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From Lights and Topicals to a Biologic - Maybe
from Ben K.

Ed:  As you may recall I was having some intensive Narrow Band UVB treatment whilst I was living in Chicago (I'm actually from the UK) mixed in with topical Dovonex and Halebetasol.  My psoriasis was almost cleared (still some on my right forearm and knees) when I returned to the UK in October.

I haven't had any treatment since and the Psoriasis has now returned with a vengeance — I can't remember the last time I had such a bad flare.  I am going to see a Derm in a couple of weeks and I will be investigating the biologics I think.  I am particularly cr*p at using any topicals. I just don't often have the time or the patience to spend 1+ hours putting all the stuff on.  I may have some convincing to do though because in the UK they seem to prefer to use MTX (methotrexate) before moving on to the biologics which have only recently been approved here.  I am somewhat nervous about the side-effects of MTX and it seems to be less of an issue with the biologics.

Infliximab seems to be the next "big thing" as far as my reading tells me.

Luckily my PA which affects my fingers and toes hasn't been too bad recently although it was causing particular discomfort today.

I don't think I'm really asking for any advice per se, rather just telling someone who probably understands, but any advice would be gratefully received!

Keep up the good work with the site — I find it a very useful resource!

Warm regards, -Ben K.


Ed’s Response:  Nice to hear from you, Ben.  Sorry to hear about your flare.  I've always argued that the inevitability of rebound makes this disease worse than the sum of its symptoms.

Infliximab (known better by its product name, Remicade, in the U.S.) is one of three biologics that have been used by rheumatologists longer than dermatologists.  Enbrel (etanercept) and Humira (adalimumab) are the other two.  All of them work by inhibiting (different) protein expressions in immune system cells that fight inflammation.  Though I was taking Raptiva last year with good skin consequences, my PA was in pretty severe rebound and my doctors and I knew I'd have to go after something that helped the PA sooner rather than later.  Hence I switched to Humira this January, after deciding the Remicade "routine" was too bothersome.  Here, Remicade is administered by infusion and though they aren't frequent — every other month after getting started — they still require a visit of several hours to a doctor's office or infusion clinic.  Humira is a weekly subcutaneous injection.  On my schedule that made more sense. 

I can tell my skin has been trying to flare since the switch to Humira (as I write this a lesion on my right forearm is begging to be scratched), but except for some scalp and ear flaking, Humira seems to be containing the skin P pretty well.  A test is coming up:  When our weather shifts from winter-cold to spring-warm I like to flare.  We'll see if the Humira can prevent that from happening. 

Best of luck to you.  Let us know what you decide to do treatment-wise, and how it works for you.  -Ed

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