 6 tabs a day as this seems to clear it as the letter for low blood count does not seem to be anything  to worry about 
I have loads of these tablets

Hi caroline, is it normal to have low energy levels on fumaderm?