Smoking has for a long time been said to be bad for psoriasis, but could passive smoking also increase ones chance of getting psoriasis?

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Background:
Smoking is a potential risk factor for psoriasis. Both psoriasis and smoking habits are partly explained by genetic factors. However, twin studies investigating the association between these traits are limited.

Methods:
Questionnaire-based data on smoking habits and psoriasis were collected for 34,781 twins, aged 20–71 years, from the Danish Twin Registry. A co-twin control analysis was performed on 1700 twin pairs discordant for lifetime history of smoking. Genetic and environmental correlations between smoking and psoriasis were estimated using classical twin modeling.

Results:
After multivariable adjustment, age group (50–71 vs. 20–49 years) and childhood exposure to environmental tobacco smoke (ETS) were significantly associated with psoriasis in the whole population (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.02–1.29 [P = 0.021] and OR 1.28, 95% CI 1.10–1.49 [P = 0.002], respectively). Risk for psoriasis increased substantially (OR 2.18, 95% CI 1.82–2.61; P < 0.001) for smokers with a history of >5 pack-years, even after adjusting for age, sex, and childhood ETS. Among twin pairs discordant for smoking, risk for psoriasis in the ever-smoking twin was lower among monozygotic twins (OR 1.23, 95% CI 0.59–2.56; P = 0.578) than among same-sex dizygotic twins (OR 2.21, 95% CI 1.36–3.58; P = 0.001). Genetic factors explained 20% (14–25%; P < 0.001) of the correlation between psoriasis and smoking, whereas non-shared environmental factors explained 8% (0–22%; P = 0.504).

Conclusions:
Tobacco consumption and childhood ETS are significantly associated with psoriasis. Results indicate shared genetic factors for smoking and psoriasis.

Hi All

Well 9 weeks in the waiting and funding is through, Bupa have called and all kicks off next week.

Skin - pure pants!! using lots of elecon, eumovate, ysp, and Drambuie.

Nurse due next Friday to train me.  So hopefully be easy and manage myself.

I've read to take out of fridge before she comes, and wondering any more tips and what to expect with Stelara?

My derm tells me to not expect it to work quickly and give it 12 weeks.

Hope your all well and will keep updating (or annoying you lot, with questions , ha )

Angie  

This study looked into the use of Kunzia oil formulations in the treatment of psoriasis, Kunzea is a genus of shrub in the myrtle family Myrtaceae native to Australia.

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What is known and objective:
Anecdotally, topical kunzea oil has been used to treat various skin conditions, including psoriasis and eczema, with good results. This study compared the clinical efficacy of kunzea oil (20%)-containing formulations in mild to moderate psoriasis.

Methods:
A randomized, comparative, double-blind, 8-week study was undertaken. Thirty patients (age range: 25–74 years and mean ± SD: 52·8 ± 13·6 years) with mild to moderate psoriasis (affecting at least 10% of one or more body regions: arms, head, legs and trunk) randomly received ointment and/or scalp lotion containing 20% kunzea oil (test group) or control medications not containing kunzea oil (control group). Formulations in both treatment arms also contained 5% liquor carbonis detergens (LCD) and 3% salicylic acid. The clinical responses to the test and control formulations were evaluated using the Psoriasis Area and Severity Index (PASI).

Results and discussion:
After 8 weeks of treatment, both test and control groups demonstrated a significant (P < 0·05) improvement in PASI scores. Subjects in the test group had a decrease in mean±SD PASI score from 12·7 ± 7·9 to 6·7 ± 7·2, whereas the control group showed a decrease in PASI score from 8·1 ± 4·6 to 3·5 ± 4·7. Comparative efficacy analysis between the test and control groups did not reveal any significant difference (P > 0·05).

What is new and conclusions:
The inclusion of kunzea oil made no difference to the efficacy of topical formulations containing LCD and salicylic acid for the treatment of psoriasis.

Here is an abstract that looked to assess the effects and safety of oral fumaric acid esters for psoriasis.

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Background:
Psoriasis is a chronic inflammatory skin condition that can markedly reduce life quality. Several systemic therapies exist for moderate to severe psoriasis, including oral fumaric acid esters (FAE). These contain dimethyl fumarate (DMF), the main active ingredient, and monoethyl fumarate. FAE are licensed for psoriasis in Germany but used off-licence in many countries.

Objectives:
To assess the effects and safety of oral fumaric acid esters for psoriasis.

Search methods:
We searched the following databases up to 7 May 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 4, 2015), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials. We handsearched six conference proceedings that were not already included in the Cochrane Skin Group Specialised Register.

Selection criteria:
Randomised controlled trials (RCTs) of FAE, including DMF monotherapy, in individuals of any age and sex with a clinical diagnosis of psoriasis.

Data collection and analysis:
Two review authors independently assessed trial quality and extracted data. Primary outcomes were improvement in Psoriasis Area and Severity Index (PASI) score and the proportion of participants discontinuing treatment due to adverse effects.

Main results:
We included 6 studies (2 full reports, 2 abstracts, 1 brief communication, and 1 letter), with a total of 544 participants. Risk of bias was unclear in several studies because of insufficient reporting. Five studies compared FAE with placebo, and one study compared FAE with methotrexate. All studies reported data at 12 to 16 weeks, and we identified no longer-term studies. When FAE were compared with placebo, we could not perform meta-analysis for the primary outcome of PASI score because the three studies that assessed this outcome reported the data differently, although all studies reported a significant reduction in PASI scores with FAE. Only 1 small study designed for psoriatic arthritis reported on the other primary outcome of participants discontinuing treatment due to adverse effects (2 of 13 participants on FAE compared with none of the 14 participants on placebo; risk ratio (RR) 5.36, 95% confidence interval (CI) 0.28 to 102.1; 27 participants; very low-quality evidence). However, these findings are uncertain due to indirectness and a very wide confidence interval. Two studies, containing 247 participants and both only reported as abstracts, allowed meta-analysis for PASI 50, which showed superiority of FAE over placebo (RR 4.55, 95% CI 2.80 to 7.40; low-quality evidence), with a combined PASI 50 of 64% in those given FAE compared with a PASI 50 of 14% for those on placebo, representing a number needed to treat to benefit of 2. The same studies reported more participants achieving PASI 75 with FAE, but we did not pool the data because of significant heterogeneity; none of the studies measured PASI 90. One study reported significant improvement in participants' quality of life (QoL) with FAE, measured with Skindex-29. However, we could not compute the mean difference because of insufficient reporting in the abstract. More participants experienced adverse effects, mainly gastrointestinal disturbance and flushing, on FAE (RR 4.72, 95% CI 2.45 to 9.08; 1 study, 99 participants; moderate-quality evidence), affecting 76% of participants given FAE and 16% of the placebo group (representing a number needed to treat to harm of 2). The other studies reported similar findings or did not report adverse effects fully.

One study of 54 participants compared methotrexate (MTX) with FAE. PASI score at follow-up showed superiority of MTX (mean Difference (MD) 3.80, 95% CI 0.68 to 6.92; 51 participants; very low-quality evidence), but the difference was not significant after adjustment for baseline disease severity. The difference between groups for the proportion of participants who discontinued treatment due to adverse effects was uncertain because of imprecision (RR 0.19, 95% CI 0.02 to 1.53; 1 study, 51 participants; very low-quality evidence). Overall, the number of participants experiencing common nuisance adverse effects was not significantly different between the 2 groups, with 89% of the FAE group affected compared with 100% of the MTX group (RR 0.89, 95% CI 0.77 to 1.03; 54 participants; very low-quality evidence). Flushing was more frequent in those on FAE, with 13 out of 27 participants affected compared with 2 out of 27 given MTX. There was no significant difference in the number of participants who attained PASI 50, 75, and 90 in the 2 groups (very low-quality evidence) whereas this study did not measure the effect of treatments on QoL. The included studies reported no serious adverse effects of FAE and were too small and of limited duration to provide evidence about rare or delayed effects.

Authors' conclusions:
Evidence suggests that FAE are superior to placebo and possibly similar in efficacy to MTX for psoriasis; however, the evidence provided in this review was limited, and it must be noted that four out of six included studies were abstracts or brief reports, restricting study reporting. FAE are associated with nuisance adverse effects, including flushing and gastrointestinal disturbance, but short-term studies reported no serious adverse effects.

Hi There! 

I was diagnosed with Guttate this past June. (Some turned into Plaque and some went Inverse. Yay.) I am not only a newbie to the board but also to Psoriasis. My dermatologist didn't tell me much - Like it's an autoimmune disorder or... Chronic... Needless to say, I've been soaking up as much info as possible from the internet while trying to avoid the quackery/rip-offery stuff. Altho', the itching has driven me to not care too much about self-experimenting. I don't care about the spots so much, even the ones on my face, it's the itching I can't stand.

My heart goes out to everyone with this condition. I'm only on my second flare up and I'm already searching for a cure! 

Take care!
-Beezie

My Dr is thinking of changing me from Acitretin which is working extremely well for me, to Otezla because my hair is getting a little thin (this was a problem before I was ever diagnosed with psoriasis, Acitretin is just making it a bit more noticeable).

Anyone here on Otezla?

Ok, has anyone heard of Cetraben ?

It's cream here in england used for red, inflammed, chapped, dry skin.

Because of my P, my skin splitting etc, i got a 500g pump dispenser bottle.

I've used it for the first time this evening & noticed straight away it was cool & soothing.

Also, i have found since putting it on, it's non greasey !!!

Most of the other creams i get prescribed tend to make feel wrapped up in treacle !

But, this stuff is the dog's doh da's !

This Danish cohort study looked at the bidirectional association between psoriatic disease and uveitis, and suggests increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with prior or current uveitis may be appropriate.

Wikipedia: Uveitis (also known as iridocyclitis) is the inflammation of the uvea, the pigmented layer that lies between the inner retina and the outer fibrous layer composed of the sclera and cornea.The uvea consists of the middle layer of pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Uveitis is an ophthalmic emergency and requires a thorough examination by an optometrist or ophthalmologist and urgent treatment to control the inflammation.

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Importance:  
Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. Limited evidence is available about the relationship between psoriatic disease and uveitis.

Objective:  
To investigate the potential bidirectional relationship between psoriatic disease, including psoriasis and psoriatic arthritis, and uveitis.

Design, Setting, and Participants:
We performed a nationwide cohort study of the Danish population from January 1, 1997, through December 31, 2011. We included 74 129 Danish patients with psoriasis who were 18 years or older during the study period. Patients were identified through administrative registries, and information on age, sex, socioeconomic status, medication, and comorbidity was obtained using individual-level linkage of administrative registers. We performed data analysis from January 27 through March 4, 2015.

Exposures:  
Diagnosis of mild or severe psoriasis or psoriatic arthritis for uveitis risk and diagnosis of uveitis for the risk for psoriasis or psoriatic arthritis.

Main Outcomes and Measures:  
Diagnosis of uveitis, mild psoriasis, severe psoriasis, or psoriatic arthritis. We calculated incidence rates (IRs) and estimated IR ratios adjusted for potential confounders using Poisson regression.

Results:  
We identified 74 129 cases of psoriasis and psoriatic arthritis and 13 114 cases of uveitis. The IRs (95% CIs) for uveitis were 2.02 (1.99-2.06), 2.88 (2.33-3.56), 4.23 (2.40-7.45), and 5.49 (3.36-8.96) for the reference population and those with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. In the reference population, these IRs (95% CIs) were 9.37 (9.30-9.45), 1.12 (1.10-1.15), and 1.04 (1.01-1.06), and in patients with uveitis, these statistics were 15.51 (12.92-18.62), 2.66 (1.72-4.13), and 4.25 (3.00-6.01) for mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. Adjusted IR ratios (95% CIs) for uveitis were 1.38 (1.11-1.70 [P = .02]), 1.40 (0.70-2.81 [P = .34]), and 2.50 (1.53-4.08 [P < .001]) for patients with mild psoriasis, severe psoriasis, and psoriatic arthritis, respectively. For patients with uveitis, IR ratios (95% CIs) were 1.59 (1.32-1.91 [P < .001]) for mild psoriasis, 2.17 (1.40-3.38 [P < .001]) for severe psoriasis, and 3.77 (2.66-5.34 [P < .001]) for psoriatic arthritis, respectively.

Conclusions and Relevance:  
We found a bidirectional association between psoriatic disease and uveitis. Increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with prior or current uveitis may be appropriate.

I originally stumbled on this forum trying to find an answer on Google, I never did find any insight. So I'll pose the question here:
Does anyone have an idea how long it takes for a trigger to cause a flare?
I know it's going to be different depending on lots of circumstances, but generally speaking - is it a matter of hours, days, weeks?
I have a few theories about mine, which is flaring pretty heavily now, after being almost totally gone for months. But I wonder what is causing it to flare - I know, the eternal question of all psoriasis sufferers.
Personally I think mine is related to fungus. I've been gluten free for over 3 years, no change. Also alcohol free for 4 years, no change.
Thanks for any comments and or insights!!!

This is another one of those interesting articles that looks at psoriasis from the side of the people that treat us, it suggests that 70% of practitioners recognized psoriasis as a complex condition but managed it as a skin condition.

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Objectives:
Individuals’ illness representations, including beliefs about psoriasis (a complex immune-mediated condition), and their emotional responses to the condition guide self-management behaviour. It is also plausible that health care providers’ illness representations guide their own management of psoriasis. Patients commonly report poor health care experiences related to psoriasis, and the role of health care providers’ beliefs, emotions, as well as their knowledge, experiences and behaviours (‘personal models’) in this is unexplored. This study aimed explore health care providers’ personal models of psoriasis.

Design and methods:
Qualitative analysis of 23 semi-structured interviews with health care professionals providing care for psoriasis patients was performed. Purposive sampling achieved maximum variation regarding participant discipline, level of experience, gender and age. The self-regulatory/common sense model informed data collection and initial data analysis. Principles of framework analysis were used to generate predetermined and emergent key issues related to practitioners’ personal models.

Results:
Three types of personal model emerged. Sophisticated–Linear Model: 70% of practitioners recognized psoriasis as a complex condition but managed it as a skin condition. Mixed Model: 17% of practitioners recognized/managed some elements of psoriasis as complex and some as a skin condition. Sophisticated–Sophisticated Model: 13% recognized and managed psoriasis as a complex condition. Across the data set, five themes emerged illustrating key patterns underpinning these different models including Recognising complexity, Putting skin first, Taking on the complexities of psoriasis with the patient, Aiming for clearance, and Affective experiences within psoriasis consultations.

Conclusions:
Health care providers recognized psoriasis as a complex condition but commonly reported managing psoriasis as a simple skin condition. Providers’ beliefs and management approaches varied in the extent to which they were consistent with one another; and their emotional experiences during consultations may vary depending upon their personal model. Findings could inform future dermatology training programmes by highlighting the role of health care providers’ illness representations in clinical management of the condition.

 This looks like a great group to belong to, I've been peeking around a bit.
I've had plaque psoriasis for 30 years, as well as a few bouts with guttate and palmo-plantar.
I have tried just about every cream, lotion and potion plus UV, nothing really works for very long though.
So I have lately decided to go au naturel, and just live around it.
Eh, could be better, but it certainly could be worse so I'm a happy camper!

Hello everyone using Cosentyx.   Any updates from you all?    I just posted mine and look forward to hearing about your Cosentyx journies!!   

This cohort study looked at whether patients with psoriasis have an increased risk of arrhythmia, arrhythmia also known as cardiac dysrhythmia or irregular heartbeat, is a group of conditions in which the heartbeat is irregular, too fast, or too slow.

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Background:
Psoriasis is associated with cardiovascular morbidity and mortality. However, the association between psoriasis and arrhythmia has not been adequately studied.

Objective:
We sought to investigate whether patients with psoriasis have an increased risk of arrhythmia.

Methods:
This population-based cohort study identified 40,637 patients with psoriasis and 162,548 subjects without psoriasis matched by age, sex, history of coronary artery disease, hypertension, and diabetes in the Taiwan National Health Insurance Research Database during 2004 through 2006.

Results:
After adjusting for medical history and medication use, patients with psoriasis were at increased risk of overall arrhythmia (adjusted hazard ratio [aHR] 1.34; 95% confidence interval [CI] 1.29-1.39). The risks of arrhythmia were higher in all subgroups, including patients with severe (aHR 1.25; 95% CI 1.12-1.39) and mild (aHR 1.35; 95% CI 1.30-1.41) psoriasis, and in patients with (aHR 1.46; 95% CI 1.22-1.74) and without (aHR 1.33; 95% CI 1.28-1.39) psoriatic arthritis.

Limitations:
The National Health Insurance Research Database did not contain information regarding Psoriasis Area and Severity Index, cigarette smoking, or alcohol consumption.

Conclusion:
Patients with psoriasis were at higher risk of developing arrhythmia, particularly for those with psoriatic arthritis, independent of traditional cardiovascular risk factors.

My dermotologist added another cream to my already endlessly supply. The cream is called Tazorac and is to be applied at nighttime. I'll keep this thread update with my thoughts.

DMF acts slowly, but I have had continuous improvement in my arthritis (less pain and greater flexibility), so the overall effect has been very substantial. A bit of tummy upset a few times a week is no big deal, but to each his own.

Cheers,

Bill

Anyone heard of being given statins by the derm to help psoriasis drugs? It's not me, but I heard about it today and was surprised because I've not heard anything about this before.
I did a bit of reading and it seems they can give you psoriasis or help it, all very confusing.

I'm new here, and a new psoriasis patient. I was diagnosed a few months ago. We've tried creams/lotions, but the plaque psoriasis keeps coming back, so now I've been prescribed Methotrexate. I hate taking medications, but I hate long sleeves more, so I'm going to give it a shot. I'm here to connect with others who are dealing with this condition and am looking forward to participating.

My Dermotologists said he has patients without arthritis that has tendon issues. He was suggesting that it was a separate disease. Just curious how many people with psoriasis (not arthritis) have tendon problems? Also, what works for it? So far nothing has helped much besides the TNFs, and even those are not that great.

Hello I decided to join after reading this. Welcome Guest

Margo

Hi everyone!   I got my first 2 injections yesterday morning!  I am using the pen and it hardly hurt at all!   Am excited and scared at the same time, of course.   No real side effects yet....did have to run to the potty one time unexpected.  lololo    This is a side effect that I have heard about.  I felt achy last night but that has also subsided.   My health insurance that I have through my company has EXCLUDED this drug.  So I have started the 5 week start up program and then I believe I was told I can then get an additional six months of medication.  What happens beyond that is unknown.   That is what is so scary too!  I am taking pictures and will post them as I get further into my treatment.  Thanks for your support and any additional input!