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.

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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?

Hi, i'm currently on fumaderm and it has almost cleared my psoriasis. However the psoriasis on my ankles is being stubbron and doesn't seem to be clearing. Also does the pigmintation leave ? I still have red skin colouring?

HI,  Would anyone know if fumaderm is licensed in Ireland?

Is there a link between stopping Humira and headaches? I didn't do last weeks jab and I've had two migraines.. Could be just coincidence but I haven't had migraines for years.

This study looked at psoriatic arthritis patients using bio treatments and concluded the rate of infection was higher than of those with just psoriasis.

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Objective:
To investigate the rate, type, characteristics, and predictors of infection in a cohort of patients with psoriatic arthritis (PsA) and a cohort of patients with psoriasis without arthritis (PsC).

Methods:
A cohort of patients with PsA and a cohort of patients with PsC were followed according to a standard protocol and information on the occurrence of infections was recorded. The rate of infection was estimated by fitting an exponential model. A Weibull regression model was fitted to estimate the relative risk of first infection associated with a number of covariates. Risk factors for recurrent infections were investigated using generalized estimating equations.

Results:
There were 498 and 74 infections reported among 695 and 509 patients with PsA and PsC, respectively, with an incidence rate of 19.6 per 100 person-years in the PsA cohort compared with 12.2 in the PsC cohort. The HR of the time to the first infection in PsA versus PsC was 1.6 (p = 0.002), and higher in patients treated with biologics versus nonbiologics at 1.56 (95% CI 1.22–2.00) in PsA and 1.50 (95% CI 0.64–3.54) in the PsC cohorts. Female sex and treatment with biologics were associated with infection in the PsA cohort, whereas a lower Psoriasis Area and Severity Index score and a higher Functional Comorbidity Index were associated with infection in the PsC cohort. Ultraviolet treatment was protective against infection in both cohorts. No difference in rates of hospitalization was found (p = 0.66). There were no infection-related deaths in either cohort.

Conclusion:
The incidence rate of infection was higher in the PsA than the PsC cohort and higher among patients treated with biologics. The data confirm the association between infection and biologic treatment in psoriatic disease.

Went to Guys hospital yesterday and asked them for an update on Fumaderm.
Because of the slim chance off getting the Jc virus,which is untreatable,
they have stopped prescribing Fumaderm to any new patients
for the few that are still on them if there lymphocyte drops to 0.7
or lower ( like me ) they are taken off them for good. the ones that have normal
lymphocyte counts are now told if they want to stay on them they have to sign a consent form.
this only applies to Guys hospital.

Phil

This study suggests the older you get the less likely you are to get a Bio treatment for psoriasis.

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Background:
Inequality in healthcare has been identified in many contexts. To the best of our knowledge, this is the first study investigating age inequality in the form of prescription patterns of biologics in psoriasis care.

Objectives:
To determine whether patients with psoriasis have equal opportunities to receive biological medications as they age. If patients did not receive equal treatment, a subsequent objective was to determine the magnitude of the disparity.

Methods:
A cohort of biologic-naive patients with psoriasis was analysed using Cox proportional hazards models to measure the impact of each additional year of life on the likelihood of initiating biological treatment, after controlling for sex, body mass index, comorbidities, disease activity and educational level. A supporting analysis used a nonparametric graphical method to study the proportion of patients initiating biological treatment as age increased, after controlling for the same covariates.

Results:
The Cox proportional hazards model resulted in hazard ratios of a 1-year increase in age of 0·96–0·97 depending on calendar-year stratification, which implies that an increase in age of 30 years corresponds to a reduced likelihood of initiating biological treatment by 61·3–67·6%. The estimated proportion of patients initiating biological medication always decreased as age increased, at a statistically significant level.

Conclusions:
Patients with psoriasis have fewer opportunities to access biological medications as they age. This result was shown to be applicable at all stages in a patient's life course and was not only restricted to the elderly, although it implies greater disparities as the age difference between patients increases. These results show that inequality in access to biological treatments due to age is prevalent in clinical practice today. Further research is needed to investigate the extent to which this result is influenced by patient preferences.