# Remicade induced Psoriasis



## crohnsinct

Sorry to bother you all with this mundane issue but.....

The rash we had been told all along was eczema (by a local adult derm) is actually Remicade induced psoriasis.  O's GI was getting concerned and sent us to the ped derm at his hospital.  Seems even though Remicade is a treatment for psoriasis it could also cause psoriasis in a small percentage of cases.  She has it all over her body.  Her face is beat red, scaly and bleeding...it is even in her privates.  

Derm says not much we can do but dropping Remicade clears up about 60-70% of the cases.  She is letting GI make the calls though as IBD is the primary concern.  

Went to lunch and O says she doesn't care how ugly or itchy she is she isn't dropping Remicade. 

I imagine we might be able to back down the dose (She is on 10) or maybe lengthen schedule (currently every 5 weeks). Waiting to hear from GI. 

I thought I saw something once about adding Imuran or Methotrexate to control the psoriasis but can seem to find it again (calling MLP). 

If anyone has experience with this I would love to hear it.


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## my little penguin

> Addition of Low-Dose Methotrexate to Infliximab in the Treatment of a Patient With Severe, Recalcitrant Pustular Psoriasis
> Chantal Barland, MD; Francisco A. Kerdel, BSc, MBBS
> Arch Dermatol. 2003;139(7):949-950. doi:10.1001/archderm.139.7.949. Text Size: A A A


From:
http://archderm.jamanetwork.com/article.aspx?articleid=479391#qundefined


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## Farmwife

I don't have any advice. Just want to send hugs to O.
You got yourself one strong young lady.:heart: Your doing a great job mom!


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## my little penguin

http://informahealthcare.com/doi/abs/10.1080/09546630802441234



> Background: There are reports of rare adverse effects of tumor necrosis factor (TNF) inhibitors, including infections, malignancies, and induction of autoimmune conditions. Intriguing, are cases of induction or exacerbation of psoriasis in conjunction with TNF inhibitor therapy, given that they are approved for treatment of the same condition. Objective: Published cases of psoriasis occurring during anti-TNF therapy were analyzed, including overviews of proposed etiologies and treatment recommendations. Methods: A literature search using Ovid MEDLINE and PubMed was performed for articles published between January 1990 and September 2007 to collect reported cases of psoriasis in patients receiving therapy with TNF blocking agents. Results: A total of 127 cases were identified: 70 in patients on infliximab (55.1%), 35 with etanercept (27.6%), and 22 with adalimumab (17.3%). Females comprised 58% of cases; mean age of reported patients was 45.8 years, and the time from initiation of treatment to onset of lesions averaged 10.5 months. These patients suffered from a number of primary conditions, with rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease accounting for the vast majority. Palmoplantar pustular psoriasis was observed in 40.5% of the cases, with plaque-type psoriasis in 33.1%, and other types comprising the remainder. Topical corticosteroids were the most commonly employed treatment modality but led to resolution in only 26.8% of cases in which they were employed solely. Switching to a different anti-TNF agent led to resolution in 15.4% of cases. Cessation of anti-TNF therapy with systemic therapy led to resolution in 64.3% of cases. Conclusion: More information and cases are needed. Biopsies of TNF-blockade-induced lesions may reveal what cytokines and cell types drive the development of these lesions. Additionally, there is a need to develop an algorithm to treat this paradoxical side effect of therapy with TNF-blockers


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## my little penguin

*Psoriasis and psoriatic arthritis induced in a patient treated with infliximab for Crohn’s disease


*



> Abstract
> 
> The induction of psoriasis as a side effect of treatment with TNF-alpha inhibitors is one of a few rare complications of treatment, the pathogenic mechanism of which has not yet been completely clarified. The clinical presentation of these reactions may show the typical characteristics of psoriasis, palmoplantar pustulosis and psoriasiform exanthema; the individual variations of which may combine to give different presentations in individual patients. We present the case of a patient who, after administration of infliximab indicated for Crohn’s disease, developed not only skin manifestations but also those of psoriatic arthritis.


From:
http://informahealthcare.com/doi/abs/10.3109/09546634.2010.521811


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## my little penguin

> Psoriasis and psoriatic arthritis induced in a patient treated with infliximab for Crohn's disease
> M Tichy Jr, M Tichy, R Kopova… - Journal of …, 2012 - informahealthcare.com
> ... Owing to escalating difficulties, biological treatment with infliximab (Remicade) was indicated. ... After 3 weeks of intensive topical corticosteroid and methotrexate therapy there were ... J, Köstler E, Haroske G. Tumor necrosis factor-alpha inhibitor-induced psoriasis or psoriasiform ...


From link above


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## my little penguin

> Nature Reviews Gastroenterology and Hepatology 7, 174-177 (March 2010) | doi:10.1038/nrgastro.2010.7
> 
> Subject Categories: Inflammatory bowel disease | Therapy
> 
> Rash induced by anti-tumor necrosis factor agents in an adolescent with Crohn's disease
> Laurie S. Conklin, Bernard Cohen, Lindsay Wilson, Carmen Cuffari & Maria Oliva-Hemker  About the authors
> 
> top of page
> Abstract
> Background. A 17-year-old white male with Crohn's disease who was receiving maintenance infusions of the anti-tumor necrosis factor (TNF) agent, infliximab, presented with a new-onset psoriasiform skin rash. The rash was not responsive to topical or oral corticosteroids and worsened after infliximab infusions and after subsequent administration of a second anti-TNF drug, adalimumab.
> 
> Investigations. Full medical history and physical examination, including assessment of the morphology of rash and the temporal correlation with administration of anti-TNF agents.
> 
> Diagnosis. Anti-TNF-agent induced psoriasiform skin rash.
> 
> Management. Discontinuation of anti-TNF therapy. The patient opted to have his gastrointestinal symptoms treated with oral mesalazine and metronidazole.


From:
http://www.nature.com/nrgastro/journal/v7/n3/abs/nrgastro.2010.7.html


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## crohnsinct

Thanks MLP!  You rock!


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## my little penguin

> « PreviousNext »Seminars in Arthritis and Rheumatism
> Volume 40, Issue 3 , Pages 233-240, December 2010
> Psoriatic Skin Lesions Induced by Tumor Necrosis Factor Antagonist Therapy: Clinical Features and Possible Immunopathogenesis
> Angelique N. Collamer, MD, Daniel F. Battafarano, DO
> Rheumatology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
> 
> published online 28 June 2010.
> 
> Abstract Full Text PDF References
> Objective
> The induction or exacerbation of psoriasis in patients treated with tumor necrosis factor (TNF) antagonists is a well-established phenomenon. The goals of this comprehensive literature analysis were to update currently available data regarding this adverse event, to identify any clinical patterns in the cohort of reported patients, and to review the possible immunopathogenesis.
> 
> Methods
> A systematic literature review was performed utilizing PubMed and Medline databases (1996 to August 2009) searching the index terms “tumor necrosis factor alpha inhibitor,” “TNF,” “infliximab,” “etanercept,” “adalimumab,” combined with the terms “psoriasis,” “pustular,” “skin,” “rash,” “palmoplantar,” and “paradoxical.” All relevant articles were reviewed. Patients who did not appear to meet accepted classification criteria for their treated disease, who had a more probable explanation or other likely diagnosis for their skin findings or known possible triggering factor for the skin eruption, including infection, were excluded from this analysis.
> 
> Results
> Two hundred seven cases met inclusion criteria for review. Of these, 43% were diagnosed with rheumatoid arthritis, 26% with seronegative spondyloarthropathy, and 20% with inflammatory bowel disease. Mean patient age was 45 years and 65% were female. Fifty-nine percent were being treated with infliximab, 22% with adalimumab, and 19% with etanercept. Lesion morphology included pustular psoriasis in 56%, plaque psoriasis in 50%, and guttate lesions in 12%; 15% experienced lesions of more than 1 type. No statistically significant predisposing factors for the development of new-onset psoriasis were found. Sixty-six percent of patients were able to continue TNF antagonist therapy with psoriasis treatments. The pathogenesis appears to involve disruption of the cytokine milieu with production of unopposed interferon-α production by plasmacytoid dendritic cells in genetically predisposed individuals. Genetic polymorphisms may play a role in this paradoxical reaction to TNF blockade.
> 
> Conclusions
> TNF antagonist induced psoriasis is a well-described adverse event without any known predisposing risk factors. Most patients can be managed conservatively without drug withdrawal. Registry data reporting is necessary to define the true incidence and prevalence of this condition. Genomic studies of affected patients may assist with identification of predisposed patients and elucidation of the molecular trigger of this perplexing


From:
http://www.semarthritisrheumatism.com/article/S0049-0172(10)00073-9/abstract


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## my little penguin

http://onlinelibrary.wiley.com/doi/...sCustomisedMessage=&userIsAuthenticated=false

Pediatric case


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## my little penguin

http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=DRM2006213004350

More pediatric cases


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## my little penguin

> Infliximab-induced psoriasis during therapy for Crohn's disease☆
> Flavio Steinwurz, Rafael Denadai, Rogério Saad-Hossne, Maria Luiza Queiroz, Fábio Vieira Teixeira, Ricardo Romiti
> Received 22 August 2011; received in revised form 12 December 2011; accepted 13 December 2011. published online 27 January 2012.
> 
> Abstract Full Text PDF Images References
> Abstract
> Although therapy with tumor necrosis factor-alpha inhibitors (anti-TNF) provides beneficial effects in different immune inflammatory disorders, paradoxical cases of anti-TNF-induced psoriasis have increasingly been reported, mostly in the setting of rheumatologic diseases. To date, less than 50 cases of infliximab-induced psoriasis in inflammatory bowel disease patients have been described. The present report was aimed at describing two new cases of infliximab-induced psoriasis during therapy for Crohn's disease and at carrying out a review on this intriguing phenomenon.


From:
http://www.ecco-jccjournal.org/article/S1873-9946(11)00363-1/abstract


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## Clash

MLP, you absolutely rock!!! Sorry to hear about the psoriasis, that O is one serious trooper!! Go O!


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## izzi'smom

Not Remi induced, but my psoriasis is kept manageable (less painful/less flaking) with Clobex steroid lotion. Not sure if it is approved in kiddos or if they would use it in this instance but I tried myriads of products before finding one that worked. (((HUGS))). As if IBD wasn't already enough.


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## crohnsinct

Hmmm. They told me it was pretty rare in kids but I didn't believe them.  Seriously by the time I got home I got a call from some study person wanted to see if O would fit the study and be interested. 

Derm said it was plaque and pustular depending on location and that it was the pustular we had to watch and if it gets bad enough would have to consider coming off Remi...but we are no where near there yet.  Just using steroids 2 weeks on 2 weeks off and seeing what that does (even though that is what the old derm had us doing for supposed Eczema).  She said old derm was conservative and she upped the pecentages considerably.  Also, waiting for GI to decide on Remi. 

Clash: I know right?  What 13 year old would choose to walk around looking like that...I guess it beats the Crohns!


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## my little penguin

One thing as a warning - open skin( aka psoraisis ) can be a problem in pools and other areas due to possible infection since she is on remicade.
DS ears and face are a mess from who know what ( hope not remicade)
We were told no swimming when the skin is broken too much risk for cellulitis .
Hugs


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## crohnsinct

Yep!  I made sure I mentioned she is a swimmer.  

I don't know what cellulitis (going to look it up right now)  is but derm's big concern was staph.  She said pools can carry that and that the temp and chlorine levels aren't good enough to kill it.  O swims in a bromine pool so I am not sure if that makes it worse or better but she just about strangled the woman when she heard that.  Oh yeah and derm said cut nails short short so there go the manicure bribes for EEN. Guess I still have pedicures


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## crohnsinct

EEK...and sorry but ears, face and scalp were the first areas for O. What does ds's face and ears look like?


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## my little penguin

Our derm I don't like thought yeast on ears- white flaky stuff
Also on scalp yellow and white scales
Face red pimple like with some white sunburn like 
I am switching derms since this one I do not like 

Cellulitis is a deep skin infection that can go septic
DS had it from a wart on his foot after starting remicade


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## crohnsinct

Um yeah...I would ask GI if they have a derm they are associated with and mention the Remi induced psoriasis.  Yellow and white scales on scalp sounds like what O has.  White flaky could also be it and ears are also one of the first places it shows.  The pimple looking thing on face doesn't sound like what O has.  

After scalp ears and face it moved to underarm, chest, back and then privates. 

Oh gosh I hope your ds doesn't have it.  Not that it is so bad but geez you don't need one more problem to manage! 

I am mad I didn't change derms sooner. Not that anything would be different but I had a suspicion but trusted old derm that it was eczema grr!


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## my little penguin

Haha sorry
But the current derm is through the same hospital as the Gi
- but I am switching anyways concerned over psoriasis.


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## crohnsinct

Oops!  I think switching and asking about the psoriasis is a good move.  I really hope that isn't it and it is something super benign.  Keep me posted.


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## Crohn's Mom

I can show you a PM pic of what cellulitis looks like ~ it's not pretty ~ and not usually "wide spread" like you explain about O's rash.

I hope they can find a way to help get it under control, without having to discontinue the Remicade


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## my little penguin

^^ yeah that
DS 's was very painful and spread quickly- hot as well


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## crohnsinct

Yeah cellulitis wasn't mentioned so I am sure she doesn't have it but since she does swim maybe you should send that to me so I am prepared should I see anything that looks like it...please tell me this isn't from personal experience!


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## Crohn's Mom

oh it's definitely from personal experience ~ Gabs that is ! 
sending now  Hope you don't have a weak stomach !


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## crohnsinct

O.K. finally looked it up and it says staph and strep cause cellulitis so I guess in a round about way derm did address some concern but didn't use the "c" word.  We bargained down to shower as soon as she is out of pool, don't touch anything and get the heck out of the locker room pronto....suits me because she is usually the last girl out!


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## Crohn's Mom

Sorry ~ can't figure out how to add photo to a PM, so I put it in my private album titled "Gabrielle" for you to see


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## crohnsinct

Thanks T...Crohns mom...weak stomach :rof::ylol2::rof:


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## Crohn's Mom

Ok you're right ~ the irony there !

:rof::rof::rof:


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## crohnsinct

Ang: Thanks I will keep that in mind...my younger one is on Protopic (tacro) for her Vitaligo and this derm said we could go with that on her face if I didn't want to do steroids but it would take longer to work.


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## my little penguin

No tacro with remi
High risk of T cell lymphoma 
It increases risk by 3.8%
It is absorbed and found in the blood of kids on it for AD

http://www.fda.gov/downloads/Adviso...ials/PediatricAdvisoryCommittee/UCM255140.pdf

http://www.fda.gov/downloads/Adviso...ials/PediatricAdvisoryCommittee/UCM255139.pdf


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## crohnsinct

WTH!!!!!!  See! Docs don't like forums but I swear this forums saves their butts!!!!!


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## my little penguin

FDA  put the black box for a reason derms still want to use sighting it only causes an issues in monkeys and rats given oral doses. --- hello 
I did my own research since I trust nothing that I didn't look up myself


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## crohnsinct

my little penguin said:


> I did my own research


...and everyone else's:ybiggrin:


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## my little penguin

> There were no reported associations with TCI use and Hodgkin’s disease. However, the study reported an increased risk of non-hodgkin’s lymphoma and TAC (adjusted OR=2.46; 95% CI 1.11, 5.47) but not for PIM (adjusted OR=0.65; 95% CI 0.29, 1.45). Similarly, the study reported an association between t-cell lymphoma and TAC use versus untreated AD (adjusted OR=4.95; 95% CI 1.86, 13.19) but no association with t- cell lymphoma and PIM use versus untreated AD and t-cell lymphoma (adjusted OR=0.85; 95% 0.25, 2.90).


From link above posted


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## crohnsinct

O.K. so can't find that stdy that specifically mentions MTX for Remicade induced psoriasis but found plenty supporting Mtx use in regular psoriasis so wondering if that might be an option.  Of course I am putting the cart before the horse again and these cremes can be just the magic.  Just trying to out guess the docs...it is my new favorite game


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## my little penguin

Oh and one more thing they excluded anyone on immunosuppressants from their findings
If you read it is not recommended for anyone on immunosuppressants


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## my little penguin

Fwiw we use metronidazol creme and bactroban 
Both abx so I am not really caring if they get into his blood
Plus a nizol shampoo wash for the face ears and scalp
Look up bleach baths as well


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## my little penguin

Oh and search wet wraps
Here is a link on KFA
http://community.kidswithfoodallergies.org/displayForumTopic/content/3682717252137825

Bleach baths
http://community.kidswithfoodallergies.org/displayForumTopic/content/3682717252231506

Good luck


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## crohnsinct

Old derm had us use Ciclopirox shampoo at $100 for 120ml...it did nothing. 

Mupirocin antibiotic...useless as although it was weeping and looked infected new derm says no infection that is waht this Remi induced Psoriasis does. 

Old steroids were .2% for scalp and neck and .5% for face.  Don't know what the new ones are as I haven't gotten script filled yet.  Waiting to hear from GI tomorrow.  

Going to look at those bleach baths and wraps now.


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## jmckinley

Sorry to hear about the psoriasis. One thought, maybe the addition of the methotrexate would allow you to push the remicade schedule out to 5-6 weeks...that would be a plus if it would also help her skin.

O rocks! What a brave girl...willing to put up with the skin condition to keep her gut well!

:headbang::headbang::headbang:


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## my little penguin

:ack: His hands were red raw and burning tonight

could be just too many days in the pool with the cold right:voodoo::voodoo::voodoo::voodoo:

 I need my bubble back


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## jmckinley

mlp, I do agree it could be the pool with the hands. Ryan's hands get very red, dry, chapped, and crack/bleed in the winter. The cold weather and the constant hand washing jus take their toll very quickly.


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## DustyKat

Awwww, O is just the best! What a champion...:hug: 

No advice cict but loads of love and healing thoughts heading your way across the great pond! :heart: 

Dusty. xxx


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## izzi'smom

I am surprised at the pool angle...I have had psoriasis for 20+ years and have never heard not to swim. Occasionally I have declined because the chlorine is drying, but I swim as much as twice a week in the winter (when psoriasis is worse) and have never had an infection. 
I get the theory, though...the skin is more fragile and there are frequently cuts/cracks in it, allowing bacteria to enter. Treatment doesn't change this much, as steroids thin skin (I have had TERRIBLE skin tears the past two years from minute scrapes). 
At any rate, the lotion I use is .05% (I recently quit Humira as my Psoriasis flared and I didn't feel Humi was helping) and it helps a lot. MLP...when I am ready to switch meds I will hire you to find the best one for me


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## my little penguin

The only reason for no swimming for DS was due to his recent cellulitis on his foot . Ped just said no swimming if its an open wound. His skin was ulcerating on the earlobe at the time .


Candela lotion work for anyone????


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## Lewiss mum

hey just reading through all your post and some really interesting threads .ellie has been given 2 and 1 percent steriod she used dermol 500 in theshower andas a moisturiser . she has also been give 10 days of erythromycinand a vitamin d cream so use only on raised areas. she is coverd in it i feel awful for here. she dosnt have crohns. but her brother does nor does she take rem but could vit d cream help . i hope u get some better results from your dermatologist . xx


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## crohnsinct

Well Gi says: 
- o.k. to swim but shower right after to lessen chance of infection since she is on Remi and Remi increases liklihood of infection.  
- no tacro go steroids 
- no steroids in her privates...she will just have to be itchy there 
- he and derm will watch closely....I guess there is increased risk of skin cancer with psoriasis and Remi and also psoriatic arthritis.  Not a large enough or scary enough risk to make us all want to stop Remi but just something to watch for...if they show then we will act but for the meanwhile we will stay on same dosage and schedule for remi. 

I picked up a slew of natural creams, body washes, shampoos etc for psoriasis for use the two weeks we are off steroids.  Probably way over priced nothings but just so I feel like we are doing something. 

Still waiting to pick up the new steroids as the derm said finish what we have then switch.   

Lew's mom: no vitamin d...I don't know why but my youngest uses it and derm said no for O.  I didn't ask.  I will next time.  

MLP: how are your sons hands today?  Did you get that derm appointment?


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## my little penguin

Hugs
Good to know on the tacro I am not the only insane one.
Hope the steriods work 
Candula creme helps alot
Hands are good but keep getting red.
Cold has made his skin burn 
Still need to call to make new appt and cancel with old derm .


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## Sascot

Seem to have missed loads on this thread, just had a read through.  Sorry to hear about the psoariasis.  You mentioned just having to suffer the itch "down there" as no steroids.  Have you tried Sudacrem - don't know if you get that where you live.  It's a nappy cream so fine for those delicate areas :thumleft: and is also listed to help psoariasis, sunburn, skin irritations and bed sores, so it might help.


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## crohnsinct

ERGH!  No sudacrem in the U.S....I will pick up some Calendula though and give it a go.  

Poor thing was on fire this morning (hurts to look at her) and this is part of her two weeks on the steroids.  I shutter to think what she will be like off.  

Going to ask derm about the cream that worked for Angie if these don't.


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## Sascot

Happy to send you some of the cream if the ones you're getting don't help.  Just let me know


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## my little penguin

Calmoseptine may be similar ( Walgreens ) for those areas .
It helps DS ... Just saying 
http://www.calmoseptineointment.com/


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## Twiggy930

So sorry to hear that O has developed psoriasis.  I have had psoriasis myself since I was about 3 years old.  Mine has always been mild and I only used steroid creams briefly when I was a kid.  One thing I have noticed is that mine always gets way better in the summer when I can expose my skin to more sunlight.  I realize that this might be hard to do in the winter so there is only one solution...TROPICAL VACATION!   :ylol::ylol::ylol::ylol::ylol::ylol:


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## Jmrogers4

Twiggy930 said:


> only one solution...TROPICAL VACATION!   :ylol::ylol::ylol::ylol::ylol::ylol:


I think this could be the perfect solution for all!


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## crohnsinct

:ylol:Sounds like a plan to me!  I also have mild psoriaisis and have found the same.  

Although doc may not agree cuz I got the ole Remicade/psoriasis high risk of skin cancer keep her out of the sun speech.  Wonder if the swim team will build a shade shelter over the outdoor pool this summer so O doesn't get skin cancer:shifty-t:


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## my little penguin

http://www.alexandme.com/mobile/default.aspx#C91

Just for practice it makes a big difference -
I burn at the beach but not with the long sleeve shirt
DS has been wearing them since birth .


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## crohnsinct

Cool.  Thanks MLP...bet the shirts create some nice drag for training too.  Now all I need  is a mask for her face for the endless hours of stupid backstroke or maybe she will change her stroke:ylol:


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## my little penguin

They are surf shirt so like a second skin
Loose drag  but tight well

http://www.amusingplanet.com/2012/08/the-latest-chinese-beach-craze-face-kini.html?m=1

Just for the back stroke
Don't laugh 
They do wear them


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## crohnsinct

OMG!  Seriously LMAO!  I like the purple and blue camouflage one.  I showed O and she threatened to disown me if I made her wear one...although she said IF she wore one she would want one with an ape face:ylol:


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## Farmwife

That their is what nightmare are made of!:ylol:


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## Jmrogers4

OMG, as a redhead or I guess now they call us Gingers my mother would have made me wear one of those when it came out I think I was about 10 how excessive sunburns caused skin cancer


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## Clash

Oh my, I may have to get one of those...just call me Mrs. Wrestler #2!!


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## DustyKat

Wouldn't they give your swimming kiddoes some extra streamlined speed in the pool??? :lol: 

Dusty. :biggrin:


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## David

I'm really late to this thread but wanted to send my support your way.  I'm sorry your daughter is having to deal with psoriasis on top of all this now 

*hugs*


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## crohnsinct

Took O to the G.I. today.  He says derm wants O off Remicade. G.I. is adament about staying on. 

Her sed rate was elevated at last infusion and they think it could be the psoriasis as it is an inflammatory disease. 

She has been complaining of some joint pain.  Could be CD could be Psoriatic arthritis.  

Hot flashes...no clue watch and see. 

G.I. is now wanting to add a low dose (10mg) of Methotrexate to try to get the psoriasis under control (I have read of Methotrexate being used for psoriasis).  If that works the added bonus is maybe we can bump out the infusion scedule from 5 weeks to longer.  He said he will test Remi levels in a few months and we can go from there.   

Other than that all good here in CT.  Spring finally came, O grew 3/4 of an inch and gained a pound.  The pound wasn't enough to move her BMI up (actually went down a little) but vertical growth is very good.


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## CarolinAlaska

I hope the addition works out all the way around for her.


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## Livilou

Hi crohnsinct! So sorry O is going through this. Just curious, have either of your docs mentioned Stelara? Will probably help both CD and psoriasis. There are several kids using it now for CD even though it is still in Phase 3 trials. We are currently fighting insurance company for the drug. My Liv is not having an easy time these days...2nd round of radiation treatment on Saturday and needing to be on a low iodine diet for the past 2 weeks. Diet is NOT crohns friendly and she has been feeling terrible...stomach pain and nausea are the worst, so living on zofran. Her labs are all perfect?? You know how it goes with this disease....not really trusting those labs. Hoping it's the sudden change in diet and nothing more!! Hope things get sorted out quickly for O! Hugs!       Kim


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## Lisa

Ugh...you did NOT want to see my body a couple years ago when I suddenly developed some type of psoriasis after having strep.....Believed it to be gutatte psoriasis, although Derm dx as eczema...yeah right...all over my body suddenly!

Anyway - the majority of it cleared up on its' own - I did use 2 different clreams to help with the worst spots - clobetasol is a steroid cream that REALLY helped - also Protonic - but be careful with this one, as I found out I could only use it on small spots - anything bogger than a couple inches and it BURNED.....yup, found out the HARD way! 

If it can be dealt with, I would stay on the Remicade, especially if it is working for hte Crohns' symptoms...my GI put me on pre-meds (solumedrol and benadryl) before my infusions, and I just use the topical creams when needed.  I swam all through my full-body break out - in a POND - with no issues.....plan on doing more swimming this summer!!!


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## crohnsinct

Livilou:  Still in awe of you and your kids and all you go through everyday.  I hope Liv feels better soon! 

Yes, there was discussion of dropping Remicade and switching to another biologic but the first they would try is Humira.  However, derm says if REmicade gave this reaction chances were high Humira would and GI doesn't want to drop Remicade before we have to because of how hard it is to go back to it.  I have heard that Stelara is awesome for psoriasis though so maybe down the road.  

MTX supposedly had an 80% clear rate in psoriasis that failed other treatments so here's hoping.


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## crohnsinct

Pasobuff, 

Interesting.  I wonder if the outbreak was caused by the Remi. Maybe not because it went away.  Not surprising it was dx'd as eczema, O's was also at first.  Since the reaction is supposedly rare not many derms are familiar with it.  We were even told the seeping was infected eczema and she was put on antibiotics only to find out the seeping was indicative of this Remi/psoriasis...ergh! 

We used steroid creams on O and they work really well on her skin but not her scalp.  We started at 2 weeks on 2 weeks off then had to wean to once a week.  Once a week did nothing.  Protopic wasn't an option because it has an increased risk of T Cell Lymphoma and with the Remi and that risk GI said no to adding Protopic.  Plus Derm said if steroids weren't working on scalp Protopic wouldn't as it is not as effective.  Did a short stint with Dovanex (topical vit d) also no help.  

My theory (and I ran it by derm) was that since this wasn't naturally occuring Psoriasis and rather caused by the drug, as long as Remi is in her Psoriasis will be on her.  She agreed. 

So their thinking is we have to use something that she can constantly be on and that is strong enough to clear the psoriasis so Methotrexate it is as it will even help with the cd...thing is they still aren't 100% sure it will work...again because this isn't naturally occuring. 

So the big question I had was why is the psoriasis bothering them so much? Of course I thought of that question AFTER I left the office!!! Doesn't bother O and I wasn't complaining.  So my theory....now she had an elevated sed rate and joint pain and both could be from cd or psoriaisis.  So the psoriasis is muddying the water so they figure lets get it out of the equation and see if sed rate comes down and joint pain goes away.  

Sound reasonable?


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## my little penguin

Psoriasis is another source of inflammation so the two different systems gut and skin could feed off each other- gut flares- skin worse- skin flares- gut gets worse.

WE see this happen alot in DS since being an over achiever has inflammation in way more than one system.

Our new derm we love also state remi tends to bring to the surface skin issues in people who are prone to them. It does not create them but makes you aware of what was already there. SHe also said skin stuff is never a reason to stop remi.

I will PM a few of the new cremes that are now working for DS.


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## DustyKat

Has O started the Metho cic? If not do you have a scheduled date? 

Good luck and I hope it nips the psoriasis in the bud! :goodluck: 

Dusty. :heart:


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## crohnsinct

Yep!  She started last week.  Had second dose last night.  No side effects so far.  She goes up in dose next week.  

She is already balding from the psoriasis so we are really hoping she doesn't get that mtx side effect. 

She had infusion Monday and they called and said sed rate all good.  I think it is probably too early for thte Mtx to have an effect on that so maybe the elevated sed rate was from something else.  Who knows...maybe the mtx...all I care is it is good.  Vit d good also!


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## DustyKat

Onwards and Upwards O! 

Fingers, toes and everything else crossed! 

Dusty. :heart:


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## CarolinAlaska

Great news!  I hope this is the perfect solution.


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## Clash

CIC, I hope all is going well for O on the MTX and it has started working on the psoriasis! Great news on the SED rate!


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## crohnsinct

Nope!  Nothing yet but I have read it can take up tp 12 weeks and you know how patient I am:ylol:


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## Sascot

Not sure how I managed to miss so much. Hope the methotrexate starts working soon.  Not very patient myself!


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## Lkslippy

Same thing happened to me! Looked like I had chicken pox all over my arms & legs. My dermatologist gave me cyclosporine for the psoriasis which is clearing most of it up and I now take Humira instead of Remicade


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## David

Lkslippy, how are you doing on the Humira?  Well I hope?


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## purdueCrohns

Bringing this one back from the grave....

Talconex has proven quite effective for me.  It's a steroid with a vitamin D suspension.


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## pdx

Seeing this thread resurface reminded me that I have a a question related to psoriasis treatment, for those of you with some experience with it.  

E has had mild scalp psoriasis for a while.  We first noticed it about 6 months after she started Remicade.  It wasn't very bad, so we basically ignored it.

When she stopped methotrexate in May, the psoriasis got worse, but it's still just on her scalp, mostly right above her ears.  We treated it with 2 weeks of clobetesol in July, and it really cleared up well.  Unfortunately, once we stopped the clobetesol, it came back fairly quickly.  We saw the dermatologist last week, and he said we should feel free to use the clobetesol on a long-term basis.  He recommended using it twice a day every weekday, and then just taking the weekend off.  That seems like too much to me, especially when I look at the official dosing info for the drug.  Has anyone else used a topical steroid so continuously?


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## polly13

crohnsinct said:


> Um yeah...I would ask GI if they have a derm they are associated with and mention the Remi induced psoriasis.  Yellow and white scales on scalp sounds like what O has.  White flaky could also be it and ears are also one of the first places it shows.  The pimple looking thing on face doesn't sound like what O has.
> 
> After scalp ears and face it moved to underarm, chest, back and then privates.
> 
> Oh gosh I hope your ds doesn't have it.  Not that it is so bad but geez you don't need one more problem to manage!
> 
> I am mad I didn't change derms sooner. Not that anything would be different but I had a suspicion but trusted old derm that it was eczema grr!


Lucy had yellow and white scales on her scalp about 6 months after starting Humira - the paed dermatologist felt it could be psoriasis induced by the Humira and give us a scalp paste to use (cant think of the name but I will look it up and post later) but it smelt like coldtar, after about a month it worked really well and her head was clear - she would have the odd flare now and one - two applications clear it up.  Dermatologist never gave us a conclusive though as to whether it is or was psoriasis.


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## crohnsinct

We have used Clobetasol (O for psoriasis and T for Vitiligo) among a list of other steroid creams.  For the most part, whenever steroids are used on the skin, the instructions we receive are two weeks on, two weeks off.  Another method was continuously until the psoriasis clears up, then every other day, then every two days etc. Until you get to a minimum amount of use to keep it clear.  Steroids thin the skin and the skin around the ears is pretty thin to begin with. 

Clobetasol is one of the stronger creams. So I would do the two weeks on/two weeks off.  If her psoriasis is mild you could also ask for a milder potency cream.  Desonide is one that comes to mind.

P.S.  Wanted to add that methotrexate treats psoriasis so it makes sense that when you stopped the mtx the psoriasis got worse.  Also, we were told that when you stop the steroid use with the psoriasis that the psoriasis flares worse...some sort of rebound reaction.


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## pdx

Thanks so much, CIC.  We've been using your second method, where we've found the minimum needed to keep things cleared up, which fortunately seems to be about one application a week.  (And E has a new pixie cut which makes treatment so much easier!)  Hope your kids are doing well.


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## Lisa

I had the same issue on my scalp/head/ears - I don't recall specifically how long I had been on Remicade at the time.....in my case, things did eventually clear up, and now I only get an occasional spot here and there.  I have Clobetasol cream, and was also told to do the @2 weeks use/2 weeks off......I did notice too the rebound effect, which I helped to minimize by using the cream as sparingly as possible.


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## Chantz

I have been on Remicade almost a year now and 3 months ago I started getting affected areas on my skin, I went to my family doctor who thought it was Hand, Foot & Mouth as my nephew had it at the same this time showed up. Long story short, three months later and I have more spots, mainly on my feet, hands and the back of my ankles and arms. When to a Dermatologist yesterday and he advised I do have Psoriasis and it was caused by the Remicade. He advised that if it gets worse we may have to look at taking me off the Remicade, which for me isn't an option. Remicade is my last resort as of now. 

 I am hoping this passes. Such an oxymoron the medication used to treat Psoriasis also causes it.


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## purdueCrohns

Taclonex comes in a generic now:

Calcipotriene and betamethasone dipropionate ointment

This is VERY effective for people with remicade induced psoriasis.


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## pdx

My daughter's Remicade-induced psoriasis only started after she went off methotrexate.  She started taking methotrexate again last December (because she had started developing a low level of antibodies to Remicade) and her psoriasis has totally cleared up.  Her antibody levels have also dropped back to an undetectable level.


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